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Nooreen N, Zahid M, Jawad M, Ullah SA, Khan MI, Khan K, Shah M, Wahab A, Ahmad R, Sajid M, Jawad SM, Khan S. Studying biodiversity of spiders species in seven different localities of Charsadda District, Khyber Pakhtunkhwa, Pakistan. BRAZ J BIOL 2024; 84:e260515. [DOI: 10.1590/1519-6984.260515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract The current research work aims to provide knowledge about the diversity of spiders’ fauna and their occurrence throughout the year from District Charsadda Khyber Pakhtunkhwa, Pakistan. Research data were collected from March-2015 to January-2017 from seven different localities of Charsadda District by using the camera, bottle, plastic bags, paraffin films, field book and 70% of ethylene alcohol and 20% of glycerine were used as chemicals. By using special identification keys, spiders were differentiated into families, genera and species. During the study time, a total of 2734 specimens of spiders were collected belonging from 35 genera, 15 families and 44 species were identified. Salticidae was the dominant family according to genera studied plus spiders samples numbers collected with 10 genera and 616 species specimens count. The high occurrence of spiders was studied during July. The result of the current study also shows a reduction of spider’s species in December due to lowering the temperature. The current study shows that Salticidae were the dominant family as capered to other species. The occurrence of spiders species greatly depends on changing the weather condition. The present study also shows great fluctuation in spider’s occurrence with changing of hot climate to colder during the study duration. Moreover, the wet season plays a great role in spiders’ population increase and growth.
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Affiliation(s)
| | - M. Zahid
- Islamia College Peshawar, Pakistan
| | - M. Jawad
- Islamia College Peshawar, Pakistan
| | | | | | - K. Khan
- Islamia College Peshawar, Pakistan
| | - M. Shah
- Government College Peshawar, Pakistan
| | - A. Wahab
- Islamia College Peshawar, Pakistan
| | - R. Ahmad
- Islamia College Peshawar, Pakistan
| | - M. Sajid
- Islamia College Peshawar, Pakistan
| | | | - S. Khan
- Islamia College Peshawar, Pakistan
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Hussaini N, Lane C, Ahmad R, Hussaini N, Hussaini A. Transient ST-elevation MI diagnosed by Holter monitoring. Ir Med J 2023; 116:862. [PMID: 37874542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
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Marshall H, Selvan T, Ahmad R, Bento M, Veiga C, Sands G, Malone C, King RB, Clark CH, McGarry CK. Evaluation of a novel phantom for the quality assurance of a six-degree-of-freedom couch 3D-printed at multiple centres. Phys Med 2023; 114:103136. [PMID: 37769414 DOI: 10.1016/j.ejmp.2023.103136] [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: 04/03/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
This study aimed to validate a bespoke 3D-printed phantom for use in quality assurance (QA) of a 6 degrees-of-freedom (6DoF) treatment couch. A novel phantom design comprising a main body with internal cube structures, was fabricated at five centres using Polylactic Acid (PLA) material, with an additional phantom produced incorporating a PLA-stone hybrid material. Correctional setup shifts were determined using image registration by 3D-3D matching of high HU cube structures between obtained cone-beam computer tomography (CBCT) images to reference CTs, containing cubes with fabricated rotational offsets of 3.5°, 1.5° and -2.5° in rotation, pitch, and roll, respectively. Average rotational setup shifts were obtained for each phantom. The reproducibility of 3D-printing was probed by comparing the internal cube size as well as Hounsfield Units between each of the uniquely produced phantoms. For the five PLA phantoms, the average rot, pitch and roll correctional differences from the fabricated offsets were -0.3 ± 0.2°, -0.2 ± 0.5° and 0.2 ± 0.3° respectively, and for the PLA hybrid these differences were -0.09 ± 0.14°, 0.30 ± 0.00° and 0.03 ± 0.10°. There was found to be no statistically significant difference in average cube size between the five PLA printed phantoms, with the significant difference (P < 0.05) in HU of one phantom compared to the others attributed to setup choice and material density. This work demonstrated the capability producing a novel 3D-printed 6DoF couch QA phantom design, at multiple centres, with each unique model capable of sub-degree couch correction.
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Affiliation(s)
- Hannah Marshall
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
| | - Tamil Selvan
- Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Reem Ahmad
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Mariana Bento
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Catarina Veiga
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Gordon Sands
- Radiotherapy Physics, UCLH NHS Foundation Trust, London, UK
| | - Ciaran Malone
- Radiotherapy Physics, St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Raymond B King
- Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Catharine H Clark
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Radiotherapy Physics, UCLH NHS Foundation Trust, London, UK; Metrology for Medical Physics, National Physical Laboratory, Teddington, UK
| | - Conor K McGarry
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Department of Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
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Ahmad R, Cantwell J, Borrelli C, Lim P, D'Souza D, Gaze MN, Moinuddin S, Gains J, Veiga C. Development of Population-Based Pediatric Computational Phantoms for Radiotherapy Applications. Int J Radiat Oncol Biol Phys 2023; 117:e456. [PMID: 37785462 DOI: 10.1016/j.ijrobp.2023.06.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Age-specific pediatric computational phantoms are used in radiotherapy (RT) for quality assurance and for reconstruction of historical RT doses (within others). Phantoms are typically developed from healthy patients and may not effectively represent those with cancer due to pathology and/or treatment effects. This study evaluated a set of population-based pediatric computational phantoms developed in-house in terms of anatomical plausibility. MATERIALS/METHODS Planning CTs and contours from historical craniospinal irradiation (CSI) patients (n = 74, median age 7y, range: 1-17y) were used to generate and evaluate a set of in-house age-specific population-based RT phantoms (RT-P). The RT-P were generated by combining a sub-set of clinical CTs and contours through groupwise deformable image registration, generating average models of CSI sub-populations (n = 74, median age 7y, range: 3-14y). Models were then compared against clinical data and two libraries of phantoms representing healthy populations: the International Commission on Radiological Protection (ICRP) pediatric reference computational phantoms (n = 8, median age 8y, range: 1-15y) and a variety of default 4D extended cardiac torso (XCAT) phantoms (n = 75, median age 9y, range: 1-18y). Variation between organ volumes for the different datasets was assessed through a linear fit of organ volume with age, reporting the slope (∑) of each fit [y-1]. Average difference between the volume datapoints and the linear fit for clinical data (Δ) [%] were also reported. This allowed for comparisons of the RT-P to clinical and reference data in terms of organ volumes across developmental stages. RESULTS The table shows 9 of the 19 investigated organs. The ∑ reported for RT-P models were of similar magnitude as the clinical data and other phantoms, effectively modelling changes with age. The greatest and least ∑ were reported from lungs and thyroid respectively, in agreement with expected relative sizes between organs. Larger values for Δ were likely due to differences in organ filling and segmentation strategy between datasets, limitations of RT-P methodology, and/or anatomical differences between healthy and cancer populations. CONCLUSION The RT-P models show promise in representing the RT cohort that may benefit from specialized anatomical phantoms. Further work is needed to address the limitations of the current methodology and its applicability to other RT cohorts.
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Affiliation(s)
- R Ahmad
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - J Cantwell
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - C Borrelli
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - P Lim
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - D D'Souza
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - M N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - S Moinuddin
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - J Gains
- Department of Radiotherapy, University College London Hospital, London, United Kingdom
| | - C Veiga
- Centre for Medical Image Computing, University College London, London, United Kingdom
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Al‐Dairy A, Ahmad R, Hasan R. Misdiagnosis of persistent left superior vena cava with unroofed coronary sinus as a coronary sinus-type atrial septal defect. Clin Case Rep 2023; 11:e7826. [PMID: 37636889 PMCID: PMC10448239 DOI: 10.1002/ccr3.7826] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 07/03/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message Awareness of persistent left superior vena cava (PLSVC) with unroofed coronary sinus is crucial. Pre- and perioperative evaluation of this association is necessary for surgical plan. Creating an intra-atrial tunnel to divert LSVC to right atrium without obstructing the mitral valve or the pulmonary veins is the safe surgical approach. Abstract Unroofed coronary sinus syndrome is a rare congenital heart defect representing less than 1% of all atrial septal defect (ASD) types, and may be associated with persistent left superior vena cava (PLSVC) which may be missed during preoperative diagnosis. Herein, we present a case of a 2-year-old patient who underwent an operation for repair of a coronary sinus-type ASD; however, PLSVC was detected intraoperatively. An antra-atrial tunnel has created to divert the flow of PLSVC into the right atrium along with the repair of the ASD.
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Affiliation(s)
- Alwaleed Al‐Dairy
- Cardiac Surgery, Faculty of MedicineDamascus UniversityDamascusSyria
| | - Reem Ahmad
- Faculty of MedicineDamascus UniversityDamascusSyria
| | - Rawan Hasan
- Faculty of MedicineDamascus UniversityDamascusSyria
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Iqbal W, Ayyub CM, Jahangir MM, Ahmad R. Effect of foliar application of bio-stimulants on growth, yield and nutritional quality of broccoli. BRAZ J BIOL 2023; 83:e263302. [PMID: 37493781 DOI: 10.1590/1519-6984.263302] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/17/2022] [Indexed: 07/27/2023] Open
Abstract
Broccoli is one of important cole crop grown all over the world due to its unique nutritional profile consumed fresh as well as processed. It contains a wide range of nutrients, vitamins, minerals and specific anti-cancer compounds such as glucosinolates. Broccoli cultivation in Pakistan is increasing rapidly, however, till now there is no standardized cropping technology for broccoli cultivation under local climate. Considering research gap (lack of suitable varieties, poor growth, and unavailability of optimized crop technology), trial was conducted at Vegetable research area, Institute of Horticultural Sciences, University of Agriculture, Faisalabad to evaluate the impact of bio-stimulants on different broccoli cultivars under local climatic conditions. The set of experimental treatments was laid out in Randomized Complete Block Design (RCBD) with three replications. Pre-harvest application of Isabion and Seaweed extract significantly enhanced the plant height (11%), dry weight (4%), leaf area (7%), and yield plant-1 (5%). Moreover, Isabion and seaweed extract application led to the increase in antioxidant enzymes i.e., superoxide dismutase (18%), peroxidase (38%) and catalase (12%). In crux, the foliar application of bio-stimulants (Isabion and seaweed extract) on broccoli enhanced the growth, yield, and contents of antioxidant enzymes.
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Affiliation(s)
- W Iqbal
- University of Agriculture, Institute of Horticultural Sciences, Faisalabad, Pakistan
| | - C M Ayyub
- University of Agriculture, Institute of Horticultural Sciences, Faisalabad, Pakistan
| | - M M Jahangir
- University of Agriculture, Institute of Horticultural Sciences, Faisalabad, Pakistan
| | - R Ahmad
- University of Agriculture, Department of Agronomy, Faisalabad, Pakistan
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Lakshminarayan R, Bent C, Taylor J, Bryant T, Ahmad R, Diamantopoulos A, Morgan RA. Developing day-case units: imperative for optimal patient care in interventional radiology. Clin Radiol 2023; 78:295-300. [PMID: 36702708 DOI: 10.1016/j.crad.2022.11.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/15/2023]
Abstract
As interventional radiology (IR) treatments have evolved, they have become less invasive, enabling rapid recovery, which expedites ambulation and promotes same-day discharge. As a result of this, a significant proportion of IR elective work can be provided using a day-case service model. Reconfiguration of IR services to increase day-case procedures using a dedicated IR day-case unit (RDU) to facilitate the passage of patients is vital to ensure best medical practice. The aim of this review is to discuss the benefits of day-case IR procedures, the optimal structure of an RDU, and to inform radiologists how to introduce and/or improve day-case IR services in their IR practice.
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Affiliation(s)
- R Lakshminarayan
- Department of Vascular Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - C Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - J Taylor
- Interventional Radiology, Frimley Health Foundation Trust, Surrey, UK
| | - T Bryant
- Department of Radiology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - R Ahmad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Diamantopoulos
- Department of Interventional Radiology, Guys' and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - R A Morgan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust and St George's, University of London, London, UK.
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Bryant T, Ahmad R, Diamantopoulos A, Lakshminarayan R, Bent C, Taylor J, Morgan RA. Access to beds for interventional radiology patients: improving patient care. Clin Radiol 2023; 78:288-294. [PMID: 36707396 DOI: 10.1016/j.crad.2022.10.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/15/2023]
Abstract
This review describes the rationale in support of admitting rights for interventional radiologists and presents options for the management of interventional radiology (IR) inpatients. The manuscript also discusses wider aspects of IR involvement in inpatient treatment, such as income and funding for IR services, and the implications for IR as a clinical specialty.
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Affiliation(s)
- T Bryant
- Department of Radiology, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - R Ahmad
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A Diamantopoulos
- Department of Interventional Radiology, Guys' and St. Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - R Lakshminarayan
- Department of Vascular Radiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - C Bent
- Department of Radiology, University Hospitals Dorset, Dorset, UK
| | - J Taylor
- Department of Radiology, Frimley Health Foundation Trust, Surrey, UK
| | - R A Morgan
- Department of Radiology, St George's University Hospitals NHS Foundation Trust and St George's, University of London, London, UK.
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Zubair A, Zhang H, Scholfield DW, Ahmad R, Ahmed J, Ali S, Ghufoor K. Head-neck dissection course during COVID-19 pandemic: challenges, adaptations and how we did it. Ann R Coll Surg Engl 2022; 104:694-699. [PMID: 35175784 PMCID: PMC9685903 DOI: 10.1308/rcsann.2021.0316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Cadaveric dissection courses have come to a standstill since the onset of the COVID-19 pandemic. In addition to limited operative opportunities, cancellation of such courses has severely impacted surgical training, especially in a craft-based specialty such as head-neck surgery. The aim of this educational project was to: (1) study the feasibility of an in-person head-neck cadaveric dissection course during COVID-19 pandemic; and (2) validate the educational benefit of this teaching method to ear, nose and throat (ENT) trainees. METHODS We developed a 2-day head-neck cadaveric dissection course for ENT trainees. The course programme covered essential head-neck open surgical procedures. Content validity (subjective feedback) was assessed using a 5-point Likert scale. Construct validity (objective usefulness) was evaluated via two pre- and post-course questionnaires, estimating knowledge of head-neck surgical anatomy and self-assessment of levels of confidence with head-neck procedures, respectively. RESULTS A risk assessment was conducted and a protocol developed (risk was deemed to be low/tolerable). Content validity showed high satisfaction compared with a median Likert score of 3, 'average' (p=0.000002). For construct validity, the mean score per question improved significantly (p=0.001). Overall levels of confidence showed a trend towards improvement (p=0.08). There was significant improvement in laryngectomy (p=0.01) and level I dissection (p=0.01), with an indication of improvement in level II-V dissection (p=0.07). CONCLUSIONS We demonstrated that a cadaveric dissection course, using thorough risk assessment and protocol, could be safely conducted with high content and construct validation during these unprecedented times. This is an invaluable learning environment that needs to be encouraged despite infection control restrictions.
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Affiliation(s)
| | - H Zhang
- The Royal Marsden NHS Foundation Trust, UK
| | | | - R Ahmad
- Queen Mary University of London, UK
| | | | - S Ali
- Barts Health NHS Trust, UK
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Vornehm M, Wetzl J, Giese D, Ahmad R, Knoll F. Spatiotemporal variational neural network for reconstruction of highly accelerated cardiac cine MRI. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeac141.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Siemens Healthcare GmbH; NIH Grant.
Background
Acquisition of cardiac cine MRI usually requires the subject to repeatedly hold their breath for several seconds. Deep learning-based reconstruction of highly undersampled data could allow higher accelerations and has been proposed for several applications. The variational network [1] (VN) was one of the first network architectures for MRI reconstruction, replicating iterative reconstruction with a regularization term learnt from training data.
Purpose
To expand the concept of VNs to spatiotemporal data from cardiac cine acquisitions. Reconstructions are presented and compared using 3D, 2D spatial-only, and 2D+t spatiotemporal convolutions.
Methods
A VN with intermediate quantities in k-space [2] was trained to reconstruct cine sequences from retrospectively undersampled data. The network architecture is illustrated in Fig. 1. It consisted of 10 cascades, each resembling a gradient descent step of an iterative reconstruction. Each refinement step contained a Residual U-Net (cf. Fig. 1d). Pre-estimated coil sensitivity maps were used in all transformations between k-space and image space.
The convolution operations were implemented as either 2D spatial-only, 3D, or separable 2D+t spatiotemporal convolutions. A 2D+t convolution consisted of a 2D spatial convolution followed by an activation function and a 1D temporal convolution (cf. Fig. 1e).
The OCMR dataset [3] was used for training and evaluation. It contains 183 fully sampled cine slices from 74 subjects in different imaging planes with 15 to 38 coils and 15 to 31 temporal frames at 1.5T and 3T. The training set contained 142 slices from 33 individuals, which includes all multi-slice acquisitions from the dataset. The validation set consisted of 22 single slices and the network performance was evaluated on the remaining, previously unseen 19 single-slice acquisitions.
The k-space data was retrospectively undersampled using a variable density mask [4]. Sensitivity-based coil combination of the fully sampled k-space was used as ground truth. Coil sensitivity maps were estimated with ESPIRiT. Six networks were trained using the different convolution types mentioned above, each for acceleration factors R=8 and R=12.
Results
Exemplary reconstructions and quantitative results are given in Fig. 2. At R=8, reconstruction with 2D+t and 3D convolutions reached high structural similarity (SSIM) scores of around 0.95, while the 2D convolutions only reached 0.74. Artifacts are clearly visible in reconstructions learnt with 2D kernels. At R=12, reconstruction quality degraded most considerably with 2D convolution kernels.
Conclusion
Reconstruction of highly accelerated cardiac cine data using VNs yielded very good preliminary results. Convolutions that exploit temporal correlations are clearly beneficial over spatial-only convolutions. 2D+t spatiotemporal convolutions may be preferable over 3D convolutions due to reduced model capacity with similar reconstruction capability. Network design with 2D+t convolutionExample reconstruction and time profiles
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Affiliation(s)
- M Vornehm
- Friedrich Alexander University, Computational Imaging Lab , Erlangen , Germany
| | - J Wetzl
- Siemens Healthcare GmbH , Erlangen , Germany
| | - D Giese
- Siemens Healthcare GmbH , Erlangen , Germany
| | - R Ahmad
- The Ohio State University, Biomedical Engineering , Columbus , United States of America
| | - F Knoll
- Friedrich Alexander University, Computational Imaging Lab , Erlangen , Germany
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Veiga C, Cantwell J, Ahmad R, Lim P, D'Souza D, Gaze M, Moinuddin S, Gains J. PO-1789 Quantitative evaluation of whole-body spatial normalisation in paediatric patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Ahmad R, Baer E, Pile K, Collins-Fekete C, Gulliford S, Wickers S, Hawkins M. PO-1731 Investigating proton therapy as a treatment option for pregnant breast cancer patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al-Siweedi SYA, Ngeow WC, Nambiar P, Abu-Hassan MI, Ahmad R, Asif MK, Chai WL. A new classification system of trifid mandibular canal derived from Malaysian population. Folia Morphol (Warsz) 2022; 82:315-324. [PMID: 35285511 DOI: 10.5603/fm.a2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to identify and classify the anatomic variation of mandibular canal among Malaysians of 3 ethnicities. MATERIALS AND METHODS The courses of the mandibular canal in 202 CBCT scanned images of healthy Malaysians were evaluated, and trifid mandibular canal (TMC) when present, were recorded and studied in detail by categorizing them to a new classification (comprising of 12 types). The diameter and length of canals were also measured, and their shape determined. RESULTS TMC were observed in 12 (5.9%) subjects or 16 (4.0%) hemi-mandibles. There were 10 obvious categories out the 12 types of TMCs listed. All TMCs (except one) were observed in older than 30 years. The prevalence according to ethnicity is 6 in Malays, 5 in Chinese and 1 in Indian. Four (33.3%) patients had bilateral TMCs, which was not seen in any Indian subject. More than half (56.3%) of the accessory canals were located above the main MC. Their mean diameter was 1.32mm and 1.26mm for the first and second accessory canal, and the corresponding lengths were 20.42mm and 21.60mm, respectively. Most canals (62.5%) had irregularly shaped lumen; there were more irregularly shaped canals in the second accessory canal than the first branch. None of the second accessory canal was oval (in shape). CONCLUSIONS This new classification can be applied for the variations in the branching pattern, length and shape of TMCs for better clinical description.
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Affiliation(s)
- S Y A Al-Siweedi
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - W C Ngeow
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - P Nambiar
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia.,Faculty of Dentistry, MAHSA University, Jln SP 2, Bandar Saujana Putra, 42610 Jenjarum, Selangor, Malaysia
| | - M I Abu-Hassan
- Centre of Studies for Restorative Dentistry, Faculty of Dentistry, Universiti Teknologi MARA, Sg Buloh 47000 Malaysia
| | - R Ahmad
- Centre of Studies for Restorative Dentistry, Faculty of Dentistry, Universiti Teknologi MARA, Sg Buloh 47000 Malaysia
| | - M K Asif
- Department of Research and Forensic Odontology, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - W L Chai
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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O'Flaherty N, Moloney K, Ahmad R, Laird E, Hughes C, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. 135 VITAMIN D FORTIFIED MILK—EFFECT ON VITAMIN D STATUS IN OLDER ADULTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.135] [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: 02/25/2023] Open
Abstract
Abstract
Background
Vitamin D fortified milk is used by some older adults to boost vitamin D status. Combined vitamin D/calcium supplements often cause gastrointestinal upset which reduces adherence. Consumption of fortified milk may be a more consistent and reliable way of increasing serum 25 hydroxyvitamin D [25(OH)D], though studies of it’s efficacy in older adults are limited.
Methods
We examined the vitamin D status of users of vitamin D fortified milk in participants of a longitudinal study of community dwelling Irish adults aged >60 yrs. Patients taking vitamin D supplements were excluded and independent effects were explored in multinomial regression models. Vitamin D deficiency was defined as a 25(OH)D level < 30 nmol/l.
Results
2496 participants were identified: mean age was 70.5 ± 7.0 years (range 60–96 yrs) and 145 (5.8%) reported using vitamin D fortified milk. In those who consumed fortified milk, there was a lower prevalence of vitamin D deficiency (17.9 vs 34.5%, P < 0.001). Vitamin D fortified milk also predicted less deficiency after adjusting for age, gender, season, BMI and physical frailty (OR 0.30. CI 0.19–0.48, P < 0.001).
Conclusion
Vitamin D fortified milk was associated with a 70% reduction in the risk of vitamin D deficiency in older adults not taking vitamin D supplements. Findings support the use of vitamin D fortified milk as an effective means of improving vitamin D status. Fortified milk also contains additional calcium and so can be used to augment daily calcium intake.
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Affiliation(s)
- N O'Flaherty
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - K Moloney
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - R Ahmad
- MedEl Directorate, St James's Hospital , Dublin, Ireland
| | - E Laird
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A M Molloy
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Cunningham
- MedEl Directorate, St James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
| | - K McCarroll
- MedEl Directorate, St James's Hospital , Dublin, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital , Dublin, Ireland
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15
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Moloney K, O'Flaherty N, Ahmad R, Laird E, Hughes C, McNulty H, Ward M, Strain JJ, Molloy AM, Cunningham C, McCarroll K. 130 PREDICTORS OF DRIVING STATUS IN OLDER IRISH ADULTS ATTENDING A GERIATRIC OUTPATIENT SERVICE. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.130] [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: 02/25/2023] Open
Abstract
Abstract
Background
The main mode of transportation in Ireland remains travel by car. Transport mobility is important for older adults in accessing shops, healthcare, services, community and in maintaining relationships. Cessation of driving is associated with negative effects on mental health, loneliness and physical health. We aimed to explore factors associated with driving status in older adults living in an urban environment.
Methods
Study included adults aged greater than 65 years attending a geriatric outpatient service in an urban environment and recruited as part of the TUDA (Trinity Ulster, Department of Agriculture) study. We excluded those with a MMSE (Mini-Mental State Exam) less than 24 as we aimed to include only non-dementia patients. Physical frailty was measured with the Timed Up and Go (TUG) and depression with the Center for Epidemiological Studies Depression scale (CES-D). Factors associated with driving status were explored in multinomial regression models.
Results
1978 adults, mean age 77.7 ± 7.1 years, 76.0% were female. 35.5% were current drivers but this differed by age category 45.9% (65–75 years), 25% (75–85 years) and 12.5% (85+ years). 28.1% were past drivers. Positive independent predictors of current driving were younger age (P < 0.001), male gender (P < 0.001), married status (P = 0.01), higher socioeconomic status (P < 0.0001) while negative predictors included physical frailty (TUG, P < 0.001), visual impairment (P = 0.01), stroke (P < 0.001), depression (P < 0.001) and self reported loneliness (P = 0.01).
Conclusion
One third of patients attending a geriatric outpatients in an urban environment were currently driving which is much lower than in the general older Irish population. However, our study included frail adults living in more deprived socioeconomic areas and had a high proportion of females who had never learned to drive. Furthermore, access to urban public transport may be a factor. Non-drivers were more likely to have depression and report loneliness independent of other factors highlighting its negative impact.
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Affiliation(s)
- K Moloney
- MedEL Directorate, St James's Hospital , Dublin, Ireland
| | - N O'Flaherty
- MedEL Directorate, St James's Hospital , Dublin, Ireland
| | - R Ahmad
- MedEL Directorate, St James's Hospital , Dublin, Ireland
| | - E Laird
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Hughes
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - H McNulty
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - M Ward
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - J J Strain
- The Nutrition Innovation Centre for Food and Health (NICHE) , School of Biomedical Sciences, , Coleraine, United Kingdom
- Ulster University , School of Biomedical Sciences, , Coleraine, United Kingdom
| | - A M Molloy
- School of Medicine, Trinity College Dublin , Dublin, Ireland
| | - C Cunningham
- MedEL Directorate, St James's Hospital , Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
| | - K McCarroll
- MedEL Directorate, St James's Hospital , Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital , Dublin, Ireland
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16
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Abd. Rahni AA, Mustaza SM, Mokri SS, Azmi NA, Ahmad R, Ramli R, Wan Abdul Rahman WN. Design of a 3D Printed Respiratory Motion Thoracic Phantom. 2021 IEEE Nuclear Science Symposium and Medical Imaging Conference (NSS/MIC) 2021. [DOI: 10.1109/nss/mic44867.2021.9875875] [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: 09/02/2023]
Affiliation(s)
| | | | | | | | - R. Ahmad
- Universiti Kebangsaan Malaysia,Malaysia
| | - R. Ramli
- Universiti Kebangsaan Malaysia,Malaysia
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17
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Mohd Amin AT, Mokri SS, Ahmad R, Rahni AAA. Evaluation of Data Driven Respiratory Signal Extraction Methods from Cone-Beam CT using MR-based Digital Phantoms. 2021 IEEE Nuclear Science Symposium and Medical Imaging Conference (NSS/MIC) 2021. [DOI: 10.1109/nss/mic44867.2021.9875497] [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: 09/02/2023]
Affiliation(s)
| | | | - R. Ahmad
- Universiti Kebangsaan Malaysia,Malaysia
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18
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Gil K, Zareba KM, Rajpal S, Simonetti OP, Addison D, Bhatti S, Chen C, Ahmad R, Tong MS. Rapid cardiovascular magnetic resonance protocol utilizing compressed sensing real-time imaging during the COVID-19 pandemic. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344820 DOI: 10.1093/ehjci/jeab090.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Coronavirus Disease 2019 (COVID-19) poses many workflow challenges for healthcare systems. Elective cardiovascular magnetic resonance (CMR) exams were postponed until safety protocols were instituted. Since reopening, imaging labs are managing COVID-19 safety triaging, exam backlog, and increased referrals, thus innovative solutions for process improvement are needed.
Purpose
An accelerated compressed sensing (CS) real-time (RT) technique offers dynamic cardiac imaging with high spatial and temporal resolution without image degradation. We sought to evaluate the efficiency of a rapid RT CMR protocol with a goal to decrease scan time without compromising study quality and comprehensiveness.
Methods
We retrospectively evaluated 219 CMRs (Siemens Magnetom Sola 1.5T) performed 09/01/2020 - 10/15/2020. After excluding 81 exams due to heterogeneous protocols (Figure 1), we analyzed 138 CMR exams using standard cardiomyopathy or myocarditis protocols. CMR studies utilized either a rapid RT short axis (SAX) cine (spatial resolution of 2.5 mm2 or better and temporal resolution of 55 ms or better) or standard breath-held (BH) SAX cine protocol (Figure 2). Protocols were chosen by the interpreting physician. Previous internal quality control demonstrated similar volumetric quantification between RT and BH SAX cines. RT cines were reconstructed inline using a CS-based method. We analyzed the length of time needed to complete each protocol and the number of series performed. Statistical analysis included student t-test with p value <0.05 considered significant.
Results
Of 138 analyzed CMR exams, there were 23 rapid protocols and 115 standard protocols performed. The mean image acquisition time for the rapid protocol was significantly shorter at 26 ± 6 minutes (range 18-44 min) vs 33 ± 6 minutes (range 22-49 min) for the standard protocol, p < 0.001. This represents a mean relative reduction in scan time of 21%. More time was saved in rapid myocarditis (scan time 25 ± 6 min vs 34 ± 6 min, p = 0.01; relative time reduction 26%) vs rapid cardiomyopathy protocols (scan time 27 ± 6 min vs 31 ± 6 min, p = 0.04; relative time reduction 13%). There was no significant difference in the number of series performed (62 ± 14 series in rapid vs 67 ± 11 series in standard protocols, p = 0.09). T1 and T2 maps constituted the same percentage of acquired images regardless of protocol used (T1 maps 1.8% vs 1.7% for cardiomyopathy, 1.4% vs 1.4% for myocarditis in standard vs rapid protocols respectively; T2 maps 1.8% vs 1.7% for cardiomyopathy, 5.6% vs 5.8% for myocarditis in standard vs rapid protocols respectively).
Conclusions
A rapid CMR protocol utilizing a CS-based RT imaging is significantly shorter as compared to the standard protocol with adequate diagnostic quality. Rapid CMR protocols are an effective tool for process improvement during the COVID-19 pandemic.
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Affiliation(s)
- K Gil
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - KM Zareba
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - S Rajpal
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - OP Simonetti
- Davis Heart & Lung Research Institute, Columbus, United States of America
| | - D Addison
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - S Bhatti
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - C Chen
- The Ohio State University, Biomedical Engineering, Columbus, United States of America
| | - R Ahmad
- Davis Heart & Lung Research Institute, Columbus, United States of America
| | - MS Tong
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
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19
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Taylor S, Lim P, Ahmad R, Alhadi A, Harris W, Rompokos V, D'Souza D, Gaze M, Gains J, Veiga C. Risk of radiation-induced second malignant neoplasms from photon and proton radiotherapy in paediatric abdominal neuroblastoma. Phys Imaging Radiat Oncol 2021; 19:45-52. [PMID: 34307918 PMCID: PMC8295851 DOI: 10.1016/j.phro.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/28/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND PURPOSE State-of-the-art radiotherapy modalities have the potential of reducing late effects of treatment in childhood cancer survivors. Our aim was to investigate the carcinogenic risk associated with 3D conformal (photon) radiation (3D-CRT), intensity modulated arc therapy (IMAT) and pencil beam scanning proton therapy (PBS-PT) in the treatment of paediatric abdominal neuroblastoma. MATERIALS AND METHODS The risk of radiation-induced second malignant neoplasm (SMN) was estimated using the concept of organ equivalent dose (OED) for eleven organs (lungs, rectum, colon, stomach, small intestine, liver, bladder, skin, central nervous system (CNS), bone, and soft tissues). The risk ratio (RR) between radiotherapy modalities and lifetime absolute risks (LAR) were reported for twenty abdominal neuroblastoma patients (median, 4y; range, 1-9y) historically treated with 3D-CRT that were also retrospectively replanned for IMAT and PBS-PT. RESULTS The risk of SMN due to primary radiation was reduced in PBS-PT against 3D-CRT and IMAT for most patients and organs. The RR across all organs ranged from 0.38 ± 0.22 (bladder) to 0.98 ± 0.04 (CNS) between PBS-PT and IMAT, and 0.12 ± 0.06 (rectum and bladder) to 1.06 ± 0.43 (bone) between PBS-PT and 3D-CRT. The LAR for most organs was within 0.01-1% (except the colon) with a cumulative risk of 21 ± 13%, 35 ± 14% and 35 ± 16% for PBS-PT, IMAT and 3D-CRT, respectively. CONCLUSIONS PBS-PT was associated with the lowest risk of radiation-induced SMN compared to IMAT and 3D-CRT in abdominal neuroblastoma treatment. Other clinical endpoints and plan robustness should also be considered for optimal plan selection.
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Affiliation(s)
- Sophie Taylor
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Pei Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Reem Ahmad
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Ammar Alhadi
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - William Harris
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vasilis Rompokos
- Radiotherapy Physics Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Derek D'Souza
- Radiotherapy Physics Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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20
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Veiga C, Lim P, Anaya VM, Chandy E, Ahmad R, D'Souza D, Gaze M, Moinuddin S, Gains J. Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer. Phys Med Biol 2021; 66. [PMID: 33735848 PMCID: PMC8112163 DOI: 10.1088/1361-6560/abf010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/18/2021] [Indexed: 11/12/2022]
Abstract
Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas construction and spatial normalisation in paediatric radiotherapy. We used planning computed tomography (CT) scans from twenty paediatric patients historically treated with craniospinal irradiation to generate a template CT that is suitable for spatial normalisation. This childhood cancer population representative template was constructed using groupwise image registration. An independent set of 53 subjects from a variety of childhood malignancies was then used to assess the quality of the propagation of new subjects to this common reference space using deformable image registration (i.e. spatial normalisation). The method was evaluated in terms of overall image similarity metrics, contour similarity and preservation of dose-volume properties. After spatial normalisation, we report a dice similarity coefficient of 0.95 ± 0.05, 0.85 ± 0.04, 0.96 ± 0.01, 0.91 ± 0.03, 0.83 ± 0.06 and 0.65 ± 0.16 for brain and spinal canal, ocular globes, lungs, liver, kidneys and bladder. We then demonstrated the potential advantages of an atlas-based approach to study the risk of second malignant neoplasms after radiotherapy. Our findings indicate satisfactory mapping between a heterogeneous group of patients and the template CT. The poorest performance was for organs in the abdominal and pelvic region, likely due to respiratory and physiological motion and to the highly deformable nature of abdominal organs. More specialised algorithms should be explored in the future to improve mapping in these regions. This study is the first step toward voxel-based analysis in radiation-induced toxicities following paediatric radiotherapy.
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Affiliation(s)
- Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Pei Lim
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Virginia Marin Anaya
- Radiotherapy Physics Services, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Edward Chandy
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,UCL Cancer Institute, University College London, London, United Kingdom
| | - Reem Ahmad
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Derek D'Souza
- Radiotherapy Physics Services, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Gaze
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Jennifer Gains
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
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21
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Chanchlani R, Jangid M, Ahmad R, Sharma P. Pediatric Ovarian Torsion: A Diagnostic Challenge in COVID-19 Times. Kathmandu Univ Med J (KUMJ) 2021; 18:120-123. [PMID: 33605255] [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: 06/12/2023]
Abstract
Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary.
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Affiliation(s)
- R Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - M Jangid
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - R Ahmad
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, India
| | - P Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, India
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Zhu N, Sánchez EC, Zhen X, Holmes A, Ahmad R. Addressing antimicrobial resistance in China: progress and challenges in translating political commitment into national action. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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23
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Jadeja N, Zhu NJ, Lebcir R, Sassi F, Ahmad R. Optimising policy analysis for AMR: A review of the capability of system dynamics for economic evaluation. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Nguyen HGT, Sims CM, Toman B, Horn J, van Zee RD, Thommes M, Ahmad R, Denayer JFM, Baron GV, Napolitano E, Bielewski M, Mangano E, Brandani S, Broom DP, Benham MJ, Dailly A, Dreisbach F, Edubilli S, Gumma S, Möllmer J, Lange M, Tian M, Mays TJ, Shigeoka T, Yamakita S, Hakuman M, Nakada Y, Nakai K, Hwang J, Pini R, Jiang H, Ebner AD, Nicholson MA, Ritter JA, Farrando-Pérez J, Cuadrado-Collados C, Silvestre-Albero J, Tampaxis C, Steriotis T, Řimnáčová D, Švábová M, Vorokhta M, Wang H, Bovens E, Heymans N, De Weireld G. A reference high-pressure CH4 adsorption isotherm for zeolite Y: results of an interlaboratory study. ADSORPTION 2020. [DOI: 10.1007/s10450-020-00253-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThis paper reports the results of an international interlaboratory study led by the National Institute of Standards and Technology (NIST) on the measurement of high-pressure surface excess methane adsorption isotherms on NIST Reference Material RM 8850 (Zeolite Y), at 25 °C up to 7.5 MPa. Twenty laboratories participated in the study and contributed over one-hundred adsorption isotherms of methane on Zeolite Y. From these data, an empirical reference equation was determined, along with a 95% uncertainty interval (Uk=2). By requiring participants to replicate a high-pressure reference isotherm for carbon dioxide adsorption on NIST Reference Material RM 8852 (ZSM-5), this interlaboratory study also demonstrated the usefulness of reference isotherms in evaluating the performance of high-pressure adsorption experiments.
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25
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Peiffer-Smadja N, Poda A, Ouedraogo AS, Delory T, Le bel J, Bouvet E, Lariven S, Jeanmougin P, Ahmad R, Lescure FX. Comment mettre en place un système d’aide à la décision antibiotique en soins primaires en Afrique de l’Ouest ? Une étude préimplantatoire. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Chelladurai G, Noor Azhar AM, Mohd Isa R, Bustam A, Ahmad R, Munisamy M. Improving cardiopulmonary resuscitation (CPR) performance using an audio-visual feedback device for healthcare providers in an emergency department setting in Malaysia: a quasi-experimental study. Med J Malaysia 2020; 75:514-518. [PMID: 32918419] [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: 06/11/2023]
Abstract
INTRODUCTION Cardiopulmonary Resuscitation (CPR) remains the primary mechanism of resuscitation for cardiac arrest victims. However, the quality of delivery of CPR varies widely in different settings, possibly affecting patient outcomes. This study is aimed to determine the efficacy of an audio-visual (AV) CPR feedback device in improving the quality of CPR delivered by healthcare providers. METHODS This pre-post, single-arm, quasi-experimental study randomly sampled 140 healthcare providers working in the Emergency Department of Hospital Ampang, Malaysia. Parameters of CPR quality, namely chest compression rate and depth were compared among participants when they performed CPR with and without an AV CPR feedback device. The efficacy of the AV CPR feedback device was assessed using the Chi-square test and Generalised Estimating Equations (GEE) models. RESULTS The use of an AV CPR feedback device increased the proportion of healthcare providers achieving recommended depth of chest compressions from 38.6% (95% Confidence Interval, 95%CI: 30.5, 47.2) to 85.0% (95%CI: 78.0, 90.5). A similar significant improvement from 39.3% (95%CI: 31.1, 47.9) to 86.4% (95%CI: 79.6, 91.6) in the recommended rate of chest compressions was also observed. Use of the AV CPR device significantly increased the likelihood of a CPR provider achieving recommended depth of chest compressions (Odds Ratio, OR=13.01; 95%CI: 7.12, 24.01) and rate of chest compressions (OR=13.00; 95%CI: 7.21, 23.44). CONCLUSION The use of an AV CPR feedback device significantly improved the delivered rate and depth of chest compressions closer to American Heart Association (AHA) recommendations. Usage of such devices within real-life settings may help in improving the quality of CPR for patients receiving CPR.
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Affiliation(s)
| | - A M Noor Azhar
- University of Malaya Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia
| | | | - A Bustam
- University of Malaya Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia
| | - R Ahmad
- University of Malaya Medical Centre, Department of Emergency Medicine, Kuala Lumpur, Malaysia
| | - M Munisamy
- Chulalongkorn University, College of Public Health Sciences, Bangkok, Thailand.
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Veepanattu P, Singh S, Mendelson M, Nampoothiri V, Edathadatil F, Surendran S, Bonaconsa C, Mbamalu O, Ahuja S, Birgand G, Tarrant C, Sevdalis N, Ahmad R, Castro-Sanchez E, Holmes A, Charani E. Building resilient and responsive research collaborations to tackle antimicrobial resistance-Lessons learnt from India, South Africa, and UK. Int J Infect Dis 2020; 100:278-282. [PMID: 32860949 PMCID: PMC7449941 DOI: 10.1016/j.ijid.2020.08.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022] Open
Abstract
Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.
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Affiliation(s)
- P Veepanattu
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - S Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - V Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - F Edathadatil
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - S Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - C Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - O Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Ahuja
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - G Birgand
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - C Tarrant
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - R Ahmad
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Division of Health Sciences, City University, London, UK
| | - E Castro-Sanchez
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK; Division of Health Sciences, City University, London, UK
| | - A Holmes
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK
| | - E Charani
- NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, UK.
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Charani E, Ahmad R, Rawson TM, Castro-Sanchèz E, Tarrant C, Holmes AH. The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics. Clin Infect Dis 2020; 69:12-20. [PMID: 30445453 PMCID: PMC6579961 DOI: 10.1093/cid/ciy844] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/28/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties. METHODS An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015-May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings. RESULTS In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use. CONCLUSIONS In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges.
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Affiliation(s)
- E Charani
- Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London
| | - R Ahmad
- Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London
| | - T M Rawson
- Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London
| | - E Castro-Sanchèz
- Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London
| | - C Tarrant
- Department of Health Sciences, University of Leicester, United Kingdom
| | - A H Holmes
- Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London
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Peiffer-Smadja N, Rawson TM, Ahmad R, Buchard A, Georgiou P, Lescure FX, Birgand G, Holmes AH. Corrigendum to 'machine learning for clinical decision support in infectious diseases: a narrative review of current applications' clinical microbiology and infection (2020) 584-595. Clin Microbiol Infect 2020; 26:1118. [PMID: 32450256 DOI: 10.1016/j.cmi.2020.05.020] [Citation(s) in RCA: 5] [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: 11/17/2022]
Affiliation(s)
- N Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR, 1137, University Paris Diderot, Paris, France.
| | - T M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - R Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | - P Georgiou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - F-X Lescure
- French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR, 1137, University Paris Diderot, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hˆopitaux de Paris, Paris, France
| | - G Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - A H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Ahmed MA, Akram B, Ul Haq MA, Ahmad R, Ahmad M. The effect of gestational age on women's preference for quality goods. Niger J Clin Pract 2020; 23:503-509. [PMID: 32246657 DOI: 10.4103/njcp.njcp_40_18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background It is a well-established fact that hormonal changes significantly influence the consumer behaviors and their purchase intentions. However, attention to the conspicuous buying due to the mood swings, as a result of hormonal changes, during the pregnancy have been largely ignored in the literature. Aims The current research aims to examine the prospective association of conspicuous purchase intentions with hormonal changes and mood swings during the pregnancy. Methods An experimental procedure was used to assess the data collected from pregnant women (n = 116) and the hypotheses were analyzed using recall probability and recall position measures. Results The hormonal changes during the pregnancy were analyzed in three stages known as pregnancy trimesters suggested by the relevant literature (Trimester-1 = 39, Trimister-2 = 36 and Trimester-3 = 41). The respondents were exposed to visual attention of specifically designed images with a unique combination of the status and functional products. The ROC values for Trimester 2 is higher in all 4 graphs (0.923, 0.960, 0.892, and 0.923) respectively than Trimester 1 and 3. Conclusion Findings revealed that the women purchase preferences shift as pregnancy move from one trimester to another. Women pay more attention to status products during the 2nd trimester as compared to 1st and 3rd trimesters of pregnancy.
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Affiliation(s)
- M A Ahmed
- Department of Management Sciences, University of Gujrat, Sialkot, Pakistan
| | - B Akram
- Department of Psychology, University of Gujrat, Sialkot, Pakistan
| | - M Anwar Ul Haq
- Department of Management Sciences, University of Gujrat, Sialkot, Pakistan
| | - R Ahmad
- Department of Gynecology, Sialkot Medical College, Sialkot, Pakistan
| | - M Ahmad
- Department of Management Sciences, University of Gujrat, Sialkot, Pakistan
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Ahmad R, Schettino G, Royle G, Barry M, Pankhurst QA, Tillement O, Russell B, Ricketts K. Radiobiological Implications of Nanoparticles Following Radiation Treatment. Part Part Syst Charact 2020; 37:1900411. [PMID: 34526737 PMCID: PMC8427468 DOI: 10.1002/ppsc.201900411] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/11/2020] [Indexed: 06/13/2023]
Abstract
Materials with a high atomic number (Z) are shown to cause an increase in the level of cell kill by ionizing radiation when introduced into tumor cells. This study uses in vitro experiments to investigate the differences in radiosensitization between two cell lines (MCF-7 and U87) and three commercially available nanoparticles (gold, gadolinium, and iron oxide) irradiated by 6 MV X-rays. To assess cell survival, clonogenic assays are carried out for all variables considered, with a concentration of 0.5 mg mL-1 for each nanoparticle material used. This study demonstrates differences in cell survival between nanoparticles and cell line. U87 shows the greatest enhancement with gadolinium nanoparticles (2.02 ± 0.36), whereas MCF-7 cells have higher enhancement with gold nanoparticles (1.74 ± 0.08). Mass spectrometry, however, shows highest elemental uptake with iron oxide and U87 cells with 4.95 ± 0.82 pg of iron oxide per cell. A complex relationship between cellular elemental uptake is demonstrated, highlighting an inverse correlation with the enhancement, but a positive relation with DNA damage when comparing the same nanoparticle between the two cell lines.
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Affiliation(s)
- Reem Ahmad
- Division of Surgery and Interventional ScienceUniversity College LondonCharles Bell House, 43–45 Foley StreetLondonW1W 7JNUK
- Medical Radiation Science GroupNational Physical LaboratoryHampton RoadTeddingtonMiddlesexTW11 0LWUK
- Department of Medical Physics and BioengineeringUniversity College LondonMalet Place Engineering Building, Gower StreetLondonWC1E 6BTUK
| | - Giuseppe Schettino
- Medical Radiation Science GroupNational Physical LaboratoryHampton RoadTeddingtonMiddlesexTW11 0LWUK
- Radiation and Medical Physics GroupFaculty of Engineering and Physical SciencesUniversity of Surrey388 Stag HillGuilfordGU2 7XHUK
| | - Gary Royle
- Department of Medical Physics and BioengineeringUniversity College LondonMalet Place Engineering Building, Gower StreetLondonWC1E 6BTUK
| | - Miriam Barry
- Medical Radiation Science GroupNational Physical LaboratoryHampton RoadTeddingtonMiddlesexTW11 0LWUK
| | - Quentin A. Pankhurst
- Healthcare Biomagnetics LaboratoryUniversity College London21 Albemarle StreetLondonW1S 4BSUK
| | - Olivier Tillement
- Institut Lumière MatièreUniversité Claude Bernard Lyon 1CNRS UMR 5306Villeurbanne69622France
| | - Ben Russell
- Nuclear Metrology GroupNational Physical LaboratoryHampton RoadTeddingtonMiddlesexTW11 0LWUK
| | - Kate Ricketts
- Division of Surgery and Interventional ScienceUniversity College LondonCharles Bell House, 43–45 Foley StreetLondonW1W 7JNUK
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Abidemi A, Abd Aziz M, Ahmad R. Vaccination and vector control effect on dengue virus transmission dynamics: Modelling and simulation. Chaos, Solitons & Fractals 2020; 133:109648. [DOI: 10.1016/j.chaos.2020.109648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Mohd Amin AT, Mokri SS, Ahmad R, Abd Rahni AA. Comparison of data-driven respiratory signal extraction methods from cone-beam CT (CBCT). J Phys : Conf Ser 2020; 1497:012004. [DOI: 10.1088/1742-6596/1497/1/012004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Abstract
In Cone-Beam CT (CBCT) imaging, respiratory motion needs to be considered to mitigate motion artifacts thus increasing the accuracy of reconstructed images. Data driven methods can be used to extract respiratory signal directly from projection data without requiring any additional equipment or surrogate devices. Digital phantoms provide an adequate option to evaluate developing methods prior to clinical implementation. In this study, four data driven methods are used to extract respiratory signal from simulated projections. An in-house 4D MRI-based CBCT digital phantom is used, where actual respiratory signal is available as ground truth. In comparing all four data driven methods, the respiratory signal extracted using the Local Principal Component Analysis (LPCA) method is found to be robust and yielded the highest correlation coefficient of 0.8644 compared to the ground truth.
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Beardsworth SF, Ahmad R, Terry E, Karim K. IntraperitonealInsulin: A Protocol for Administration during CAPD and Review of Published Protocols. Perit Dial Int 2020. [DOI: 10.1177/089686088800800208] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
For many diabetics in end-stage renal failure, the initial therapy they receive will be continuous ambulatory peritoneal dialysis (CAPD) together with i.p. insulin. To date, all published protocols rely on empirical dosages based upon predialysis insulin requirements. A practical regimen for the institution of i.p. insulin administration during CAPD is described. The only endpoints used to determine insulin dosage were fasting plasma glucose 5 to 10 mmol/L and 2 h postprandial plasma glucose 8 to 15 mmol/L. An initial protocol related to body weight, dextrose content, volume, and timing of dialysate was based on a retrospective analysis of the results in our first 10 patients. Subsequently, a prospective assessment in an additional 22 patients confirmed the effectiveness of the regimen. The following protocol is recommended for the institution of i.p. insulin therapy in patients undergoing CAPD: Preprandial exchanges 1.36% dextrose-0.175 U/L dialysate/kg body weight 3.86% dextrose-0.25 U/L/kg Overnight exchanges 1.36% dextrose-0.1 U/L/kg 3.86% dextrose-0.15 U/L/kg Further adjustment of insulin dosage is then made on the basis of four hourly plasma glucose profiles. Self-monitoring of capillary blood glucose is recommended.
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Affiliation(s)
| | - R. Ahmad
- Renal Unit, Sefton General Hospital, Liverpool, United Kingdom
| | - E. Terry
- Renal Unit, Sefton General Hospital, Liverpool, United Kingdom
| | - K. Karim
- Renal Unit, Sefton General Hospital, Liverpool, United Kingdom
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Affiliation(s)
| | - B. Parys
- MRAKR Research Fellow in Urology
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Affiliation(s)
- B.K. Pandya
- Regional Renal Unit Royal Liverpool University Hospitals NHS Trust Prescott Street Liverpool L7 8XP United Kingdom
| | - L. Marshall
- Regional Renal Unit Royal Liverpool University Hospitals NHS Trust Prescott Street Liverpool L7 8XP United Kingdom
| | - R. Ahmad
- Regional Renal Unit Royal Liverpool University Hospitals NHS Trust Prescott Street Liverpool L7 8XP United Kingdom
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Lim O, Yeoh B, Omar N, Mohamed M, Zin A, Ahmad R. Stingless Bee Propolis Alleviates Diabetic Cardiomyopathy: Antioxidative Modulation Through esRAGE-AGE Interaction. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Lim O, Yeoh B, Omar N, Mohamed M, Zin A, Ahmad R. Combination of Stingless Bee Propolis and Metformin Prevented Diabetic-induced Cardiac Hypertrophy by Reducing Lipid Peroxidation: An Interplay Between AGE and esRAGE in Heart and Plasma. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Peiffer-Smadja N, Rawson TM, Ahmad R, Buchard A, Georgiou P, Lescure FX, Birgand G, Holmes AH. Machine learning for clinical decision support in infectious diseases: a narrative review of current applications. Clin Microbiol Infect 2019; 26:584-595. [PMID: 31539636 DOI: 10.1016/j.cmi.2019.09.009] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [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: 06/27/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Machine learning (ML) is a growing field in medicine. This narrative review describes the current body of literature on ML for clinical decision support in infectious diseases (ID). OBJECTIVES We aim to inform clinicians about the use of ML for diagnosis, classification, outcome prediction and antimicrobial management in ID. SOURCES References for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, biorXiv, ACM Digital Library, arXiV and IEEE Xplore Digital Library up to July 2019. CONTENT We found 60 unique ML-clinical decision support systems (ML-CDSS) aiming to assist ID clinicians. Overall, 37 (62%) focused on bacterial infections, 10 (17%) on viral infections, nine (15%) on tuberculosis and four (7%) on any kind of infection. Among them, 20 (33%) addressed the diagnosis of infection, 18 (30%) the prediction, early detection or stratification of sepsis, 13 (22%) the prediction of treatment response, four (7%) the prediction of antibiotic resistance, three (5%) the choice of antibiotic regimen and two (3%) the choice of a combination antiretroviral therapy. The ML-CDSS were developed for intensive care units (n = 24, 40%), ID consultation (n = 15, 25%), medical or surgical wards (n = 13, 20%), emergency department (n = 4, 7%), primary care (n = 3, 5%) and antimicrobial stewardship (n = 1, 2%). Fifty-three ML-CDSS (88%) were developed using data from high-income countries and seven (12%) with data from low- and middle-income countries (LMIC). The evaluation of ML-CDSS was limited to measures of performance (e.g. sensitivity, specificity) for 57 ML-CDSS (95%) and included data in clinical practice for three (5%). IMPLICATIONS Considering comprehensive patient data from socioeconomically diverse healthcare settings, including primary care and LMICs, may improve the ability of ML-CDSS to suggest decisions adapted to various clinical contexts. Currents gaps identified in the evaluation of ML-CDSS must also be addressed in order to know the potential impact of such tools for clinicians and patients.
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Affiliation(s)
- N Peiffer-Smadja
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University Paris Diderot, Paris, France.
| | - T M Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - R Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | - P Georgiou
- Department of Electrical and Electronic Engineering, Imperial College, London, UK
| | - F-X Lescure
- French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University Paris Diderot, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - G Birgand
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - A H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
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Khan A, Rafique M, Afzal N, Khaliq Z, Ahmad R. Structural characterization of Zircaloy-4 subjected to helium ions irradiation of variable fluence. Nuclear Materials and Energy 2019. [DOI: 10.1016/j.nme.2019.100690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shmuylovich L, Paller A, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom W, Hedlund K, Ahmad R, Garcia-Romero M, Irfan M, Kollman K, Hunt R, Stein S, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennet H, Cordoro K, Bercovitch L, Chiu Y. 385 Patterning of linear morphea on the face and neck: Blaschkoid or not? J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Seecharan S, Seecharan S, Genese J, Arana C, Liggett A, Kulsum N, Ahmad R. Fall Risk Associated with Mechanical Lifts in Nursing Homes. J Am Med Dir Assoc 2019. [DOI: 10.1016/j.jamda.2019.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kaushal-Deep SM, Ahmad R, Lodhi M, Chana RS. A prospective study of evaluation of operative duration as a predictor of mortality in pediatric emergency surgery: Concept of 100 minutes laparotomy in resource-limited setting. J Postgrad Med 2018; 65:248492. [PMID: 30588925 PMCID: PMC6380133 DOI: 10.4103/jpgm.jpgm_52_18] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/16/2018] [Accepted: 03/26/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Operative duration is an important but under-studied predictor of mortality in emergency laparotomies. AIMS AND OBJECTIVES The primary objective of this study was to quantify the effect of duration of emergency laparotomy in children on mortality; and to identify a rough cut-off duration of laparotomy to serve as a guide so that a laparotomy can be planned to optimize pediatric surgical patient outcome. MATERIALS AND METHODS This is a prospective study conducted in a government tertiary teaching institution over a period of 24 months. All children in the age group of 5-10 years presenting in the emergency department with Pediatric Risk of Mortality III score ≤8, undergoing emergency laparotomy in emergency operation theater, were included. OBSERVATIONS AND RESULTS In all, 213 children were included in the study. The mean time from presentation to shifting to the operating room was 3.7 h. The mean operative duration was 108 min. The mean operative time in survived patients was 102 min as compared to 135 min in expired patients (P < 0.05). The 30-day in-hospital mortality rate was 17.4%. After application of binary logistic regression analysis, it was found that time to laparotomy and operative duration were significant risk factors (<0.05) predicting post-operative mortality. Kaplan-Meier survival curve showed a decrease at a mean weighted operative duration of approximately 100 min. Receiver operating characteristic curve analysis yielded operative duration of 123.5 min at which Youden's index maximized. CONCLUSION This 100-min duration of laparotomy might appear a long duration but in casualty setup of a government hospital with limited resources, there are so many hurdles for optimal working that completion of an emergency laparotomy in children in 100 min can be considered a realistic target for improving post-operative outcome. At an operative duration of <123.50 min, mortality rates within acceptable limits can be achieved.
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Affiliation(s)
- SM Kaushal-Deep
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - R Ahmad
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - M Lodhi
- Department of Anesthesia, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - RS Chana
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Ricketts K, Ahmad R, Beaton L, Cousins B, Critchley K, Davies M, Evans S, Fenuyi I, Gavriilidis A, Harmer QJ, Jayne D, Jefford M, Loizidou M, Macrobert A, Moorcroft S, Naasani I, Ong ZY, Prise KM, Rannard S, Richards T, Schettino G, Sharma RA, Tillement O, Wakefield G, Williams NR, Yaghini E, Royle G. Recommendations for clinical translation of nanoparticle-enhanced radiotherapy. Br J Radiol 2018; 91:20180325. [PMID: 30179039 PMCID: PMC6319829 DOI: 10.1259/bjr.20180325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023] Open
Abstract
A multi-disciplinary cooperative for nanoparticle-enhanced radiotherapy (NERT) has been formed to review the current status of the field and identify key stages towards translation. Supported by the Colorectal Cancer Healthcare Technologies Cooperative, the cooperative comprises a diverse cohort of key contributors along the translation pathway including academics of physics, cancer and radio-biology, chemistry, nanotechnology and clinical trials, clinicians, manufacturers, industry, standards laboratories, policy makers and patients. Our aim was to leverage our combined expertise to devise solutions towards a roadmap for translation and commercialisation of NERT, in order to focus research in the direction of clinical implementation, and streamline the critical pathway from basic science to the clinic. A recent meeting of the group identified barriers to and strategies for accelerated clinical translation. This commentary reports the cooperative's recommendations. Particular emphasis was given to more standardised and cohesive research methods, models and outputs, and reprioritised research drivers including patient quality of life following treatment. Nanoparticle design criteria were outlined to incorporate scalability of manufacture, understanding and optimisation of biological mechanisms of enhancement and in vivo fate of nanoparticles, as well as existing design criteria for physical and chemical enhancement. In addition, the group aims to establish a long-term and widespread international community to disseminate key findings and create a much-needed cohesive body of evidence necessary for commercial and clinical translation.
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Affiliation(s)
- Kate Ricketts
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Reem Ahmad
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Laura Beaton
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | - Brian Cousins
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Kevin Critchley
- School of Physics and Astronomy, University of Leeds, Leeds, UK
| | | | - Stephen Evans
- School of Physics and Astronomy, University of Leeds, Leeds, UK
| | - Ifeyemi Fenuyi
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | | | - David Jayne
- Leeds Institute of Clinical Sciences, St James’s University Hospital, Leeds, UK
| | | | - Marilena Loizidou
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alexander Macrobert
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Sam Moorcroft
- School of Physics and Astronomy, University of Leeds, Leeds, UK
| | | | | | - Kevin M Prise
- Centre for Cancer Research & Cell Biology, Queens University Belfast, Belfast, UK
| | - Steve Rannard
- Department of Chemistry and Materials Innovation Factory, University of Liverpool, Liverpool, UK
| | - Thomas Richards
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Schettino
- Medical Radiation Science Group, National Physical Laboratory, Teddington, UK
| | - Ricky A Sharma
- NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK
| | | | | | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Elnaz Yaghini
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Gary Royle
- Department of Medical Physics and Bioengineering, University College London, London, UK
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47
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Kyratsis Y, Ahmad R, Iwami M, Castro Sanchez E, Atun R, Holmes A. A multi-level analysis of infection control in English hospitals: coerced safety culture change. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.529] [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: 11/14/2022] Open
Affiliation(s)
| | - R Ahmad
- Imperial College London, London, UK
| | - M Iwami
- Imperial College London, London, UK
| | | | - R Atun
- Harvard University, Boston, USA
| | - A Holmes
- Imperial College London, London, UK
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48
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Abstract
We report a case of incarcerated left indirect inguinal hernia in a male child which on exploration revealed the presence of free air and fecal matter containing fluid in the hernial sac. This is the second reported case of the presence of cecal perforation in left Amyand's hernia in pediatric age group and unique in the sense of the form of abnormal anatomy encountered per-operatively.
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Affiliation(s)
- S M Kaushal-Deep
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - R Ahmad
- Department of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - M Lodhi
- Department of Anesthesia, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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49
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Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K, Kyratsis Y, Meads G, Otter JA, Holmes AH, Imanaka Y, Ahmad R. Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. J Hosp Infect 2018; 100:280-298. [PMID: 30369423 DOI: 10.1016/j.jhin.2018.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND National responses to healthcare-associated infections vary between high-income countries, but, when analysed for contextual comparability, interventions can be assessed for transferability. AIM To identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England. METHODS A longitudinal analysis (2000-2017), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: (a) type: mandatory requirements, recommendations, or national campaigns; (b) method: restrictive, persuasive, structural in nature; (c) level of implementation: macro (national), meso (organizational), micro (individual) levels. Healthcare organizational structures and role of media were also assessed. FINDINGS In England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multi-disciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public. CONCLUSION Policy interventions need to be relevant to local epidemiological trends, while acceptable within the health system, culture, and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and economic challenges.
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Affiliation(s)
- S Mizuno
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - M Iwami
- Division of Infectious Diseases, Imperial College London, London, UK
| | - S Kunisawa
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - N Naylor
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - K Yamashita
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - Y Kyratsis
- Health Services Research & Management Division, School of Health Sciences, City University of London, London, UK
| | - G Meads
- Health and Wellbeing Research Group, University of Winchester, Winchester, UK
| | - J A Otter
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - A H Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Y Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - R Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Health Group, Management Department, Imperial College Business School, London, UK.
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50
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Earl HM, Hiller L, Dunn JA, Blenkinsop C, Grybowicz L, Vallier AL, Gounaris I, Abraham JE, Hughes-Davies L, McAdam K, Chan S, Ahmad R, Hickish T, Rea D, Caldas C, Bartlett JMS, Cameron DA, Provenzano E, Thomas J, Hayward RL. Disease-free and overall survival at 3.5 years for neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin and cyclophosphamide, for women with HER2 negative early breast cancer: ARTemis Trial. Ann Oncol 2018; 28:1817-1824. [PMID: 28459938 PMCID: PMC5834079 DOI: 10.1093/annonc/mdx173] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The ARTemis trial previously reported that addition of neoadjuvant bevacizumab (Bev) to docetaxel (D) followed by fluorouracil, epirubicin and cyclophosphamide (D-FEC) in HER2 negative breast cancer improved the pathological complete response (pCR) rate. We present disease-free survival (DFS) and overall survival (OS) with central pathology review. Patients and methods Patients were randomized to 3 cycles of D followed by 3 cycles of FEC (D-FEC), ±4 cycles of Bev (Bev + D-FEC). DFS and OS were analyzed by treatment and by central pathology reviewed pCR and Residual Cancer Burden (RCB) class. Results A total of 800 patients were randomized [median follow-up 3.5 years (IQR 3.2–4.4)]. DFS and OS were similar across treatment arms [DFS hazard ratio (HR)=1.18 (95% CI 0.89–1.57), P = 0.25; OS HR = 1.26 (95% CI 0.90–1.76), P = 0.19). Both local pathology report review and central histopathology review confirmed a significant improvement in DFS and OS for patients who achieved a pCR [DFS HR = 0.38 (95% CI 0.23–0.63), P < 0.001; OS HR = 0.43 (95% CI 0.24–0.75), P = 0.003]. However, significant heterogeneity was observed (P = 0.02); larger improvements in DFS were obtained with a pCR achieved with D-FEC than a pCR achieved with Bev + D-FEC. As RCB class increased, significantly worse DFS and OS was observed (P for trend <0.0001), which effect was most marked in the ER negative group. Conclusions The addition of short course neoadjuvant Bev to standard chemotherapy did not demonstrate a DFS or OS benefit. Achieving a pCR with D-FEC is associated with improved DFS and OS but not when pCR is achieved with Bev + D-FEC. At the present time therefore, Bev is not recommended in early breast cancer. ClinicalTrials.gov number NCT01093235.
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Affiliation(s)
- H M Earl
- Department of Oncology, University of Cambridge, Cambridge.,NIHR Cambridge Biomedical Research Centre, Cambridge.,Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - L Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - C Blenkinsop
- Warwick Clinical Trials Unit, University of Warwick, Coventry
| | - L Grybowicz
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - A-L Vallier
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - I Gounaris
- Department of Oncology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn.,Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge
| | - J E Abraham
- Department of Oncology, University of Cambridge, Cambridge.,NIHR Cambridge Biomedical Research Centre, Cambridge.,Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - L Hughes-Davies
- Department of Oncology, University of Cambridge, Cambridge.,Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - K McAdam
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge.,Department of Oncology, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough
| | - S Chan
- Department of Oncology, Nottingham City Hospital, Nottingham
| | - R Ahmad
- Department of Oncology, West Middlesex University Hospital, Isleworth
| | - T Hickish
- Department of Oncology, Poole Hospital NHS Foundation Trust/Bournemouth University, Poole
| | - D Rea
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston, UK
| | - C Caldas
- Department of Oncology, University of Cambridge, Cambridge.,NIHR Cambridge Biomedical Research Centre, Cambridge.,Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge.,Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge
| | - J M S Bartlett
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Canada.,Cancer Research Centre, University of Edinburgh, IGMM, Western General Hospital, Edinburgh
| | - D A Cameron
- Cancer Research Centre, University of Edinburgh, IGMM, Western General Hospital, Edinburgh
| | - E Provenzano
- NIHR Cambridge Biomedical Research Centre, Cambridge.,Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - J Thomas
- Department of Pathology, University of Edinburgh, Edinburgh, UK
| | - R L Hayward
- Cancer Research Centre, University of Edinburgh, IGMM, Western General Hospital, Edinburgh
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