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Janvier A, Bourque CJ, Pearce R, Thivierge E, Duquette LA, Jaworski M, Barrington KJ, Synnes AR, Church P, Luu TM. Fragility and resilience: parental and family perspectives on the impacts of extreme prematurity. Arch Dis Child Fetal Neonatal Ed 2023; 108:575-580. [PMID: 36997307 DOI: 10.1136/archdischild-2022-325011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVES Extremely preterm babies have a significant risk of neurodevelopmental impairment (NDI). There has been little investigation regarding the impact of prematurity on families. The objective of this study was to explore parental perspectives regarding the impact of prematurity on themselves/their family. METHODS Over 1 year, parents of children born <29 weeks' gestational age (GA) who were between 18 months old and 7 years old and came for their follow-up visit were invited to participate. They were asked to categorise the impacts of prematurity on their life and their family as positive, negative or both and to describe those impacts in their own words. Thematic analysis was performed by a multidisciplinary group, including parents. Logistic regression was performed to compare parental responses. RESULTS Among parents (n=248, 98% participation rate), most (74%) reported that their child's prematurity had both positive and negative impacts on their life or their family's life, while 18% reported only positive impacts and 8% only negative impacts. These proportions were not correlated with GA, brain injury, nor level of NDI. The positive impacts reported included: an improved outlook on life, such as gratitude and perspective (48%), stronger family relationships (31%) and the gift of the child (28%). The negative themes were stress and fear (42%), loss of equilibrium due to medical fragility (35%) and concerns about developmental outcomes including the child's future (18%). CONCLUSION Parents report both positive and negative impacts after an extremely preterm birth, independent of disability. These balanced perspectives should be included in neonatal research, clinical care and provider education.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics and Clinical Ethics, Bureau de l'éthique clinique, Université de Montréal, Montreal, Quebec, Canada
- Neonatology, Palliative Care, Reserch Center, Unité d'éthique Clinique, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Claude Julie Bourque
- Department of Pediatrics, CHU Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
- Clinical Ethics and Family Partnership Research Unit, CHU Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
| | - Rebecca Pearce
- Parent Representative, Canadian Premature Baby Foundation, Montreal, Quebec, Canada
| | - Emilie Thivierge
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | | | - Magdalena Jaworski
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
- CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Keith J Barrington
- Department of Neonatology, Centre de Recherche, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Anne R Synnes
- Department of Neonatology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Paige Church
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thuy Mai Luu
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
- Pediatrics and Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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Boutillier B, Ethier G, Boucoiran I, Reichherzer M, Luu TM, Morin L, Pearce R, Janvier A. Prenatal Workshops and Support Groups for Prospective Parents Whose Children Will Need Neonatal Care at Birth: A Feasibility and Pilot Study. Children (Basel) 2023; 10:1570. [PMID: 37761531 PMCID: PMC10529479 DOI: 10.3390/children10091570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Support groups in neonatal intensive care units (NICUs) are beneficial to parents. The usefulness of prenatal support groups for prospective parents who will have a newborn requiring admission to the NICU has never been investigated. Methods: We assessed the needs of NICU parents regarding topics they would have wished to discuss prenatally and developed the content of a prenatal support workshop. A standardized survey prospectively evaluated the perspectives of pregnant women admitted to a high-risk pregnancy unit who participated in the resulting workshops. Results: During needs assessment, 295 parents invoked themes they would have wished to discuss antenatally: parental guilt, future parental role, normalizing their experience/emotions, coping with many losses, adapting to their new reality, control and trust, information about the NICU, technology around the baby, common neonatal interventions, the NICU clinical team, and the role of parents in the team. These findings were used to develop the workshop, including a moderator checklist and a visual presentation. Practical aspects of the meetings were tested/finalized during a pre-pilot phase. Among 21 pregnant women who answered the survey (average gestational age 29.3 weeks), all agreed that the workshop was useful, that it made them feel less lonely (95%), that exchanges with other women were beneficial (95%) and gave them a certain amount of control over their situation (89%). All answers to open-ended questions were positive. Conclusion: Prenatal educational/support workshops provide a unique and useful means to support future NICU parents. Future investigations will explore whether these prenatal interventions improve clinical outcomes.
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Affiliation(s)
- Béatrice Boutillier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Guillaume Ethier
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Isabelle Boucoiran
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Martin Reichherzer
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
| | - Thuy Mai Luu
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Lucie Morin
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Maternal-Fetal Medicine, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Rebecca Pearce
- Parent Representative, Collaborates with Canadian Premature Babies Foundation, Etobicoke, ON M8X 1Y3, Canada;
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (B.B.); (I.B.); (T.M.L.); (L.M.)
- Division of Neonatology, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada; (G.E.); (M.R.)
- Unité D’éthique Clinique, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, Montréal, QC H3T 1C5, Canada
- Bureau de L’éthique Clinique (BEC), Université de Montréal, Montréal, QC H3C 3J7, Canada
- Unité de Soins Palliatifs, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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Synnes A, Chera A, Richter LL, Bone JN, Bourque CJ, Zhang-Jiang S, Pearce R, Janvier A, Luu TM. Redefining Neurodevelopmental Impairment: Perspectives of Very Preterm Birth Stakeholders. Children (Basel) 2023; 10:children10050880. [PMID: 37238428 DOI: 10.3390/children10050880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Children born very preterm are at risk of severe neurodevelopmental impairment, a composite endpoint that includes cerebral palsy, developmental delay, and hearing and visual impairment defined by medical professionals. We aimed to describe preterm birth stakeholders' perspectives on this classification. Ten clinical scenarios describing 18-month-old children with different components of severe neurodevelopmental impairment and one scenario of a typically developing child (control) were distributed to parents and stakeholders using a snowball sampling technique. For each scenario, participants rated health on a scale from 0 to 10 and whether the scenario represented a severe condition. Results were analyzed descriptively and mean differences from the control scenario were compared using a linear mixed-effects model. Stakeholders (number = 827) completed 4553 scenarios. Median health scores for each scenario varied from 6 to 10. The rating for the cerebral palsy and language delay scenario was significantly lower (mean difference -4.3; 95% confidence interval: -4.4, -4.1) than the control. The proportion of respondents rating a scenario as "severe" ranged from 5% for cognitive delay to 55% for cerebral palsy and language delay. Most participants disagreed with the rating used in research to describe severe neurodevelopmental impairment in preterm children. The term should be redefined to align with stakeholder perceptions.
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Affiliation(s)
- Anne Synnes
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Amarpreet Chera
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jeffrey N Bone
- BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | | | - Sofia Zhang-Jiang
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Rebecca Pearce
- Science and Mathematics Education Research Group, Faculty of Education, McGill University, Montreal, QC H3A 0G4, Canada
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique (BEC), Université de Montréal, QC H3C 3J7, Canada
- Division of Neonatology, Unité d'Éthique Clinique, Unité de Soins Palliatifs, Bureau du Partenariat Patients-Familles-Soignants, Montréal, QC H3T 1C5, Canada
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
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Milette AA, Richter LL, Bourque CJ, Janvier A, Pearce R, Church PT, Synnes A, Luu TM. Parental perspectives of outcomes following very preterm birth: Seeing the good, not just the bad. Acta Paediatr 2023; 112:398-408. [PMID: 36479723 DOI: 10.1111/apa.16616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
AIM To describe parental perspective on health and developmental outcomes of their preterm child in relation to level of neurodevelopmental impairment (NDI). METHODS A parental survey about their children aged 15-36 months corrected age born ˂29 weeks' gestation investigated parental concerns and positive attributes. Parental responses in relation to their child's level of NDI were examined using Kruskal-Wallis and chi-square for trend tests. RESULTS One hundred ninety-nine parental responses were obtained for 163 children, including 44% with NDI. Vast majority of parents reported their children were developing well with good physical health. All parents, irrespective of NDI, reported their children were happy and had a positive personality. Appreciation of social interactions was higher for parents of children without versus with NDI (96% vs. 87%, p = 0.039). Parents of children with NDI were more likely to express concerns than those without NDI. Overall, development was the most common area of concern (45%), followed by the child's future (40%) and physical health (35%). CONCLUSION Parents of preterm children report many positive points and concerns, some of which are not examined in neonatal follow-up data. These parental perspectives could be used to inform parents of preterm infants, both antenatally and in the neonatal unit.
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Affiliation(s)
- Audrey-Anne Milette
- Department of Pediatrics, Research Center, CHU Sainte-Justine, University of Montreal, Quebec, Montreal, Canada
| | - Lindsay L Richter
- Department of Pediatrics, British Columbia Women's Hospital, University of British Columbia, British Columbia, Vancouver, Canada
| | - Claude Julie Bourque
- Department of Pediatrics, Research Center, CHU Sainte-Justine, University of Montreal, Quebec, Montreal, Canada.,Clinical Ethics Unit, CHU Sainte-Justine, Quebec, Montreal, Canada
| | - Annie Janvier
- Department of Pediatrics, Research Center, CHU Sainte-Justine, University of Montreal, Quebec, Montreal, Canada.,Clinical Ethics Unit, CHU Sainte-Justine, Quebec, Montreal, Canada.,Palliative Care Unit, CHU Sainte-Justine, Quebec, Montréal, Canada.,Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Quebec, Montreal, Canada.,Bureau de l'éthique clinique, Université de Montréal, Quebec, Montreal, Canada
| | - Rebecca Pearce
- Bureau du Partenariat Patients-Familles-Soignants, CHU Sainte-Justine, Quebec, Montreal, Canada
| | - Paige Terrien Church
- Department of Pediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Toronto, Canada
| | - Anne Synnes
- Department of Pediatrics, British Columbia Women's Hospital, University of British Columbia, British Columbia, Vancouver, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Research Center, CHU Sainte-Justine, University of Montreal, Quebec, Montreal, Canada
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Thivierge E, Luu TM, Bourque CJ, Barrington KJ, Pearce R, Jaworski M, Janvier A. Pulmonary important outcomes after extremely preterm birth: Parental perspectives. Acta Paediatr 2023; 112:970-976. [PMID: 36815277 DOI: 10.1111/apa.16723] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 02/21/2023] [Indexed: 02/24/2023]
Abstract
AIM To describe pulmonary important outcomes (PIO) reported by parents of children born extremely preterm. METHODS Over 1-year, all parents of children aged 18 months-7-years born <29 weeks' GA were asked regarding their perspectives. The proportion of parents who described PIO and the themes they invoked were examined. Results were analysed using mixed methods. RESULTS Among parental responses (n = 285, 98% participation rate), 44% spoke about PIO, invoking 24 themes pertaining to NICU hospitalisation and/or long-term respiratory health. Some themes had an impact primarily on the child (e.g. exercise limitation), while the majority had an impact on the whole family (e.g. hospital readmissions). None mentioned oxygen at 36 weeks nor bronchopulmonary dysplasia (BPD). The proportion of responses invoking PIO were statistically similar between parents of children with and without BPD, born before or after 25 weeks or with birthweight < or ≥750 g. PIO were more likely to be mentioned in males and among those readmitted for respiratory problems. CONCLUSION Parents describe many PIO, most related to the functional impact of lung disease on their child (and family), rather than the diagnosis of BPD itself. Most of these PIO are not primary outcomes in large neonatal trials nor collected in neonatal databases.
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Affiliation(s)
- Emilie Thivierge
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Division of general pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Keith J Barrington
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Division of Neonatology, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Rebecca Pearce
- Parent representative; involved in Canadian Premature Babies Foundation, Montréal, Québec, Canada
| | - Magdalena Jaworski
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,Division of general pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada.,Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Annie Janvier
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Québec, Canada.,Division of Neonatology, CHU Sainte-Justine, Montréal, Québec, Canada.,Bureau de l'éthique Clinique, Université de Montréal, Montréal, Québec, Canada.,Unité de soins palliatifs, CHU Sainte-Justine, Montréal, Québec, Canada
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Thivierge E, Luu TM, Bourque CJ, Duquette LA, Pearce R, Jaworski M, Barrington KJ, Synnes A, Janvier A. Guilt and Regret Experienced by Parents of Children Born Extremely Preterm. J Pediatr 2022:S0022-3476(22)01019-8. [PMID: 36463935 DOI: 10.1016/j.jpeds.2022.10.042] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To explore decisional regret of parents of babies born extremely preterm and analyze neonatal, pediatric, and parental factors associated with regret. STUDY DESIGN Parents of infants born <29 weeks of gestational age, aged between 18 months and 7 years, attending neonatal follow-up were enrolled. Hospital records were reviewed to examine morbidities and conversations with parents about levels of care. Parents were asked the following question: "Knowing what you know now, is there anything you would have done differently?" Mixed methods were used to analyze responses. RESULTS In total, 248 parents (98% participation) answered, and 54% reported they did not have regret. Of those who reported regret (n = 113), 3 themes were most frequently invoked: 35% experienced guilt, thinking they were responsible for the preterm birth; 28% experienced regret about self-care decisions; and 20% regretted decisions related to their parental role, generally wishing they knew sooner how to get involved. None reported regret about life-and-death decisions made at birth or in the neonatal intensive care unit. Impairment at follow-up, gestational age, and decisions about levels/reorientation of care were not associated with regret. More mothers reported feeling guilt about the preterm birth (compared with fathers); parents of children with severe lesions on ultrasonography of the head were less likely to report regret. CONCLUSIONS Approximately one-half of the parents of infants born extremely preterm had regrets regarding their neonatal intensive care unit stay. Causes of regret and guilt should be addressed and minimized.
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Affiliation(s)
- Emilie Thivierge
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montréal, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Canada; Centre d'excellence en éthique clinique, CHU Sainte-Justine, Montréal, Canada
| | | | - Rebecca Pearce
- Canadian Premature Baby Foundation, Montréal, Quebec, Canada
| | - Magdalena Jaworski
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montréal, Canada
| | - Keith J Barrington
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada
| | - Anne Synnes
- Department of Pediatrics, BC Women's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Janvier
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, Canada; CHU Sainte-Justine Research Center, Montréal, Canada; Centre d'excellence en éthique clinique, CHU Sainte-Justine, Montréal, Canada; Bureau de l'éthique Clinique, Université de Montréal, Montréal, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montréal, Canada.
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Jaworski M, Janvier A, Bourque CJ, Mai-Vo TA, Pearce R, Synnes AR, Luu TM. Parental perspective on important health outcomes of extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 107:495-500. [PMID: 34815239 PMCID: PMC9411910 DOI: 10.1136/archdischild-2021-322711] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/03/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Neonatal outcome research and clinical follow-up principally focus on neurodevelopmental impairment (NDI) after extremely preterm birth, as defined by the scientific community, without parental input. This survey aimed to investigate parental perspectives about the health and development of their preterm children. METHODS Parents of children aged 18 months to 7 years born <29 weeks' gestational age presenting at a neonatal follow-up clinic over a 1-year period were asked to evaluate their children's health and development. They were also asked the following question: 'if you could improve two things about your child, what would they be?' Responses were analysed using mixed methods. Logistic regressions were done to compare parental responses. RESULTS 248 parents of 213 children (mean gestational age 26.6±1.6 weeks, 20% with severe NDI) were recruited. Parents evaluated their children's health at a median of 9/10. Parental priorities for health improvements were (1) development, mainly behaviour, emotional health and language/communication (55%); (2) respiratory heath and overall medical fragility (25%); and (3) feeding/growth issues (14%). Nineteen per cent explicitly mentioned 'no improvements'. Parents were more likely to state 'no improvements' if child had no versus severe NDI OR 4.33 (95% CI 1.47 to 12.75)) or if parents had no versus at least a high school diploma (OR 4.01 (95% 1.99 to 8.10)). CONCLUSIONS Parents evaluate the health of their preterm children as being very good, with positive perspectives. Parental concerns outside the developmental sphere should also be addressed both in clinical follow-up and research.
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Affiliation(s)
- Magdalena Jaworski
- Department of pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada,Clinical Ethics Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Annie Janvier
- Department of pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada,Clinical Ethics Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada,Clinical Ethics and Family Partnership Research Unit, CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada,Palliative care unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada,Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Québec, Canada,Bureau du partenariat patients-familles-soignants, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada,Bureau de l'éthique clinique, Université de Montréal, Montreal, Québec, Canada
| | - Claude Julie Bourque
- Clinical Ethics Unit, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada,Clinical Ethics and Family Partnership Research Unit, CHU Sainte-Justine Centre de Recherche, Montreal, Québec, Canada,Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Québec, Canada
| | - Thuy-An Mai-Vo
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Québec, Canada
| | - Rebecca Pearce
- Bureau du partenariat patients-familles-soignants, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Anne R Synnes
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Thuy Mai Luu
- Department of pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada .,Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Québec, Canada
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McPherson H, Pearce R. The shifting educational landscape: science teachers' practice during the COVID-19 pandemic through an activity theory lens. Discip Interdscip Sci Educ Res 2022; 4:19. [PMID: 37520630 PMCID: PMC9066144 DOI: 10.1186/s43031-022-00061-2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/23/2022] [Indexed: 08/01/2023]
Abstract
In March 2020, the COVID-19 pandemic closed all educational institutions. Teachers were called upon to respond quickly to the needs of K-12 students. They had to learn how to navigate online learning systems while simultaneously delivering engaging inquiry-based activities in high-stakes school science courses. To understand how teachers navigated these dual tensions, we have drawn on Cultural-Historical Activity Theory (CHAT) to describe how teachers learned and mediated their professional practices to meet the educational needs of their students. We examine the rapidly changing school activity system and how these changes impacted teachers' epistemological beliefs about student engagement and evaluation. We report that teachers developed new styles and attitudes about teaching that reflected the new educational landscape imposed by the pandemic. We explore the pedagogical shifts that characterize this specific time and how the newly acquired pedagogies could find permanence in teachers' activities post-pandemic. This study reports on the experiences of ten teachers from two high schools as they adapt to change during the global pandemic. We followed the teachers' professional journey as they worked in a professional learning community to develop online practices. Professional learning meetings, semi-structured interviews, and participant journals captured teachers' successes and failures as they struggled to adapt inquiry-based science lessons to meet the challenges of teaching online. Their practices shifted as they engaged students in synchronous collaborative projects and laboratory activities, and they developed alternative formative and summative assessment practices. This study contributes to a growing body of research of teacher practice through a CHAT theoretical framework to understand teachers' professional learning during a time of change and upheaval.
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Martínez-Albertos P, Pedroche G, Dremel M, Pearce R, Loughlin M, Tonqueze YL, Sanz J, Juárez R. Shielding conceptual designs of ITER TCP ports to protect electronics. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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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10
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Pearce R, Grant R. Do Open Data Badges Influence Author Behaviour? a Case Study at Springer Nature. IJDC 2020. [DOI: 10.2218/ijdc.v15i1.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Digital badges have previously been shown to incentivise journal authors to share their data openly. In this paper we introduce an Open data badging project at the Springer Nature journal BMC Microbiology. The development of the Open data badge is described, as well as the challenges of developing standard badging criteria and ensuring authors’ awareness of the badges. Next steps for the badging project are outlined, which are based on the experiences of the team assessing the badges, the number of badges awarded at the journal to date, and the results of an author survey.
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11
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Duquette LA, Luu TM, Janvier A, Mai-Vo TA, Fortin A, Thivierge E, Bourque CJ, Pearce R, Synnes A, Jaworski M. 25 More than meets the eye: Parental perspectives on the health of their extremely preterm children when they reach 18 months, 5 and 7 years. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Extremely preterm birth is associated with death and a higher risk of adverse long-term outcomes. Neurodevelopmental impairment (NDI) has become the focus of neonatal follow-up and outcome research, with classifications chosen by clinicians and researchers. However, parents were never consulted about this classification.
Objectives
To examine parental perspectives about the health of their ex-preterm infants.
Design/Methods
Over a one-year period, at Sainte-Justine University Hospital’s Neonatal Follow-Up Clinic, all parents of children born <29 weeks’ gestational age, aged between 18 months corrected age and 7 years were approached. They were asked two questions: “Please rate your child’s health from your point of view on a scale from 0 (very poor) to 10 (excellent)” and “If you could improve up to two things about your child’s health and/or development, what would they be?” Responses were analyzed using mixed methods.
Results
249 parental responses were obtained (98% participation rate). On average, parents rated their child’s health to be 8/10 (range 3-10/10, median 8/10). Main themes invoked about areas for improvement were developmental outcomes (65%):“if he could talk and hold his head up himself”; respiratory heath and overall medical fragility (35%): “improve the health of her lungs”; and behavior/emotional issues (21%): “his anxiety”. Twenty-three percent did not wish to improve anything: “I am very happy with his health and development. I hope he continues on the same path.” When examining developmental outcomes more closely, the recurrent sub-themes for improvement were: language/communication (22%), motor/movement (17%) and cognitive/learning (16%): “improving her attention in school”.
Conclusion
When they come to neonatal follow-up, parents generally perceive the health of their extremely preterm children in a positive way. While some parents have no wishes for improvement in their children, many are concerned by their children’s NDI. On the other hand, several parent-important outcomes, such as lung health and overall medical fragility, are insufficiently investigated during follow-up at the present time.
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Thivierge E, Duquette LA, Mai-Vo TA, Fortin A, Jaworski M, Bourque CJ, Pearce R, Luu TM, Janvier A. 26 Not What Clinicians Thought: Decisional Regret in Parents of Extremely Preterm Children. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Preterm birth is associated with higher risk of death and severe neurodevelopmental impairment. There is an increased risk in extremely preterm infants, raising questions among ethicists and clinicians as to whether providing active care to infants born at the lower extreme is worth the outcomes, and if these outcomes are a source of decisional regrets for parents.
Objectives
Explore decisional regrets in parents of extremely preterm children.
Design/Methods
We consecutively recruited all parents of infants born <29 weeks’ gestational age, aged between 18 months corrected age and 7 years, and seen for neonatal follow-up at a single tertiary center over a one-year period. We asked the following question: “Knowing what you know now, is there anything you would have done differently?” Answers were analyzed independently by two reviewers using qualitative methodology, and discrepancies were resolved by a third reviewer. Mixed methods were used to examine the frequency of each theme and associate parental answers to demographic and clinical factors.
Results
Responses were obtained from 249 parents (98% participation rate). The following main themes emerged: (1) Nothing – I did what I could or was told to do: 53%; (2) Regrets about self-care: 31%; “I would listen to the nurses’ advice to sleep more” (3) Guilt related to the impression preterm labor could have been prevented by them or the medical team: 19%; “I would have pushed for better care and monitoring during pregnancy. I felt as though I wasn’t listened to when I thought I was in labour when sure enough I was” (4) Regrets about parental role in decision-making: 15%; “I would speak up more at the beginning of the hospitalisation”. None of the parents reported on regretting any life-and-death decisions they made at birth and in the neonatal unit.
Conclusion
In our cohort, more than half of parents of surviving preterm infants did not have any regrets associated to their NICU experience. However, lessons can be learned to improve parental support, self-care and solutions to improve their role as parents. Unlike what can be stated using “opinion-based medicine”, limiting or forgoing intensive care is not a solution to eliminate decisional regrets in parents.
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13
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Nicholas MK, Costa DSJ, Linton SJ, Main CJ, Shaw WS, Pearce R, Gleeson M, Pinto RZ, Blyth FM, McCauley JH, Maher CG, Smeets RJEM, McGarity A. Predicting Return to Work in a Heterogeneous Sample of Recently Injured Workers Using the Brief ÖMPSQ-SF. J Occup Rehabil 2019; 29:295-302. [PMID: 29796980 DOI: 10.1007/s10926-018-9784-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose (1) to examine the ability of the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) to predict time to return to pre-injury work duties (PID) following a work-related soft tissue injury (regardless of body location); and (2) to examine the appropriateness of 50/100 as a suitable cut-off score for case identification. Methods Injured workers (IW) from six public hospitals in Sydney, Australia, who had taken medically-sanctioned time off work due to their injury, were recruited by insurance case managers within 5-15 days of their injury. Eligible participants (N = 213 in total) were administered the ÖMPSQ-SF over the telephone by the case manager. For objective (1) Cox proportional hazards regression analysis was used to predict days to return to PID using the ÖMPSQ-SF. For objective (2) receiver operator characteristic (ROC) analysis was used to determine the ÖMPSQ-SF total score that optimises sensitivity and specificity in detecting whether or not participants had returned to PID within 2-7 weeks. Results The total ÖMPSQ-SF score significantly predicted number of days to return to PID, such that for every 1-point increase in the total ÖMPSQ-SF score the predicted chance of returning to work reduced by 4% (i.e., hazard ratio = 0.96), p < 0.001. Sensitivity and specificity for the ROC analysis comparing ÖMPSQ-SF total score to return to PID within 2-7 weeks suggested 48 as the optimal cut off (sensitivity = 0.65, specificity = 0.79). Conclusion The results provide strong support for the use of the ÖMPSQ-SF in an applied setting for identifying those IW likely to have delayed RTW when administered within 15 days of the injury. While a score of 48/100 was the optimal cut point for sensitivity and specificity, pragmatically, 50/100 should be acceptable as a cut-off in future studies of this type.
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Affiliation(s)
- M K Nicholas
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - D S J Costa
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - S J Linton
- Department of Law, Psychology, and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - C J Main
- Arthritis Care UK Primary Care Centre, Keele University, North Staffordshire, UK
| | - W S Shaw
- University of Connecticut Health Center, Farmington, CT, USA
| | - R Pearce
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - M Gleeson
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - R Z Pinto
- Sydney Medical School - Northern, University of Sydney & Royal North Shore Hospital, St Leonards, NSW, Australia
| | - F M Blyth
- School of Public Health, Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - J H McCauley
- Neuroscience Research Australia and School of Medical Sciences, University of NSW, Sydney, NSW, Australia
| | - C G Maher
- The George Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - R J E M Smeets
- Knowledge Centre Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands
- Department of Rehabilitation Medicine, Caphri, Maastricht University, Maastricht, The Netherlands
| | - A McGarity
- Injury Management, Health & Safety Branch, NSW Fire and Safety, Sydney, Australia
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Killey R, Mynors C, Pearce R, Nell A, Prentis A, Day MJ. Long-lived immunity to canine core vaccine antigens in UK dogs as assessed by an in-practice test kit. J Small Anim Pract 2017; 59:27-31. [PMID: 29087557 DOI: 10.1111/jsap.12775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/28/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the utility of an in-practice test kit to detect protective serum antibody against canine distemper virus, canine adenovirus and canine parvovirus type 2 in a sample of the UK dog population. MATERIALS AND METHODS Serum samples from 486 dogs, last vaccinated between less than 1 month and 124 months previously, were tested with the VacciCheck™ test kit for protective antibodies against distemper, adenovirus and parvovirus type 2. RESULTS A high proportion of the dogs tested (93·6%) had protective antibody against all three of the core vaccine antigens: 95·7% of the dogs were seropositive against canine distemper virus, 97·3% against canine adenovirus and 98·5% against canine parvovirus type 2. The small number of dogs that were seronegative for one or more of the antigens (n = 31) may have had waning of previous serum antibody or may have been rare genetic non-responders to that specific antigen. CLINICAL SIGNIFICANCE UK veterinarians can be reassured that triennial revaccination of adult dogs with core vaccines provides long-lived protective immunity. In-practice serological test kits are a valuable tool for informing decision-making about canine core revaccination.
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Affiliation(s)
- R Killey
- Moreton Morrell College, Moreton Morrell, Warwickshire, CV35 9BL, UK
| | - C Mynors
- Moreton Morrell College, Moreton Morrell, Warwickshire, CV35 9BL, UK
| | - R Pearce
- Moreton Morrell College, Moreton Morrell, Warwickshire, CV35 9BL, UK
| | - A Nell
- Medivet, Watford, Hertfordshire, WD24 7UY, UK
| | - A Prentis
- Hyde Park Veterinary Centre, London, W2 2AE, UK
| | - M J Day
- School of Veterinary Sciences, University of Bristol, Langford, North Somerset, BS40 5DU, UK
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15
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Black N, Liu CG, Pearce R, Li B, Maier SA, Cohen LF, Gallop JC, Hao L. Graphene gas sensing using a non-contact microwave method. Nanotechnology 2017; 28:395501. [PMID: 28726674 DOI: 10.1088/1361-6528/aa80f7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a non-contact CVD graphene gas sensing method that utilises a high Q microwave dielectric resonator perturbation technique. A graphene sample is coupled to the evanescent field of a dielectric resonator whereupon nitrogen dioxide (NO2), a p-doping gas, is detected by monitoring the change in the linewidth and frequency of the resonant mode. The resonant peak shape is dependent on the number of carriers in the graphene sheet. Therefore, the linewidth perturbation can be converted to a measurement of the graphene sheet resistance. To demonstrate the strength of this technique, sensor response curves for NO2 at different concentrations and temperatures are measured showing sub ppm sensitivity. This technique eliminates interactions between the trace gas and metal contacts that otherwise effect the sensor response of the graphene device.
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Affiliation(s)
- Ncg Black
- National Physical Laboratory, Hampton Road, Teddington, TW11 0LW, United Kingdom. Department of Physics, Imperial College London, London SW7 2AZ, United Kingdom
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Martin A, Andrew P, Jokinen T, Komarov V, Kukushkin A, Loarte A, Maruyama S, Merola M, Palmer J, Pearce R, Pick M, Pitts R, Walker C. ITER Divertor System Integration. Fusion Science and Technology 2017. [DOI: 10.13182/fst09-a8877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Martin
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - P. Andrew
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - T. Jokinen
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - V. Komarov
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - A. Kukushkin
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - A. Loarte
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - S. Maruyama
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - M. Merola
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - J. Palmer
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - R. Pearce
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - M. Pick
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - R. Pitts
- ITER Organization, St. Paul-lez-Durance, France, 13108
| | - C. Walker
- ITER Organization, St. Paul-lez-Durance, France, 13108
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17
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Lässer R, Antipenkov A, Bekris NB, Boccaccini L, Caldwell-Nichols C, Cristescu I, Day C, Gasparotto M, Glugla M, Dell’Orco G, Gabriel F, Gastaldi O, Grisolia C, Knipe S, Magielsen AJ, Möslang A, Murdoch D, Pearce R, Perevezentsev A, Piazza G, Poitevin Y, Ricapito I, Salavy JF, Sedano L, Zmitko M. Tritium in Fusion: R&D in the EU. Fusion Science and Technology 2017. [DOI: 10.13182/fst08-a1761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R. Lässer
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
| | - A. Antipenkov
- Forschungszentrum Karlsruhe, P.O. Box 3640, Karlsruhe, D-76021, Germany
| | - N. Bekris Bekris
- EFDA Close Support Unit, Culham Science Centre, Abingdon, Oxon OX14 43DB, UK
| | - L.V. Boccaccini
- Forschungszentrum Karlsruhe, P.O. Box 3640, Karlsruhe, D-76021, Germany
| | | | - I. Cristescu
- Forschungszentrum Karlsruhe, P.O. Box 3640, Karlsruhe, D-76021, Germany
| | - Ch. Day
- Forschungszentrum Karlsruhe, P.O. Box 3640, Karlsruhe, D-76021, Germany
| | - M. Gasparotto
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
| | - M. Glugla
- Forschungszentrum Karlsruhe, P.O. Box 3640, Karlsruhe, D-76021, Germany
| | - G. Dell’Orco
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
| | - F. Gabriel
- Commissariat à l’Energie Atomique, CEA/Saclay, F-91191 Gif-surYvette, France
| | - O. Gastaldi
- Commissariat à l’Energie Atomique, CEA/Cadarache, F-13108 Saint Paul Lez Durance, France
| | - Ch. Grisolia
- Commissariat à l’Energie Atomique, CEA/Cadarache, F-13108 Saint Paul Lez Durance, France
| | - S. Knipe
- Culham Science Centre, UKAEA, Abingdon, Oxon, OX14 3DB, UK
| | | | - A. Möslang
- Forschungszentrum Karlsruhe, P.O. Box 3640, Karlsruhe, D-76021, Germany
| | - D. Murdoch
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
| | - R. Pearce
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
| | | | - G. Piazza
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
| | - Y. Poitevin
- ENEA Brasimone, I-40032 Camugnano, Bologna, Italy
| | - I. Ricapito
- NRG, P.O. Box 25, 1755 ZG Petten, The Netherlands
| | - J.-F. Salavy
- Commissariat à l’Energie Atomique, CEA/Saclay, F-91191 Gif-surYvette, France
| | | | - M. Zmitko
- EFDA Close Support Unit, Boltzmannstrasse 2, D-85748 Garching, Germany
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O'Hare P, Lucchini G, Cummins M, Veys P, Potter M, Lawson S, Vora A, Wynn R, Peniket A, Kirkland K, Pearce R, Perry J, Amrolia PJ. Allogeneic stem cell transplantation for refractory acute myeloid leukemia in pediatric patients: the UK experience. Bone Marrow Transplant 2017; 52:825-831. [DOI: 10.1038/bmt.2017.3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/28/2022]
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Abstract
Medium- and long-term outcomes have been collected and described among survivors of neonatal intensive care units for decades, for a number of purposes: (1) quality control within units, (2) comparisons of outcomes between NICUs, (3) clinical trials (whether an intervention improves outcomes), (4) end-of-life decision-making, (5) to better understand the effects of neonatal conditions and/or interventions on organs and/or long-term health, and finally (6) to better prepare parents for the future. However, the outcomes evaluated have been selected by investigators, based on feasibility, availability, cost, stability, and on what investigators consider to be important. Many of the routinely measured outcomes have major limitations: they may not correlate well with long-term difficulties, they may artificially divide continuous outcomes into dichotomous ones, and may have no clear relationship with quality of life and functioning of children and their families. Several investigations, such as routine term cerebral resonance imaging for preterm infants, have also not yet been shown to improve the outcome of children nor their families. In this article, the most common variables used in neonatology as well as some variables which are rarely measured but may be of equal importance for families are presented. The manner in which these outcomes are communicated to families will be examined, as well as recommendations to optimize communication with parents.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, Université de Montréal; Division of Neonatology and centre de recherche, CHU Sainte-Justine, Montréal, Canada; Bureau de l'Éthique Clinique, Université de Montréal, Canada; Unité d'éthique clinique, unité de soins palliatifs, unité de recherche en éthique clinique et partenariat famille, Hôpital Sainte-Justine, Montréal, Canada.
| | - Barbara Farlow
- Parent and patient representative, patients for Patient Safety Canada, Edmonton, Alberta, Canada; The deVeber Institute for Bioethics and Social Research, North York, Ontario Canada
| | - Jason Baardsnes
- Parent representative, Human Health Therapeutics, National Research Council, Montréal, Canada
| | - Rebecca Pearce
- Parent representative, Villa Maria High School, Montreal, Quebec'
| | - Keith J Barrington
- Department of Pediatrics, Université de Montréal; Division of Neonatology and centre de recherche, CHU Sainte-Justine, Montréal, Canada
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Pearce R, Miles F. 7-year retrospective review of quad bike injuries admitted to Starship Children's Hospital. N Z Med J 2015; 128:44-50. [PMID: 26117390] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIMS To ascertain morbidity and mortality of children who presented to Starship Children's Hospital with injuries from a quad bike incident from 2007 to 2014, and to review whether current guidelines are sufficient to prevent injury. METHODS A retrospective case note review of all children under the age of 16 years who presented to Starship Hospital with an injury sustained whilst riding a quad bike between January 2007 and July 2014. RESULTS Twenty-seven patients were identified through both the Starship Children's Hospital Trauma and Paediatric Intensive Care databases with injuries resulting from a quad bike incident. Fifteen patients (56%) had multisystem injuries. The average injury severity score (ISS) was 14 (range 1-75). ISS was higher in those of younger age (<5 years), lower body weight (<20kg), requiring PICU admission and those sustaining head injuries with no helmet. Seven (25.9%) patients required PICU admission, two patients died (7.4%) and three patients (12%) survived to discharge with disability. CONCLUSIONS This study supports current published guidelines which recommend limiting the use of quad bikes by children. Current guidelines do not, however, prevent injury in the paediatric population.
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Affiliation(s)
- Rebecca Pearce
- Paediatric Intensive Care Unit, Starship Hospital, Private Bag 92024, Auckland 1142, New Zealand.
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21
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Pearce R. Health star ratings of reality television food products. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Staub K, Baardsnes J, Hébert N, Hébert M, Newell S, Pearce R. Our child is not just a gestational age. A first-hand account of what parents want and need to know before premature birth. Acta Paediatr 2014; 103:1035-8. [PMID: 24920539 DOI: 10.1111/apa.12716] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Katharina Staub
- Canadian Premature Babies Foundation-Fondation pour Bébés Prématurés Canadiens; Sherwood Park AB Canada
| | - Jason Baardsnes
- Canadian Premature Babies Foundation-Fondation pour Bébés Prématurés Canadiens; Sherwood Park AB Canada
| | - Nina Hébert
- Canadian Premature Babies Foundation-Fondation pour Bébés Prématurés Canadiens; Sherwood Park AB Canada
| | - Michael Hébert
- Canadian Premature Babies Foundation-Fondation pour Bébés Prématurés Canadiens; Sherwood Park AB Canada
| | - Stephanie Newell
- Canadian Premature Babies Foundation-Fondation pour Bébés Prématurés Canadiens; Sherwood Park AB Canada
| | - Rebecca Pearce
- Canadian Premature Babies Foundation-Fondation pour Bébés Prématurés Canadiens; Sherwood Park AB Canada
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Maznytsya A, Chang C, Brade S, Aljabbary T, Pearce R, Eta-Ndu C, Bennett J, Wyllie A, Mak S. EFFICACY AND SAFETY OF A NURSE IMPLEMENTED STANDARDIZED INTRAVENOUS FUROSEMIDE PROTOCOL (MSH LA6 PROTOCOL) FOR THE TREATMENT OF ACUTE DECOMPENSATED HEART FAILURE: A PROSPECTIVE OBSERVATIONAL STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
INTRODUCTION Acetabular fractures due to high energy injuries are common and well documented; those secondary to low energy mechanisms are less well described. We undertook a retrospective study of the acetabular fracture referrals to our unit to evaluate the proportion of injuries resulting from a low energy mechanism. METHODS A total of 573 acetabular fractures were evaluated from 1 January 2005 to 31 December 2008. The plain radiography and computed tomography of those sustaining a low energy fracture were assessed and the fracture patterns classified. RESULTS Of the 573 acetabular fractures, 71 (12.4%) were recorded as being a result of a low energy mechanism. The male-to-female ratio was 2.4:1 and the mean patient age was 67.0 years (standard deviation: 19.1 years). There was a significantly higher number of fractures (p<0.001) involving the anterior column (with or without a posterior hemitransverse component) than in a number of previously conducted large acetabular fracture studies. CONCLUSIONS Our results demonstrate that low energy fractures make up a considerable proportion of acetabular fractures with a distinctly different fracture pattern distribution. With the continued predicted rise in the incidence of osteoporosis, life expectancy and an aging population, it is likely that this type of fracture will become increasingly more common, posing difficult management decisions and leading to procedures that are technically more challenging.
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25
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Quilty S, Pearce R. Drug shortages and medication quality: integrally related. Intern Med J 2014; 44:430. [PMID: 24754698 DOI: 10.1111/imj.12391] [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: 12/18/2013] [Accepted: 01/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- S Quilty
- Katherine Hospital, Menzies School of Health Research, Katherine, Northern Territory, Australia
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26
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White M, Cunningham L, Pearce R, Newnam S. Reward sensitivity predicts attentional bias towards alcohol-related cues in young binge drinkers. Personality and Individual Differences 2014. [DOI: 10.1016/j.paid.2013.07.358] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Patel K, Udintsev V, Hughes S, Walker C, Andrew P, Barnsley R, Bertalot L, Drevon J, Encheva A, Kashchuk Y, Maquet P, Pearce R, Taylor N, Vayakis G, Walsh M. ITER diagnostic system: Vacuum interface. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Woodthorpe J, Pearce R. Microstructural observations on the frequency effect in the fatigue behaviour of superplastic Zn-Al eutectoid. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/msc.1977.11.3.103] [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] [Indexed: 10/31/2022]
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Medd PG, Peniket AJ, Littlewood TJ, Pearce R, Perry J, Kirkland KE, Shaw BE, Potter MN, Craddock CF, Milligan DW, Fielding AK, Marks DI, Cook G. Evidence for a GVL effect following reduced-intensity allo-SCT in ALL: a British Society of Blood and Marrow Transplantation study. Bone Marrow Transplant 2013; 48:982-7. [PMID: 23318533 DOI: 10.1038/bmt.2012.261] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/26/2012] [Accepted: 11/20/2012] [Indexed: 11/09/2022]
Abstract
Myeloablative allo-SCT decreases relapse incidence (RI) in ALL. Reduced intensity conditioning (RIC) may extend allo-SCT to older and less fit patients. Sixty-nine ALL patients reported to the BSBMT underwent fludarabine-based RIC allo-SCT, 38 from unrelated donors (UD). Forty-four patients received alemtuzumab. ALL was in CR in 64 patients (93%). This was a second or third SCT in 23 patients. Two-year OS and PFS were 36% and 32%, respectively. In multivariate analysis male recipients demonstrated better OS and PFS (hazard ratio (HR) = 0.42, P = 0.008 and HR = 0.45, P = 0.012, respectively). Two-year TRM was 29%: higher with younger age (HR = 0.97/year, P = 0.041), female recipient (HR = 2.55, P = 0.049) and increasing grade of acute GVHD (HR = 1.87, P = 0.001). Two-year RI was 38% and was lower in patients with acute and chronic GVHD (HR = 0.62 per increasing grade, P = 0.035 and HR = 0.52, P = 0.025, respectively). Long-term ALL-free survival is achievable following fludarabine-based RIC allo-SCT. The association between GVHD and decreased RI suggests the presence of a GVL effect.
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Affiliation(s)
- P G Medd
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
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Reid AL, Millward M, Pearce R, Lee M, Frank MH, Ireland A, Monshizadeh L, Rai T, Heenan P, Medic S, Kumarasinghe P, Ziman M. Markers of circulating tumour cells in the peripheral blood of patients with melanoma correlate with disease recurrence and progression. Br J Dermatol 2012; 168:85-92. [PMID: 23013138 DOI: 10.1111/bjd.12057] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multimarker quantitative real-time polymerase chain reaction (qRT-PCR) represents an effective method for detecting circulating tumour cells in the peripheral blood of patients with melanoma. OBJECTIVES To investigate whether the phenotype of circulating melanoma cells represents a useful indicator of disease stage, recurrence and treatment efficacy. METHODS Peripheral blood was collected from 230 patients with melanoma and 152 healthy controls over a period of 3years and 9months. Clinical data and blood samples were collected from patients with primary melanoma (early stages, 0-II, n=154) and metastatic melanoma (late stages, III-IV, n=76). Each specimen was examined by qRT-PCR analysis for the expression of five markers: MLANA, ABCB5, TGFβ2, PAX3d and MCAM. RESULTS In total, 212 of the patients with melanoma (92%) expressed markers in their peripheral blood. Two markers, MLANA and ABCB5, had the greatest prognostic value, and were identified as statistically significant among patients who experienced disease recurrence within our study period, being expressed in 45% (MLANA) and 49% (ABCB5) of patients with recurrence (P=0·001 and P=0·031, respectively). For patients administered nonsurgical treatments, MCAM expression correlated with poor treatment outcome. CONCLUSIONS Circulating tumour cells were detectable at all stages of disease and long after surgical treatment, even when patients were considered disease free. Specifically, expression of ABCB5 and MLANA had significant prognostic value in inferring disease recurrence, while MCAM expression was associated with poor patient outcome after treatment, confirming multimarker qRT-PCR as a potential technique for monitoring disease status.
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Affiliation(s)
- A L Reid
- School of Medical Sciences, Edith Cowan University, Perth, WA, Australia
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Cameron Smail R, McColgan P, Pearce R. PARKINSON'S DISEASE ‘GET IT ON TIME’ AUDIT. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rickman M, Young J, Bircher M, Pearce R, Hamilton M. The management of complex acetabular fractures in the elderly with fracture fixation and primary total hip replacement. Eur J Trauma Emerg Surg 2012; 38:511-6. [DOI: 10.1007/s00068-012-0231-9] [Citation(s) in RCA: 16] [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] [Received: 06/10/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
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MESH Headings
- Brain Injuries/complications
- Brain Injuries/diagnosis
- Cerebellar Cortex/pathology
- Cerebral Hemorrhage/complications
- Cerebral Hemorrhage/diagnosis
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases
- Infections
- Intensive Care Units, Neonatal
- Magnetic Resonance Imaging/standards
- Parents/education
- Parents/psychology
- Prognosis
- Shock, Septic/complications
- Shock, Septic/diagnosis
- Shock, Septic/therapy
- Twins
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Affiliation(s)
- Rebecca Pearce
- Life Sciences, NRC Human Health Therapeutics Portfolio, National Research Council Canada, Montréal, QC, Canada
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Abstract
INTRODUCTION AND OBJECTIVES Heminephroureterectomy (HN) is our treatment of choice in a duplex system with non-functioning moiety. We examined the need for endoscopic incision (EI)/bladder reconstructive surgery (BRS) and whether ureteroceles and/or vesicoureteric reflux (VUR) influenced management options. METHODS Retrospective study of patients undergoing HN by a single surgeon (2003-2008). Patients were classified according to the presence (Group 1) or absence (Group 2) of ureterocele. The groups were subdivided with coexisting dilating VUR (a) or not (b). Statistical analysis included Fisher's exact test. RESULTS Thirty-one children were identified. Seventeen (54.8%) had ureterocele (Group 1) and 14 patients had no ureterocele (Group 2). Group 1 had eight with VUR (1a) and nine without (1b). Group 2 had seven with VUR (2a) and seven without (2b). Significantly more patients with ureterocele required EI/BRS (p = 0.006). Five (29%) in Group 1 required BRS versus none in Group 2 (p = 0.04). Six (75%) in Group 1a underwent EI/BRS versus three (33%) in Group 1b (p = 0.15). Significantly more in Group 1a required EI prior to HN versus Group 1b (p = 0.04). Similar numbers of patients required BRS in Groups 1a and 1b (p = 0.61). CONCLUSIONS In the absence of ureterocele, there is minimal likelihood of requiring surgery apart from HN, independent of VUR. Presence of ureterocele is an indicator for additional procedure within the bladder. There is a higher incidence of EI when ureterocele co-exists with dilating VUR.
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Affiliation(s)
- R Pearce
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Papastergiou S, Lässer R, Piazza G, Wikus P, Day C, Haas H, Hanke S, Hauer V, Poncet JM, Antipenkov A, Dremel M, Mayaux C, Pearce R, Fellin F. The European Supplied Components of the ITER Vacuum Pumping Systems. Fusion Science and Technology 2011. [DOI: 10.13182/fst11-a12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - R. Lässer
- Fusion for Energy, Plant Systems Division, Barcelona, Spain
| | - G. Piazza
- Fusion for Energy, Plant Systems Division, Barcelona, Spain
| | - P. Wikus
- Fusion for Energy, Plant Systems Division, Barcelona, Spain
| | - Ch. Day
- Karlsruhe Institute for Technology, Institute for Technical Physics, Vacuum Department, Karlsruhe, Germany
| | - H. Haas
- Karlsruhe Institute for Technology, Institute for Technical Physics, Vacuum Department, Karlsruhe, Germany
| | - S. Hanke
- Karlsruhe Institute for Technology, Institute for Technical Physics, Vacuum Department, Karlsruhe, Germany
| | - V. Hauer
- Karlsruhe Institute for Technology, Institute for Technical Physics, Vacuum Department, Karlsruhe, Germany
| | - J. M. Poncet
- Commissariat à L’energie Atomique, Direction des Sciences de la Materie, Institut Nanosciences et Cryogenie, Service des Basses Temperatures, Grenoble, France
| | - A. Antipenkov
- ITER Organisation, Central Engineering and Plant Support Department, VPS Group, Saint Paul Les Durance, France
| | - M. Dremel
- ITER Organisation, Central Engineering and Plant Support Department, VPS Group, Saint Paul Les Durance, France
| | - Ch. Mayaux
- ITER Organisation, Central Engineering and Plant Support Department, VPS Group, Saint Paul Les Durance, France
| | - R. Pearce
- ITER Organisation, Central Engineering and Plant Support Department, VPS Group, Saint Paul Les Durance, France
| | - F. Fellin
- Consorzio RFX - Associazione ENEA-Euratom, Area della Ricerca del C.N.R., Padova, Italy
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Day C, Haas H, Hanke S, Hauer V, Luo X, Scannapiego M, Simon R, Strobel H, Fellin F, Lässer R, Masiello A, Papastergiou S, Dremel M, Mayaux C, Pearce R. Design progress for the ITER torus and neutral beam cryopumps. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2010.11.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Malisa A, Pearce R, Abdullah S, Mutayoba B, Mshinda H, Kachur P, Bloland P, Roper C. Molecular monitoring of resistant dhfr and dhps allelic haplotypes in Morogoro and Mvomero districts in south eastern Tanzania. Afr Health Sci 2011; 11:142-150. [PMID: 21857842 PMCID: PMC3158517] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Resistance to the antimalarial drug sulfadoxine-pyrimethamine (SP) emerged in Plasmodium falciparum from Asia in the 1960s and subsequently spread to Africa. In Tanzania, SP use as a national policy began in 1983 as a second line to chloroquine (CQ) for the treatment of uncomplicated malaria, until August 2001 when it was approved to replace CQ as a national first line. OBJECTIVE The present study assesses the frequency of resistant dhfr and dhps alleles in Morogoro-Mvomero district in south eastern Tanzania and contrast their rate of change during 17 years of SP second line use against five years of SP first line use. METHODOLOGY Cross sectional surveys of asymptomatic infections were carried out at the end of rainy season during July-September of 2000, when SP was the national second line (CQ was the first line) and 2006 when SP was the national first line antimalarial treatment. Genetic analysis of SP resistance genes was carried out on 1,044 asymptomatic infections and the effect of the two policies on SP evolution compared. RESULTS The frequency of the most resistant allele, the double dhps-triple dhfr mutant genotype, increased by only 1% during 17 years of SP second line use, but there was a dramatic increase by 45% during five years of SP first line use. CONCLUSION We conclude that National policy change from second line to first line SP, brought about an immediate shift in treatment practice and this in turn had a highly significant impact on drug pressure. The use of SP in specific programs only such as intermittent preventive treatment of infants (IPTi) and intermittent preventive treatment of pregnant women (IPTp) will most likely reduce substantially SP selection pressure and the SP resistance alleles alike.
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Affiliation(s)
- A Malisa
- Sokoine University of Agriculture, Department of Biological Sciences, Faculty of Science, Morogoro, Tanzania.
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Abstract
We report the outcome of 161 of 257 surgically fixed acetabular fractures. The operations were undertaken between 1989 and 1998 and the patients were followed for a minimum of ten years. Anthropometric data, fracture pattern, time to surgery, associated injuries, surgical approach, complications and outcome were recorded. Modified Merle D'Aubigné score and Matta radiological scoring systems were used as outcome measures. We observed simple fractures in 108 patients (42%) and associated fractures in 149 (58%). The result was excellent in 75 patients (47%), good in 41 (25%), fair in 12 (7%) and poor in 33 (20%). Poor prognostic factors included increasing age, delay to surgery, quality of reduction and some fracture patterns. Complications were common in the medium- to long-term and functional outcome was variable. The gold-standard treatment for displaced acetabular fractures remains open reduction and internal fixation performed in dedicated units by specialist surgeons as soon as possible.
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Affiliation(s)
- N Briffa
- Department of Trauma and Orthopaedics, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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40
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Putnis SE, Pearce R, Wali UJ, Bircher MD, Rickman MS. Open reduction and internal fixation of a traumatic diastasis of the pubic symphysis: one-year radiological and functional outcomes. ACTA ACUST UNITED AC 2011; 93:78-84. [PMID: 21196548 DOI: 10.1302/0301-620x.93b1.23941] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to review the number of patients operated on for traumatic disruption of the pubic symphysis who developed radiological signs of movement of the anterior pelvic metalwork during the first post-operative year, and to determine whether this had clinical implications. A consecutive series of 49 patients undergoing internal fixation of a traumatic diastasis of the pubic symphysis were studied. All underwent anterior fixation of the diastasis, which was frequently combined with posterior pelvic fixation. The fractures were divided into groups using the Young and Burgess classification for pelvic ring fractures. The different combinations of anterior and posterior fixation adopted to stabilise the fractures and the type of movement of the metalwork which was observed were analysed and related to functional outcome during the first post-operative year. In 15 patients the radiographs showed movement of the anterior metalwork, with broken or mobile screws or plates, and in six there were signs of a recurrent diastasis. In this group, four patients required revision surgery; three with anterior fixation and one with removal of anterior pelvic metalwork; the remaining 11 functioned as well as the rest of the study group. We conclude that radiological signs of movement in the anterior pelvic metalwork, albeit common, are not in themselves an indication for revision surgery.
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Affiliation(s)
- S E Putnis
- Department of Trauma and Orthopaedic Surgery, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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Fink R, Mortlock S, Pearce R, Raamkoleea P, Underhill J. Association of γ-Glutamyl Transferase with Cardiovascular Risk: A Prognostic Outlook. Arch Med Res 2010; 41:232; author reply 233. [DOI: 10.1016/j.arcmed.2010.04.001] [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] [Received: 02/01/2010] [Accepted: 03/30/2010] [Indexed: 11/24/2022]
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Oakes R, Sood N, Pearce R, Swirsky D, Cook G, Gilleece M. Prognostic impact of serum ferritin concentration on survival following reduced-intensity conditioned allogeneic haemopoietic SCT. Bone Marrow Transplant 2010; 45:1754-5. [DOI: 10.1038/bmt.2010.36] [Citation(s) in RCA: 2] [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: 11/09/2022]
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Rogers BA, Pearce R, Jones C. The safe referral and transfer of patients to major trauma centres. Br J Hosp Med (Lond) 2010; 70:M166-9. [PMID: 20081605 DOI: 10.12968/hmed.2009.70.sup11.45069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B A Rogers
- Department of Trauma and Orthopaedics, St George's Hospital, London, UK
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Croaker GDH, Pearce R, Li J, Nahon I, Javaid A, Kecskes Z. Idiopathic slow transit constipation is rare. But delayed passage of meconium is common in the constipation clinic. Pediatr Surg Int 2007; 23:1153-9. [PMID: 17972085 DOI: 10.1007/s00383-007-2021-8] [Citation(s) in RCA: 3] [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: 12/15/2022]
Abstract
We hypothesise that constipated children would be more likely to come from a socially deprived background. We also hypothesise that a percentage of children with resistant constipation would have a congenital gut motility problem that might be recognised at birth, and that some of these would have slow transit constipation that could be recognised on nuclear transit study. One hundred and forty children with a constipation related diagnosis were seen in the last 4 years, and were reviewed as a retrospective audit. Twenty-six children who were felt likely to have a congenital cause for their constipation were offered nuclear colon transit study to search for slow transit constipation. One hundred and forty children from the constipation clinic were reviewed. There were 67 females (47.9%) and 73 males (52.1%), a sex ratio near equality. The mean age at presentation was 5.38 years. Forty-one percent were formally discharged, 36% were lost to follow up, and 23% are still being seen. There was a highly significant tendency for these children to have delayed passage of meconium, as compared normal newborns (P << 0.001). Twenty-six children were considered for possible transit study, and 14 were performed. Four of these were normal, seven showed hold up in the recto-sigmoid, and three showed more proximal slow transit. Two of these probably have non ISTC diagnoses. Social class seems similar to the general population on the criterion employed. Delayed passage of meconium in this group was significantly more frequent than in the general population, but only one of the group seems likely to have truly idiopathic slow transit constipation, and he did not have delayed passage of meconium. There is no evidence for an effect of social class in this population. Idiopathic slow transit constipation itself is rare.
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Affiliation(s)
- G D H Croaker
- The Canberra Hospital, Garran, ACT, 2605, Australia.
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Hill QA, Buxton D, Pearce R, Gesinde MO, Smith GM, Cook G. An analysis of the optimal timing of peripheral blood stem cell harvesting following priming with cyclophosphamide and G-CSF. Bone Marrow Transplant 2007; 40:925-30. [PMID: 17846599 DOI: 10.1038/sj.bmt.1705847] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Increasing demand on the apheresis service makes efficient harvesting of peripheral blood stem cells (PBSCs) essential. A total of 168 adult patients with haematological malignancy were primed using low-moderate dose cyclophosphamide (1.5-3 g/m(2)) with G-CSF 5-10 microg/kg per day. Harvesting was booked and peripheral blood (PB) counts first checked between 6 and 10 days post-priming. One hundred and thirty (77%) patients harvested successfully (total harvest yield > or =2 x 10(6) CD34(+)/kg) and the median PBSC collection per procedure was 2.18 x 10(6)/kg (range 0.1-14.5). Only more lines of prior chemotherapy predicted failure to harvest in multivariate analysis (P=0.003). The PB CD34(+) cell count correlated significantly with harvest yield (r=0.8448, P<0.0001). A PB CD34(+) count > or =10/microl predicted a collection of > or =2 x 10(6)/kg (positive-predictive value of 61%, negative-predictive-value 100%). Patients first attending day 9 required significantly fewer visits to achieve a successful harvest than those first attending days 6-8 without increasing the risk of failure. No significant difference in failure rates, number of days attending and total harvest yield was found between days 9 and 10 attendees. Collection from day 9 may however enable higher target yields to be achieved. PB CD34(+) count monitoring should commence and harvesting booked from day 9 to optimize both the harvest and the efficiency of the PBSC harvesting service.
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Affiliation(s)
- Q A Hill
- Department of Haematology, Leeds General Infirmary, Leeds, UK.
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Feyler S, Prince HM, Pearce R, Towlson K, Nivison-Smith I, Schey S, Gibson J, Patton N, Bradstock K, Marks DI, Cook G. The role of high-dose therapy and stem cell rescue in the management of T-cell malignant lymphomas: a BSBMT and ABMTRR study. Bone Marrow Transplant 2007; 40:443-50. [PMID: 17589529 DOI: 10.1038/sj.bmt.1705752] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [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: 11/12/2022]
Abstract
Peripheral T-cell lymphomas (PTCL) are a rare and heterogeneous subset of lymphomas with a poorer prognosis compared with B-cell lymphomas. We conducted a retrospective study of 82 patients who received high-dose therapy for PTCL (autologous SCT (ASCT) N=64; allogeneic SCT (Allo-SCT) N=18). With a median follow-up from ASCT of 37 months from transplant, 33 patients were alive; 20 died of progressive disease, 10 died from non-relapse mortality (NRM) with 1 unknown cause. Three-year overall survival (OS) and progression-free survival (PFS) were 53% (95% confidence interval (CI) 42, 67) and 50% (95% CI 39, 64), respectively. Factors significantly affecting OS and PFS on univariate analysis were histological subtype and chemotherapy sensitivity. In a multivariate analysis, the only factor with significant impact was chemotherapy sensitivity. After a median follow-up from Allo-SCT of 57 months, five patients were alive; five died of progressive disease and eight died from NRM. The 3-year OS and PFS were 39% (95% CI 22, 69) and 33% (95% CI 17, 64), respectively, and the 3-year relapse rate was 28% (95% CI 6, 50). These results demonstrate that high-dose chemotherapy with autologous stem cell rescue has a substantial role in the management of T-cell lymphoma. The use of full-intensity allogeneic transplantation is limited by high transplant-related mortality, and exploration of reduced intensity regimens is warranted.
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Affiliation(s)
- S Feyler
- BMTU, St James's University Hospital, Leeds, UK
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Abstract
OBJECTIVE To assess the role of imported cases in the local epidemiology of malaria and population genetics of Plasmodium falciparum in an urban endemic area in Colombia. METHOD A total of 679 P. falciparum cases presenting in the city were interviewed, mapped, and genotyped using msp1 and msp2 molecular markers. RESULTS Among the cases, 75% were classified as imported and harboured single-clone infections. The P. falciparum parasite population had low genetic diversity with a preponderant haplotype (mean genetic diversity H = 0.36), even when microsatellite markers were used (H = 0.49), partly because of the small scale at which population movement was studied. Nevertheless, indigenous and potentially introduced cases were identified. CONCLUSION Migration is a confounder in planning malaria control in this endemic urban area. Longitudinal studies which monitor the P. falciparum population in imported and autochthonous cases at larger spatial scales would be necessary to study the effect of population movement on malaria transmission and, with suitable molecular markers, on the spread of drug resistance.
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Affiliation(s)
- L Osorio
- International Center for Medical Research and Training, Cali, Colombia.
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Vancso GJ, Beekmans LGM, Pearce R, Trifonova D, Varga J. From microns to nanometers: Morphology development in semicrystalline polymers by scanning force microscopy. J MACROMOL SCI B 2006. [DOI: 10.1080/00222349908248115] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. J. Vancso
- a University of Twente Faculty of Chemical Technology Materials Science and Technology of Polymers , P.O. Box 217, NL-7500, AE Enschede, The Netherlands
| | - L. G. M. Beekmans
- a University of Twente Faculty of Chemical Technology Materials Science and Technology of Polymers , P.O. Box 217, NL-7500, AE Enschede, The Netherlands
| | - R. Pearce
- a University of Twente Faculty of Chemical Technology Materials Science and Technology of Polymers , P.O. Box 217, NL-7500, AE Enschede, The Netherlands
- b Barringer Research , 1730 Aico, Mississauga, L4W 1V1, Ont, Canada
| | - D. Trifonova
- a University of Twente Faculty of Chemical Technology Materials Science and Technology of Polymers , P.O. Box 217, NL-7500, AE Enschede, The Netherlands
| | - J. Varga
- a University of Twente Faculty of Chemical Technology Materials Science and Technology of Polymers , P.O. Box 217, NL-7500, AE Enschede, The Netherlands
- c Friedrich-Alexander Universität, Erlangen-Nürnberg, Lehrstuhl für Kunststofftechnik , D-91058, Erlangen, Germany
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Abstract
BACKGROUND Salivary gland agenesis is a rare condition. It can be associated with some equally rare syndromes so that diagnosis can be delayed. CASE REPORT The authors describe a case report. A 3-year-old girl, presented with dry mouth, carious teeth, recurrent herpes labialis and tonsillitis to Newcastle Dental Hospital. This case highlights the diagnostic and therapeutic challenges posed by 'salivary gland agenesis'. CONCLUSION Primary and secondary paediatric healthcare professionals should be aware of the possibility of salivary gland agenesis in the setting of the 'non drooling baby'. Early detection of 'salivary gland agenesis' would do much to prevent the deleterious oral affects which follow the absence of salivary protection in the oral cavity.
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Affiliation(s)
- N Heath
- Oral and Maxillofacial Radiology, Newcastle Dental Hospital, UK.
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Abstract
William Beatty, the surgeon aboard the Victory who tended Nelson in his final moments, had an unusual set of surgical instruments, put together to his own specification
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