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Shah SK, Perez-Cardona L, Helner K, Massey SH, Premkumar A, Edwards R, Norton ES, Rogers CE, Miller ES, Smyser CD, Davis MM, Wakschlag LS. How penalizing substance use in pregnancy affects treatment and research: a qualitative examination of researchers' perspectives. J Law Biosci 2023; 10:lsad019. [PMID: 37435609 PMCID: PMC10332932 DOI: 10.1093/jlb/lsad019] [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] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
Introduction Laws regulating substance use in pregnancy are changing and may have unintended consequences on scientific efforts to address the opioid epidemic. Yet, how these laws affect care and research is poorly understood. Methods We conducted semi-structured qualitative interviews using purposive and snowball sampling of researchers who have engaged pregnant people experiencing substance use. We explored views on laws governing substance use in pregnancy and legal reform possibilities. Interviews were double coded. Data were examined using thematic analysis. Results We interviewed 22 researchers (response rate: 71 per cent) and identified four themes: (i) harms of punitive laws, (ii) negative legal impacts on research, (iii) proposals for legal reform, and (iv) activism over time. Discussion Researchers view laws penalizing substance use during pregnancy as failing to treat addiction as a disease and harming pregnant people and families. Respondents routinely made scientific compromises to protect participants. While some have successfully advocated for legal reform, ongoing advocacy is needed. Conclusion Adverse impacts from criminalizing substance use during pregnancy extend to research on this common and stigmatized problem. Rather than penalizing substance use in pregnancy, laws should approach addiction as a medical issue and support scientific efforts to improve outcomes for affected families.
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Affiliation(s)
| | - Leishla Perez-Cardona
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Khrystyna Helner
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Suena H Massey
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashish Premkumar
- Department of Obstetrics & Gynecology, Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
| | - Renee Edwards
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Elizabeth S Norton
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Cynthia E Rogers
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Division of Maternal Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics, and Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Matthew M Davis
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
| | - Lauren S Wakschlag
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, USA
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Sohn SY, Russell CD, Jamjoom AAB, Poon MT, Lawson McLean A, Ahmed AI, Abdulla MAH, Alalade A, Bailey M, Basu S, Baudracco I, Bayston R, Bhattacharya A, Bodkin P, Boissaud-Cooke M, Bojanic S, Brennan PM, Bulters DO, Buxton N, Chari A, Corns R, Coulter C, Coulter I, Critchley G, Dando A, Dardis R, Duddy J, Dyson E, Edwards R, Garnett M, Gatcher S, Georges H, Glancz LJ, Gray WP, Hallet J, Harte J, Haylock-Vize P, Hutchinson PJ, Humphreys H, Jenkinson MD, Joannides AJ, Kandasamy J, Kitchen J, Kolias AG, Loan JJM, Ma R, Madder H, Mallucci CL, Manning A, Mcelligott S, Mukerji N, Narayanamurthy H, O’Brien D, Okasha M, Papadopoulos M, Phan V, Phang I, Poots J, Rajaraman C, Roach J, Ross N, Sharouf F, Shastin D, Simms N, Steele L, Solth A, Tajsic T, Talibi S, Thanabalasundaram G, Vintu M, Wan Y, Wang D, Watkins L, Whitehouse K, Whitfield PC, Williams A, Zaben M. Comparison of suspected and confirmed internal EVD-related infections: a prospective multi-centre U.K. observational study. Open Forum Infect Dis 2022; 9:ofac480. [PMID: 36267249 PMCID: PMC9578167 DOI: 10.1093/ofid/ofac480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Diagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI. Methods Data on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion. Results Internal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range {IQR}, 7–24.5] for confirmed cases and 9.5 days [IQR, 5.75–14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes. Conclusions Suspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship.
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Affiliation(s)
- Sei Yon Sohn
- Division of Anaesthesia, University of Cambridge , Cambridge , U.K
| | - Clark D Russell
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute , Edinburgh , U.K
| | - Aimun AB Jamjoom
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , U.K
| | - Michael T Poon
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , U.K
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena , Jena , Germany
| | - Aminul I Ahmed
- Wolfson CARD, King’s College London and Department of Neurosurgery, King’s College Hospital , London , U.K
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3
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MacNeill LA, Krogh‐Jespersen S, Zhang Y, Giase G, Edwards R, Petitclerc A, Mithal LB, Mestan K, Grobman WA, Norton ES, Alshurafa N, Moskowitz JT, Tandon SD, Wakschlag LS. Lability of prenatal stress during the COVID-19 pandemic links to negative affect in infancy. Infancy 2022; 28:136-157. [PMID: 36070207 PMCID: PMC9538880 DOI: 10.1111/infa.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/01/2022] [Accepted: 07/30/2022] [Indexed: 01/19/2023]
Abstract
The association between prenatal stress and children's socioemotional development is well established. The COVID-19 pandemic has been a particularly stressful period, which may impact the gestational environment. However, most studies to-date have examined prenatal stress at a single time point, potentially masking the natural variation in stress that occurs over time, especially during a time as uncertain as the pandemic. This study leveraged dense ecological momentary assessments from a prenatal randomized control trial to examine patterns of prenatal stress over a 14-week period (up to four assessments/day) in a U.S. sample of 72 mothers and infants. We first examined whether varied features of stress exposure (lability, mean, and baseline stress) differed depending on whether mothers reported on their stress before or during the pandemic. We next examined which features of stress were associated with 3-month-old infants' negative affect. We did not find differences in stress patterns before and during the pandemic. However, greater stress lability, accounting for baseline and mean stress, was associated with higher infant negative affect. These findings suggest that pathways from prenatal stress exposure to infant socioemotional development are complex, and close attention to stress patterns over time will be important for explicating these pathways.
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Affiliation(s)
- Leigha A. MacNeill
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Sheila Krogh‐Jespersen
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Yudong Zhang
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Gina Giase
- Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Renee Edwards
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | | | - Leena B. Mithal
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Ann & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Karen Mestan
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Ann & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - William A. Grobman
- Department of Obstetrics and GynecologyThe Ohio State UniversityColumbusOhioUSA
| | - Elizabeth S. Norton
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA,Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonIllinoisUSA
| | - Nabil Alshurafa
- Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA,Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Judith T. Moskowitz
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - S. Darius Tandon
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Lauren S. Wakschlag
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Institute for Innovations in Developmental SciencesNorthwestern UniversityChicagoIllinoisUSA
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Pifer P, Jaishankar S, Bhargava R, Keller A, Musunuru H, Cohen M, Sukumvanich P, Courtney-Brooks M, Boisen M, Berger J, Taylor S, Olawaiye A, Lesnock J, Edwards R, Vargo J, Beriwal S. PD-0913 Is substantial LVSI prognostic in patients with pathological lymph node-negative endometrial cancer? Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02992-9] [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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5
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Jaishankar S, Pifer PM, Bhargava R, Keller A, Musunuru HB, Patel AK, Sukumvanich P, Boisen M, Berger JL, Taylor S, Courtney-Brooks M, Olawaiye A, Lesnock J, Edwards R, Vargo JA, Beriwal S. Is Substantial Lymphovascular Space Invasion Prognostic for Clinical Outcomes in Type II Endometrial Cancer? Clin Oncol (R Coll Radiol) 2022; 34:452-458. [PMID: 35264314 DOI: 10.1016/j.clon.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
Abstract
AIMS Substantial lymphovascular space invasion (LVSI) compared with none or focal LVSI is predictive of lymph node involvement and worse clinical outcomes in endometrioid-type endometrial carcinoma. We aimed to quantify the incidence of substantial LVSI in type II (clear cell and serous) endometrial cancer and correlate the extent of LVSI with clinical outcomes. MATERIALS AND METHODS A retrospective review was conducted on type II endometrial cancer patients who underwent surgical management from July 2017 to December 2019 using the three-tier LVSI scoring system. Binary logistic regression and Cox regression were used to analyse predictors of lymph node involvement or survival outcomes, respectively. The Kaplan-Meier method and Log-rank test were used to analyse differences in locoregional disease-free survival (LR-DFS), distant metastasis disease-free survival (DM-DFS) and overall survival between patients with substantial versus none/focal LVSI. RESULTS In 79 patients with type II endometrial carcinoma, no LVSI, focal LVSI and substantial LVSI was present in 48.1%, 15.2% and 36.7% of patients, respectively. Lymph nodes were involved in 0.0% with no LVSI, 20.0% with focal LVSI and 60.0% with substantial LVSI (P < 0.001). The median follow-up was 22.2 months. In patients with none/focal versus substantial LVSI, the 2-year LR-DFS and DM-DFS rates were 91.5% versus 71.4% (P = 0.01) and 90.2% versus 63.8% (P = 0.005), respectively. On univariate analysis, myometrial invasion ≥50%, tumour size ≥3.6 cm, substantial versus none/focal LVSI, lymph node involvement and omission of adjuvant radiotherapy were significant predictors for worse LR-DFS and DM-DFS (P < 0.05). DISCUSSION Substantial LVSI has a high incidence in type II pathology at our institution and predicts for lymph node involvement and worse clinical outcomes.
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Affiliation(s)
- S Jaishankar
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - P M Pifer
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Bhargava
- Department of Pathology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - A Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - H B Musunuru
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - A K Patel
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - P Sukumvanich
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Boisen
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J L Berger
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - S Taylor
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Courtney-Brooks
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - A Olawaiye
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J Lesnock
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Edwards
- Department of Gynecologic Oncology, Magee-Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - J A Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - S Beriwal
- Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA; Varian Medical Systems, Charlottesville, VA, USA.
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Edwards R, Jones G, Pickford R, Mungin-Jenkins E, Lucas J. The Impact of a Pre-Operative Spinal Education (POSE) program on post-operative length of stay following spinal fusion surgery. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.268] [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: 10/19/2022]
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7
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Gorton HC, Macfarlane H, Edwards R, Farid S, Garner E, Mahroof M, Rasul S, Keating D, Zaman H, Scott J, Maidment I, Strawbridge J. UK and Ireland survey of MPharm student and staff experiences of mental health curricula, with a focus on Mental Health First Aid. J Pharm Policy Pract 2021; 14:73. [PMID: 34465394 PMCID: PMC8406829 DOI: 10.1186/s40545-021-00364-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background One in four people experience a mental health problem every year and improving mental health care is an international priority. In the course of their work, pharmacists frequently encounter people with mental health problems. The experience of mental health teaching, including Mental Health First Aid (MHFA) training, in undergraduate pharmacy (MPharm) students in the UK and Ireland is not well documented. Students’ viewpoints, contextualised with curricular overviews provided by staff, were analysed to understand their experience. Methods An anonymous, online questionnaire was distributed to MPharm students and staff in the UK and Ireland. Students were asked closed questions regarding their course and exposure to MHFA, which were analysed using descriptive statistics. Open questions were included to enable explanations and these data were used to contextualise the quantitative findings. One member of staff from each university was invited to answer a modified staff version of the questionnaire, to provide a curriculum overview and staff perspective. Results 232 students and 13 staff, from 22 universities, responded. Three-quarters of students did not agree with the statement that ‘mental health was embedded throughout the MPharm’. Most students (80.6%) stated that they were taught neuropharmacology whilst 44.8% stated that their course included communicating with people about their mental health. One-third (33.2%) of students stated that their degree ‘adequately prepared them to help people with their mental health’. Twenty-six students (11.6%) had completed MHFA training of which 89% would endorse inclusion of this within the MPharm. Of those who had not completed the training, 81% expressed a desire to do so. Those who completed MHFA training self-reported greater preparedness than those who did not, but student numbers were small. Conclusions Mental health teaching for pharmacy undergraduates is more focussed on theoretical aspects rather than applied skills. MHFA was viewed by students as one way to enhance skill application. The association of the increased self-reported preparedness of those who completed MHFA could be confounded by a positive environmental cultural. MPharm programmes need sufficient focus on real-world skills such as communication and crisis response, to complement the fundamental science. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00364-1.
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Affiliation(s)
- H C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK.
| | - H Macfarlane
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK.,Pharmacy Department, Secure and Complex Care, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - R Edwards
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - S Farid
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - E Garner
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - M Mahroof
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - S Rasul
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - D Keating
- Pharmacy Department, Saint John of God Hospital, Stillorgan, County Dublin, Ireland
| | - H Zaman
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - J Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - I Maidment
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J Strawbridge
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Keller A, Rodríguez-López J, Patel A, Kim H, Houser C, Sukumvanich P, Berger J, Boisen M, Edwards R, Taylor S, Courtney-Brooks M, Olawaiye A, Orr B, Beriwal S. PO-0178 Feasibility and Outcomes for Cervical Cancer Patients Treated with Hybrid Brachytherapy Applicators. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Gorton HC, Macfarlane H, Edwards R, Farid S, Garner E, Mahroof M, Rasul S, Keating D, Zaman H, Scott J, Maidment I, Strawbridge J. Mental health curricula and Mental Health First Aid in the MPharm. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Improving mental health care is an international priority, and one that is championed by the Royal Pharmaceutical Society. (1) In the course of their work, pharmacists frequently encounter people with mental health problems. The extent to which mental health is taught on the undergraduate pharmacy degree in the UK and Ireland, and the inclusion of Mental Health First Aid (MHFA) training, has not be described recently.
Aim
We aimed to determine how mental health teaching is embedded into the MPharm and students’ perception of their own preparedness to help people with their mental health. We explored if and how MHFA training is included, and students’ experience of, or desire to complete this.
Methods
We conducted an anonymous, online questionnaire of UK and Ireland MPharm students, distributed via networks and social media. Students were asked a series of closed questions about mental health teaching in the MPharm, and exposure to MHFA. We analysed answers using descriptive statistics. We included some open-ended questions to enable students to expand on their answers. We used this qualitative data to contextualize findings. We invited one member of staff from each university to answer a modified staff version of the questionnaire, in order to provide a curriculum overview and staff perspective on MHFA provision.
Results
232 students and 13 staff responded, from 22 universities in total. Eighty percent of student participants were female and 70% were in the third or final year of study. Three-quarters of students felt that mental health was not embedded throughout the MPharm. Eighty-percent of students stated that they were taught about neuropharmacology and 44.8% stated that their course included communicating with people about their mental health. One third of students felt that their degree adequately prepared them to help people with their mental health. Twenty-six students (11.6%) had completed MHFA training of which 89% would endorse inclusion of this within the MPharm. Of those who had not completed the training, 81% expressed a desire to do so. Those who completed MHFA training self-reported more preparedness than those who did not, but student numbers were small.
Conclusion
Mental health teaching remains focused on theoretical aspects, such as pharmacology, with less emphasis on practical skills, such as communication skills that might support interactions about mental health. MHFA was viewed by students as one way to enhance this. Of the small number of students who had completed MHFA, they displayed an increased self-reported preparedness. This could, however, be linked to the environmental culture of the programme rather than the training per se. MPharm programmes need sufficient focus on skills including communication and crisis response that may be required by pharmacists, alongside the fundamental scientific knowledge relating to mental health.
References
1. Royal Pharmaceutical Society. No health without mental health: How can pharmacy support people with mental health problems? London: RPS; 2018.
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Affiliation(s)
- H C Gorton
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, UK
| | - H Macfarlane
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
- Pharmacy Department, Secure and Complex Care, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - R Edwards
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - S Farid
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, UK
| | - E Garner
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, UK
| | - M Mahroof
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, UK
| | - S Rasul
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, UK
| | - D Keating
- Pharmacy Department, Saint John of God Hospital, Stillorgan, Co Dublin, Ireland
| | - H Zaman
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - J Scott
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
| | - I Maidment
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J Strawbridge
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Gu Z, Bates-Powell J, Das R, Zaman A, Edwards R. Next-day discharge after transcatheter aortic valve implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2605] [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
Background
Transcatheter aortic valve implantation (TAVI) is being used increasingly in patients with severe symptomatic aortic stenosis. Few studies focused on hospital length of stay (LOS) and feasibility of next-day discharge.
Purpose
This study aims to evaluate the feasibility and factors associated with next-day discharge post TAVI, which can be used to help selecting suitable patients for a “fast-track” TAVI admission.
Methods
Data from all TAVI procedures conducted at our centre from January 2014 to March 2019 were collected in our local TAVI registry, and analysed retrospectively. Patients discharged within 1 day of TAVI (early discharge group) were compared with consecutive patients discharged after 24 h (late discharge group). Degree of frailty was assessed by the Canadian Study of Health and Aging (CSHA) frailty scale, and baseline functional status was assessed by Katz index of independence in activities of daily living.
Results
Of 502 patients, 274 (54.6%) were male, mean age 83.2±7.3 years, and 87 (17.7%) patients were considered frail by CSHA frailty scale. Median Katz index was 6 (i.e. functionally independent, interquartile range [IQR] 1), and mean logistic Euroscore 17.4±10.7. Percutaneous transfemoral access was performed in 468 (95.5%), and general anaesthesia was used in 64 (14.4%) patients. Early complications before discharge were comparable to national standards: death in 11 (2.3%), myocardial infarction (MI) in 1 (0.2%), permanent pacemaker (PPM) in 20 (4.3%), gastrointestinal bleed in 3 (0.6%), and tamponade in 5 (1.1%) patients. Median LOS post procedure was 2 (IQR 3), median length of total hospital stay was 3 (IQR 5). Early discharge was achieved in 213 (44.7%) patients. Multivariate logistic regression analysis showed that male gender (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.68 to 4.7; p<0.001), baseline New York Heart Association (NYHA) class below III (OR: 2.04, 95% CI 1.19 to 3.51; p=0.01) were associated with early discharge after TAVI. Furthermore, advancing age (OR: 0.96, 95% CI 0.93–0.99; p=0.02), and presence of extensive ascending aorta calcification (OR: 0.38, 95% CI 0.16–0.88; p=0.025) were associated with less probability of early discharge (i.e. presence of these features were associated with delayed discharge).
Conclusions
Next-day discharge after TAVI can be achieved in nearly half of all patients. Male younger patients with minimal symptoms at baseline (NYHA < III), without feature of extensive ascending aorta calcification (porcelain aorta) are a potential suitable group to be considered for a “fast-track” next-day TAVI discharge.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Z.S Gu
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | | | - R Das
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - A Zaman
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
| | - R Edwards
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom
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11
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Merkel MJ, Edwards R, Ness J, Eriksson C, Yoder S, Gilliam S, Ellero K, Barreto-Costa C, Graven P, Terry JR, Heilman J. Statewide Real-Time Tracking of Beds and Ventilators During Coronavirus Disease 2019 and Beyond. Crit Care Explor 2020; 2:e0142. [PMID: 32696005 PMCID: PMC7314348 DOI: 10.1097/cce.0000000000000142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This brief report describes the rapid deployment of a real-time electronic tracking board for all hospitals in the state of Oregon. In preparation for the coronavirus disease 2019 surge on hospital resources, and in collaboration across health systems, with health authorities and an industry partner, we combined existing infrastructures to create the first automated tracking board for our entire state, including bed types by health system and geographic area, and with granularity to the individual unit level for each participating hospital. At the time of submission, we have a live snapshot of 87% of beds in the state, including real-time ventilator data across eight health systems. The tracking board allows for rapid assessment of available bed and ventilator resources and pulls electronic health record data that is created through normal care processes rather than relying upon manual entry. It is updated every 5 minutes and is drillable from state to unit level. Together these factors make the data actionable, which is essential in a crisis. The new tracking system integrates seamlessly with our preexisting statewide, manually updated tracking board via bidirectional data sharing to ensure existing processes across the state can continue. This new tool allows any health system in our state to visualize occupancy by type and location in real time. Amid pandemic uncertainty, having a reliable tool for tracking critical hospital resources will enhance our statewide ability to maintain healthcare functionality in a world with coronavirus disease 2019.
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Affiliation(s)
- Matthias Johannes Merkel
- OHSU Health, Mission Control, Portland, OR
- Department of Anesthesiology and Perioperative Medicine, OHSU Health, Portland, OR
| | | | - Joe Ness
- OHSU Health, Hospital Administration, Portland, OR
| | - Carl Eriksson
- OHSU Health, Mission Control, Portland, OR
- Department of Pediatrics, OHSU Health, Portland, OR
| | | | | | | | | | - Peter Graven
- OHSU Health, ITG Business Intelligence & Advanced Analytics & School of Public Health, Portland, OR
| | | | - James Heilman
- OHSU Health, Mission Control, Portland, OR
- Department of Emergency Medicine, OHSU Health, Portland, OR
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12
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Boughey P, Jones C, Williams V, Rowe L, Marchant A, Lacey E, Evans B, Morcam C, Webb N, Davies R, Smith E, Shankland H, Leopold N, Harris W, Hudson C, Edwards R. Integrated care of older people (iCOP): an service delivering comprehensive geriatric assessment on the acute assessment unit at Singleton Hospital. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.249] [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: 11/27/2022]
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13
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Pickford R, Edwards R, Nicolas S, Payne K. Determining the information needs of patients undergoing lumbar fusion. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Abstract
‘Care and Responsibility’, previously labelled ‘Control and Restraint’, is a nationally recognized approach to physical restraint. This study explores how 11 nursing staff, who work with people with learning disabilities and behaviour that challenges services, evaluate the method. Whilst there has been a considerable debate in the literature concerning physical restraint methods – and the discussion is often vociferous – there is no consensus about the appropriateness of different approaches. Peculiarly, the opinions of staff are at the periphery, or worse still, absent from the arena. In this qualitative project, this issue is addressed by using intensive, semi-structured interviews to probe the views of the participants. The interviewees discussed a range of topics and identified a number of main themes. This paper details one of these, teamwork, and explores three key elements associated with this category.
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Affiliation(s)
- R. Edwards
- Community Nurse, 29B, Bridge Road, Cwmbach, Aberdare CF44 0LS, UK
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15
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Neven P, Iles RK, Howes I, Sharma K, Shepherd JH, Edwards R, Collins WP, Chard T. Substantial urinary concentrations of material resembling beta-core fragment of chorionic gonadotropin beta-subunit in mid-menstrual cycle. Clin Chem 2019. [DOI: 10.1093/clinchem/39.9.1857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
We measured the day-to-day variations in concentrations of beta-core, luteinizing hormone (LH), and alpha-subunit in urine during the menstrual cycle. The alpha-subunit concentrations showed a pattern similar to that of the LH concentrations. beta-Core-like material was increased during and up to 3 to 4 days after the surge in urine LH. The urine LH concentration was associated with the presence of beta-core immunoreactivity during the urine LH peak. Chromatography showed that, at the peak LH concentration and at 2 days after the LH peak, beta-core immunoreactivity could be accounted for by the presence of a peptide of low molecular mass similar to the beta-core molecule of hCG, but probably originating from the degradation of LH. The prolonged excretion of gonadotropin metabolites in the midcycle must be considered when beta-core is being assessed as a tumor marker.
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Affiliation(s)
- P Neven
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - R K Iles
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - I Howes
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - K Sharma
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - J H Shepherd
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - R Edwards
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - W P Collins
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
| | - T Chard
- Williamson Laboratory for Molecular Oncology, Joint Academic Department of Obstetrics, Gynaecology and Reproductive Physiology, St. Bartholomew's Hospital Medical College, West Smithfield, London, UK
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16
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Hedvat C, Lee G, Baxi V, Dziuba K, Locke D, Li B, Edwards R. Quantitative spatial profiling of lymphocyte-activation gene 3 (LAG-3)/major histocompatibility complex class II (MHC II) interaction in gastric and urothelial tumors. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz269.039] [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: 11/14/2022] Open
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17
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Edwards R, Blakeslee P. Evaluating Efficacy of a Recently Implemented Malnutrition Screening Tool. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.019] [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: 11/27/2022]
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18
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Scaife J, Boughey P, Jones C, Williams V, Rowe L, Marchant A, Lacey E, Rees O, Morcam C, Webb N, Davies R, Smith E, Leopold N, Harris W, Hudson C, Edwards R. 20INTEGRATED CARE OF OLDER PEOPLE (ICOP): A NEW SERVICE DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) ON THE ACUTE ASSESSMENT UNIT AT SINGLETON HOSPITAL: RESULTS OF 2 PDSA CYCLES. Age Ageing 2019. [DOI: 10.1093/ageing/afz055.20] [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: 11/13/2022] Open
Affiliation(s)
- J Scaife
- Department of Medicine for Older People, Singleton Hospital
| | - P Boughey
- Department of Medicine for Older People, Singleton Hospital
| | - C Jones
- Department of Medicine for Older People, Singleton Hospital
| | - V Williams
- Department of Medicine for Older People, Singleton Hospital
| | - L Rowe
- Department of Medicine for Older People, Singleton Hospital
| | - A Marchant
- Department of Medicine for Older People, Singleton Hospital
| | - E Lacey
- Department of Medicine for Older People, Singleton Hospital
| | - O Rees
- Department of Medicine for Older People, Singleton Hospital
| | - C Morcam
- Department of Medicine for Older People, Singleton Hospital
| | - N Webb
- Department of Medicine for Older People, Singleton Hospital
| | - R Davies
- Department of Medicine for Older People, Singleton Hospital
| | - E Smith
- Department of Medicine for Older People, Singleton Hospital
| | - N Leopold
- Department of Medicine for Older People, Singleton Hospital
| | - W Harris
- Department of Medicine for Older People, Singleton Hospital
| | - C Hudson
- Department of Medicine for Older People, Singleton Hospital
| | - R Edwards
- Department of Medicine for Older People, Singleton Hospital
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19
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Isenburg K, Loggia M, Ellingsen D, Protsenko E, Mawla I, Kowalski M, Swensen D, O'Dwyer-Swensen D, Edwards R, Napadow V, Kettner N. (270) Increased Salience Network Connectivity following Spinal Manipulative Therapy is Associated with Reduced Pain in Chronic Low Back Pain Patients. The Journal of Pain 2019. [DOI: 10.1016/j.jpain.2019.01.192] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Farcot E, Best S, Edwards R, Belgacem I, Xu X, Gill P. Chaos in a ring circuit. Chaos 2019; 29:043103. [PMID: 31042954 DOI: 10.1063/1.5079941] [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] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
A ring-shaped logic circuit is proposed here as a robust design for a True Random Number Generator (TRNG). Most existing TRNGs rely on physical noise as a source of randomness, where the underlying idealized deterministic system is simply oscillatory. The design proposed here is based on chaotic dynamics and therefore intrinsically displays random behavior, even in the ideal noise-free situation. The paper presents several mathematical models for the circuit having different levels of detail. They take the form of differential equations using steep sigmoid terms for the transfer functions of logic gates. A large part of the analysis is concerned with the hard step-function limit, leading to a model known in mathematical biology as a Glass network. In this framework, an underlying discrete structure (a state space diagram) is used to describe the likely structure of the global attractor for this system. The latter takes the form of intertwined periodic paths, along which trajectories alternate unpredictably. It is also invariant under the action of the cyclic group. A combination of analytical results and numerical investigations confirms the occurrence of symmetric chaos in this system, which when implemented in (noisy) hardware, should therefore serve as a robust TRNG.
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Affiliation(s)
- E Farcot
- School of Mathematical Sciences, University of Nottingham, United Kingdom
| | - S Best
- Rambus Inc., Sunnyvale, California, USA
| | - R Edwards
- Department of Mathematics and Statistics, University of Victoria, British Columbia, Canada
| | - I Belgacem
- Department of Mathematics and Statistics, University of Victoria, British Columbia, Canada
| | - X Xu
- Electrical and Computer Engineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - P Gill
- Sunnyvale, California 94085, USA
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21
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Stein JE, Soni A, Danilova L, Cottrell TR, Gajewski TF, Hodi FS, Bhatia S, Urba WJ, Sharfman WH, Wind-Rotolo M, Edwards R, Lipson EJ, Taube JM. Major pathologic response on biopsy (MPRbx) in patients with advanced melanoma treated with anti-PD-1: evidence for an early, on-therapy biomarker of response. Ann Oncol 2019; 30:589-596. [PMID: 30689736 PMCID: PMC6503625 DOI: 10.1093/annonc/mdz019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND With increasing anti-PD-1 therapy use in patients with melanoma and other tumor types, there is interest in developing early on-treatment biomarkers that correlate with long-term patient outcome. An understanding of the pathologic features of immune-mediated tumor regression is key in this endeavor. MATERIALS AND METHODS Histologic features of immune-related pathologic response (irPR) following anti-PD-1 therapy were identified on hematoxylin and eosin (H&E)-stained slides in a discovery cohort of pre- and on-treatment specimens from n = 16 patients with advanced melanoma. These features were used to generate an irPR score [from 0 = no irPR features to 3 = major pathologic response on biopsy (MPRbx, ≤10% residual viable tumor)]. This scoring system was then tested for an association with objective response by RECIST1.1 and overall survival in a prospectively collected validation cohort of pre- and on-treatment biopsies (n = 51 on-treatment at 4-week timepoint) from melanoma patients enrolled on the nivolumab monotherapy arm of CA209-038 (NCT01621490). RESULTS Specimens from responders in the discovery cohort had features of immune-activation (moderate-high TIL densities, plasma cells) and wound-healing/tissue repair (neovascularization, proliferative fibrosis) compared to nonresponders, (P ≤ 0.021, for each feature). In the validation cohort, increasing irPR score associated with objective response (P = 0.009) and MPRbx associated with increased overall survival (n = 51; HR 0.13; 95%CI, 0.054-0.31, P = 0.015). Neither tumoral necrosis nor pretreatment histologic features were associated with response. Eight of 16 (50%) of patients with stable disease showed irPR features, two of which were MPRbx, indicating a disconnect between pathologic and radiographic features at the 4-week on-therapy timepoint for some patients. CONCLUSIONS Features of immune-mediated tumor regression on routine H&E-stained biopsy slides from patients with advanced melanoma correlate with objective response to anti-PD-1 and overall survival. An on-therapy biopsy may be particularly clinically useful for informing treatment decisions in patients with radiographic stable disease. This approach is inexpensive, straightforward, and widely available.
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Affiliation(s)
| | - A Soni
- Departments of Dermatology
| | - L Danilova
- Biostatistics, Johns Hopkins University SOM, Baltimore; The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore
| | - T R Cottrell
- Department of Pathology, Johns Hopkins University SOM, Baltimore
| | - T F Gajewski
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago
| | - F S Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S Bhatia
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - W J Urba
- Earle A. Chiles Research Institute, Providence Cancer Center, Portland
| | - W H Sharfman
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University SOM, Baltimore
| | | | - R Edwards
- Bristol-Myers Squibb, Princeton, USA
| | - E J Lipson
- The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University SOM, Baltimore
| | - J M Taube
- Departments of Dermatology; The Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins, Baltimore; Department of Pathology, Johns Hopkins University SOM, Baltimore; Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University SOM, Baltimore.
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22
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Luke J, Edwards R, Hedvat C, Pandya D, Ely S, Meier R, McDonald D, Harbison C, Baxi V, Lee G, Szabo P, Garcia T, Bao R, Reilly T, Jaffee E, Hodi F. Characterization of the immune tumor microenvironment (TME) to inform personalized medicine with immuno-oncology (IO) combinations. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.008] [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: 11/13/2022] Open
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23
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Gu SZ, Sinclair H, Batty J, Veerasamy M, Qiu W, Brugaletta S, Das R, Bagnall A, Zaman A, Edwards R, Egred M, Purcell I, Calvert P, Mintz G, Kunadian V. P4636Coronary artery lesion phenotype in frail older patients with non-ST elevation acute coronary syndrome undergoing invasive care - ICON1 invasive study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4636] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Z Gu
- Newcastle University, Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
| | - H Sinclair
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - J Batty
- Newcastle University, Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
| | - M Veerasamy
- Newcastle University, Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
| | - W Qiu
- Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, United States of America
| | - S Brugaletta
- Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Cardiovascular Clinic Institute, Barcelona, Spain
| | - R Das
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - A Bagnall
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - A Zaman
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - R Edwards
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - M Egred
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - I Purcell
- Freeman Hospital, Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
| | - P Calvert
- Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - G Mintz
- Cardiovascular Research Foundation, New York, United States of America
| | - V Kunadian
- Newcastle University, Institute of Cellular Medicine, Newcastle upon Tyne, United Kingdom
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24
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25
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Abstract
A case of spontaneous fracture of the outlet catheter of a totally implanted catheter system (Port-A-Cath) is presented. The outlet catheter was fractured at the entrance into the left subclavian vein twenty-one weeks after insertion and the distal part was embolized in the right ventricle. The embolized catheter fragment was retrieved by a ‘goose-neck’ snare via the right femoral vein. The awareness of a possible spontaneous fracture of the outlet catheter of a totally implanted catheter system (Port-A-Cath) is important to prevent accidental spillage of potent cytotoxic substances.
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Affiliation(s)
- H. Myint
- University Department of Haematology, Glasgow - UK
| | - J. McGregor
- University Department of Surgery, Glasgow - UK
| | - R. Edwards
- Department of Radiology, Western Infirmary, Glasgow - UK
| | - N.P. Lucie
- University Department of Haematology, Glasgow - UK
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26
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Albrecht D, Kim M, Torrado-Carvajal A, Akeju O, Edwards R, Wasan A, Zhang Y, Bergan C, Protsenko E, Hooker J, Napadow V, Loggia M. Glial activation in chronic back pain: replication of the original observation and association with negative affect. The Journal of Pain 2018. [DOI: 10.1016/j.jpain.2017.12.015] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Coffey W, Magee B, Harris J, Edwards R, McKillop D. CENTRIFUGATION IN GP PRACTICES - CAN IT IMPROVE DIAGNOSTIC EFFICIENCY? Ulster Med J 2018; 87:52-53. [PMID: 29588563 PMCID: PMC5849960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- W Coffey
- Clinical Biochemistry, Southern HSC Trust, Craigavon
| | - B Magee
- Clinical Biochemistry, Southern HSC Trust, Craigavon
| | - J Harris
- Dromore GP Surgery, 50 Gallows Street, Dromore
| | - R Edwards
- Dromore GP Surgery, 50 Gallows Street, Dromore
| | - D McKillop
- Clinical Biochemistry, Southern HSC Trust, Craigavon
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28
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Charles J, Roberts J, Din N, Williams N, Yeo S, Edwards R. Preferences of older patients regarding hip fracture rehabilitation service configuration: A feasibility discrete choice experiment. J Rehabil Med 2018; 50:636-642. [DOI: 10.2340/16501977-2350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Smith M, Signal L, Edwards R, Hoek J. Children's and parents' opinions on the sport-related food environment: a systematic review. Obes Rev 2017; 18:1018-1039. [PMID: 28560820 DOI: 10.1111/obr.12558] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/29/2017] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
Abstract
Sport is a key setting for interventions to address child obesity given its obesogenic nature. Understanding children's and parents' opinions on the sport-related food environment is critical in developing effective programmes and policies to improve children's health. This systematic review synthesizes quantitative and qualitative research examining children's and parents' opinions on the sport-related food environment. During July 2016, a range of electronic databases of academic and grey literature were searched. Thirty-two publications (11 including children, 17 parents and 4 both) were included for review. The publications were assessed using the Analysis Grid for Environments Linked to Obesity framework to categorize the sport-related food environment into the physical, sociocultural, economic and political environments. The literature available investigating children's and parents' opinions of the sport-related food environment suggests that many children and parents consider the environment neither conducive to nor supportive of children's healthy food behaviours or wider health and well-being. Both groups would likely support actions to change and improve it. This systematic review found that original research specifically investigating children's and parents' perspectives on almost all aspects of the sport-related food environment is limited. Thus, there is scope for further investigation into this important part of children's food environments.
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Affiliation(s)
- M Smith
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - L Signal
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - R Edwards
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - J Hoek
- Department of Marketing, University of Otago, Dunedin, New Zealand
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30
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Ritchie S, Edwards R, Clarke R, Williams L, Jones GD. 60ABSORBING SENSORY-INTEGRATION EXERCISES INTO A STRENGTH AND BALANCE INTERVENTION FOR OLDER PEOPLE WHO HAVE FALLEN. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Monk BJ, Brady MF, Aghajanian C, Lankes HA, Rizack T, Leach J, Fowler JM, Higgins R, Hanjani P, Morgan M, Edwards R, Bradley W, Kolevska T, Foukas P, Swisher EM, Anderson KS, Gottardo R, Bryan JK, Newkirk M, Manjarrez KL, Mannel RS, Hershberg RM, Coukos G. A phase 2, randomized, double-blind, placebo- controlled study of chemo-immunotherapy combination using motolimod with pegylated liposomal doxorubicin in recurrent or persistent ovarian cancer: a Gynecologic Oncology Group partners study. Ann Oncol 2017; 28:996-1004. [PMID: 28453702 PMCID: PMC5406764 DOI: 10.1093/annonc/mdx049] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A phase 2, randomized, placebo-controlled trial was conducted in women with recurrent epithelial ovarian carcinoma to evaluate the efficacy and safety of motolimod-a Toll-like receptor 8 (TLR8) agonist that stimulates robust innate immune responses-combined with pegylated liposomal doxorubicin (PLD), a chemotherapeutic that induces immunogenic cell death. PATIENTS AND METHODS Women with ovarian, fallopian tube, or primary peritoneal carcinoma were randomized 1 : 1 to receive PLD in combination with blinded motolimod or placebo. Randomization was stratified by platinum-free interval (≤6 versus >6-12 months) and Gynecologic Oncology Group (GOG) performance status (0 versus 1). Treatment cycles were repeated every 28 days until disease progression. RESULTS The addition of motolimod to PLD did not significantly improve overall survival (OS; log rank one-sided P = 0.923, HR = 1.22) or progression-free survival (PFS; log rank one-sided P = 0.943, HR = 1.21). The combination was well tolerated, with no synergistic or unexpected serious toxicity. Most patients experienced adverse events of fatigue, anemia, nausea, decreased white blood cells, and constipation. In pre-specified subgroup analyses, motolimod-treated patients who experienced injection site reactions (ISR) had a lower risk of death compared with those who did not experience ISR. Additionally, pre-treatment in vitro responses of immune biomarkers to TLR8 stimulation predicted OS outcomes in patients receiving motolimod on study. Immune score (tumor infiltrating lymphocytes; TIL), TLR8 single-nucleotide polymorphisms, mutational status in BRCA and other DNA repair genes, and autoantibody biomarkers did not correlate with OS or PFS. CONCLUSIONS The addition of motolimod to PLD did not improve clinical outcomes compared with placebo. However, subset analyses identified statistically significant differences in the OS of motolimod-treated patients on the basis of ISR and in vitro immune responses. Collectively, these data may provide important clues for identifying patients for treatment with immunomodulatory agents in novel combinations and/or delivery approaches. TRIAL REGISTRATION Clinicaltrials.gov, NCT 01666444.
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Affiliation(s)
- B. J. Monk
- Arizona Oncology (US Oncology Network), University of Arizona, College of Medicine, Creighton University School of Medicine at St. Joseph's Hospital, Phoenix
| | - M. F. Brady
- GOG Foundation Statistical and Data Center, Roswell Park Cancer Institute, Buffalo
| | - C. Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - H. A. Lankes
- GOG Foundation Statistical and Data Center, Roswell Park Cancer Institute, Buffalo
| | - T. Rizack
- Women & Infants Hospital, Alpert Medical School of Brown University, Providence
| | - J. Leach
- Metro-Minnesota Community Oncology Research Consortium, Minneapolis
| | | | - R. Higgins
- Carolinas Medical Center Levine Cancer Institute, Charlotte
| | - P. Hanjani
- Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington
| | - M. Morgan
- University of Pennsylvania Health System, Philadelphia
| | - R. Edwards
- University of Pittsburgh Medical Center, Pittsburgh
| | - W. Bradley
- The Medical College of Wisconsin, Milwaukee
| | - T. Kolevska
- Kaiser Permanente Medical Center–Vallejo, Vallejo
| | - P. Foukas
- Ludwig Institute for Cancer Research, Lausanne
| | | | | | - R. Gottardo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle
| | | | | | | | - R. S. Mannel
- The Oklahoma University College of Medicine, Oklahoma City, USA
| | | | - G. Coukos
- Ludwig Institute for Cancer Research, Lausanne
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Dorado K, Lazaridou A, Franceschelli O, Protsenko K, Napadow V, Edwards R. (310) The association between catastrophizing, fatigue, and sleep quality among patients with fibromyalgia. The Journal of Pain 2017. [DOI: 10.1016/j.jpain.2017.02.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schreiber K, Zinboonyahgoon N, Vasudevan G, Cornelius M, Edwards R. (405) Use of a brief, portable bedside quantitative sensory test in mastectomy patients: longitudinal assessment of individual differences in pain sensitivity and prediction of clinical pain. The Journal of Pain 2017. [DOI: 10.1016/j.jpain.2017.02.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Haralambos K, Ashfield-Watt P, Edwards R, Gingell R, Townsend D, Whatley S, Datta D, McDowell I. Five year experience of scoring criteria for familial hypercholesterolaemia (FH) genetic testing in wales: Should the criteria be refined to include age? Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
This research explores the relationship between imagined interaction dimensions [1], conversational sensitivity dimensions [2], and communication competence [3]. Results of a study reveal features of imagined interaction predicting both conversational sensitivity and self-reported communication competence. Mental experiences of communication (i.e., imagined interaction) are thought to activate sensitivity to conversations and to provide knowledge structures for competent interaction. A path analysis revealed the mediating role of overall conversational sensitivity leading to communication competence.
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Honeycutt JM, Edwards R, Zagacki KS. Using Imagined Interaction Features to Predict Measures of Self-Awareness: Loneliness, Locus of Control, Self-Dominance, and Emotional Intensity. ACTA ACUST UNITED AC 2016. [DOI: 10.2190/02l8-1gmp-jv5c-jq7x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Imagined interactions are covert dialogues that occur with significant others and are a part of the social cognition process. Imagined interactions may call up plans for anticipated encounters. Using a multidimensional instrument known as the “Survey of Imagined Interaction” (SII), the multivariate relationship between general characteristics of imagined interactions and various measures of self-awareness and emotional intensity were examined. Measures reflecting loneliness, locus of control, being dominant in an imagined interaction as well as feeling satisfied and pleasant with an imagined interaction were regressed on the general dimensions of the SII. Results from the regression models are discussed in terms of imagined interactions being associated with and possibly creating more self-awareness.
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Kemp A, Nickerson E, Trefan L, Houston R, Hyde P, Pearson G, Edwards R, Parslow RC, Maconochie I. Selecting children for head CT following head injury. Arch Dis Child 2016; 101:929-34. [PMID: 27449674 PMCID: PMC5050290 DOI: 10.1136/archdischild-2015-309078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 04/02/2016] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Indicators for head CT scan defined by the 2007 National Institute for Health and Care Excellence (NICE) guidelines were analysed to identify CT uptake, influential variables and yield. DESIGN Cross-sectional study. SETTING Hospital inpatient units: England, Wales, Northern Ireland and the Channel Islands. PATIENTS Children (<15 years) admitted to hospital for more than 4 h following a head injury (September 2009 to February 2010). INTERVENTIONS CT scan. MAIN OUTCOME MEASURES Number of children who had CT, extent to which NICE guidelines were followed and diagnostic yield. RESULTS Data on 5700 children were returned by 90% of eligible hospitals, 84% of whom were admitted to a general hospital. CT scans were performed on 30.4% of children (1734), with a higher diagnostic yield in infants (56.5% (144/255)) than children aged 1 to 14 years (26.5% (391/1476)). Overall, only 40.4% (984 of 2437 children) fulfilling at least one of the four NICE criteria for CT actually underwent one. These children were much less likely to receive CT if admitted to a general hospital than to a specialist centre (OR 0.52 (95% CI 0.45 to 0.59)); there was considerable variation between healthcare regions. When indicated, children >3 years were much more likely to have CT than those <3 years (OR 2.35 (95% CI 2.08 to 2.65)). CONCLUSION Compliance with guidelines and diagnostic yield was variable across age groups, the type of hospital and region where children were admitted. With this pattern of clinical practice the risks of both missing intracranial injury and overuse of CT are considerable.
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Affiliation(s)
- A Kemp
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - E Nickerson
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - L Trefan
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - R Houston
- Research fellow CMACE (at the time of the project). Placements Manager at Kids Company, London, UK
| | - P Hyde
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | - G Pearson
- Consultant in Intensive Care, Birmingham Children's Hospital, Birmingham, UK
| | - R Edwards
- Department of Neurosurgery, Bristol Hospital for Children, Bristol, UK
| | - RC Parslow
- Senior Lecturer in Epidemiology, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - I Maconochie
- Paediatric Emergency Medicine Consultant, Imperial College NHS Healthcare Trust, London, UK
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Trefan L, Houston R, Pearson G, Edwards R, Hyde P, Maconochie I, Parslow RC, Kemp A. Epidemiology of children with head injury: a national overview. Arch Dis Child 2016; 101:527-532. [PMID: 26998632 PMCID: PMC4893082 DOI: 10.1136/archdischild-2015-308424] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The National Confidential Enquiry describes the epidemiology of children admitted to hospital with head injury. METHOD Children (<15 years old) who died or were admitted for >4 h with head injury were identified from 216 UK hospitals (1 September 2009 to 28 February 2010). Data were collected using standard proformas and entered on to a database. A descriptive analysis of the causal mechanisms, child demographics, neurological impairment, CT findings, and outcome at 72 h are provided. RESULTS Details of 5700 children, median age 4 years (range 0-14.9 years), were analysed; 1093 (19.2%) were <1 year old, 3500 (61.4%) were boys. There was a significant association of head injury with social deprivation 39.7/100 000 (95% CI 37.0 to 42.6) in the least deprived first quintile vs. 55.1 (95% CI 52.1 to 58.2) in the most deprived fifth quintile (p<0.01). Twenty-four children died (0.4%). Most children were admitted for one night or less; 4522 (79%) had a Glasgow Coma Scale score of 15 or were Alert (on AVPU (Alert, Voice, Pain, Unresponsive)). The most common causes of head injury were falls (3537 (62.1%); children <5 years), sports-related incidents (783 (13.7%); median age 12.4 years), or motor vehicle accidents (MVAs) (401 (7.1%); primary-school-aged children). CT scans were performed in 1734 (30.4%) children; 536 (30.9%) were abnormal (skull fracture and/or intracranial injury or abnormality): 269 (7.6%) were falls, 82 (10.5%) sports related and 100 (25%). A total of 357 (6.2%) children were referred to social care because of child protection concerns (median age 9 months (range 0-14.9 years)). CONCLUSIONS The data described highlight priorities for targeted age-specific head injury prevention and have the potential to provide a baseline to evaluate the effects of regional trauma networks (2012) and National Institute of Health and Care Excellence (NICE) head injury guidelines (2014), which were revised after the study was completed.
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Affiliation(s)
- L Trefan
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - R Houston
- Placements Manager at Kids Company, London, UK
| | - G Pearson
- Birmingham Children's Hospital, Birmingham, UK
| | - R Edwards
- Department of Neurosurgery, Bristol Hospital for Children, Bristol, UK
| | - P Hyde
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | - I Maconochie
- Imperial College NHS Healthcare Trust, London, UK
| | - R C Parslow
- Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - A Kemp
- College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
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Richards J, Pejsa M, Hand M, Cornelius M, Campbell C, Haythornthwaite J, Edwards R, Smith M. (166) Psychometric evaluation and predictive validity of the sleep and pain behaviors survey in knee osteoarthritis patients undergoing total knee replacement. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lee R, Rogers S, Caress A, Molassiotis A, Edwards R, Ryder D, Sanghera P, Lunt C, Yeo T, Slevin N. PO-0637: RCT pilot study of Therabite vs wooden spatula in amelioration of trismus in H&N cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31887-4] [Citation(s) in RCA: 2] [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: 11/17/2022]
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Haralambos K, Whatley S, Edwards R, Gingell R, Townsend D, Holmans P, Clarke A, Datta D, Butler R, Palmer-Smith S, Wood M, McDowell I. GENETIC VARIANTS OF UNCERTAIN SIGNIFICANCE (VUS) IN FAMILIAL HYPERCHOLESTEROLAEMIA (FH) IN WALES: YEAR 2 UPDATE. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2015.10.035] [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: 11/27/2022]
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Ashfield-Watt P, Haralambos K, Sharif B, Edwards R, Gingell R, Townsend D, Datta D, McDowell I. Web based tools to assess eligibility for genetic testing for Familial Hypercholesterolaemia (FH). Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2015.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abreu J, Haralambos K, Ashfield-Watt P, Edwards R, Gingell R, Townsend D, Datta D, McDowell I. Relationship between measurements of non-HDL-cholesterol and LDL-cholesterol in Familial Hypercholesterolaemia. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2015.10.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zingg W, Castro-Sanchez E, Secci FV, Edwards R, Drumright LN, Sevdalis N, Holmes AH. Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). Public Health 2015; 133:19-37. [PMID: 26704633 DOI: 10.1016/j.puhe.2015.10.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 02/10/2015] [Accepted: 10/29/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES With the aim to facilitate a more comprehensive review process in public health including patient safety, we established a tool that we have termed ICROMS (Integrated quality Criteria for the Review Of Multiple Study designs), which unifies, integrates and refines current quality criteria for a large range of study designs including qualitative research. STUDY DESIGN Review, pilot testing and expert consensus. METHODS The tool is the result of an iterative four phase process over two years: 1) gathering of established criteria for assessing controlled, non-controlled and qualitative study designs; 2) pilot testing of a first version in two systematic reviews on behavioural change in infection prevention and control and in antibiotic prescribing; 3) further refinement and adding of additional study designs in the context of the European Centre for Disease Prevention and Control funded project 'Systematic review and evidence-based guidance on organisation of hospital infection control programmes' (SIGHT); 4) scrutiny by the pan-European expert panel of the SIGHT project, which had the objective of ensuring robustness of the systematic review. RESULTS ICROMS includes established quality criteria for randomised studies, controlled before-and-after studies and interrupted time series, and incorporates criteria for non-controlled before-and-after studies, cohort studies and qualitative studies. The tool consists of two parts: 1) a list of quality criteria specific for each study design, as well as criteria applicable across all study designs by using a scoring system; 2) a 'decision matrix', which specifies the robustness of the study by identifying minimum requirements according to the study type and the relevance of the study to the review question. The decision matrix directly determines inclusion or exclusion of a study in the review. ICROMS was applied to a series of systematic reviews to test its feasibility and usefulness in the appraisal of multiple study designs. The tool was applicable across a wide range of study designs and outcome measures. CONCLUSION ICROMS is a comprehensive yet feasible appraisal of a large range of study designs to be included in systematic reviews addressing behaviour change studies in patient safety and public health. The tool is sufficiently flexible to be applied to a variety of other domains in health-related research. Beyond its application to systematic reviews, we envisage that ICROMS can have a positive effect on researchers to be more rigorous in their study design and more diligent in their reporting.
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Affiliation(s)
- W Zingg
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom; Infection Control Programme, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland.
| | - E Castro-Sanchez
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
| | - F V Secci
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
| | - R Edwards
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
| | - L N Drumright
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
| | - N Sevdalis
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom; Department of Surgery and Cancer, St Mary's Hospital, Norfolk Place, London W2 1PG, United Kingdom
| | - A H Holmes
- Imperial College London, Du Cane Road, London W12 0HS, United Kingdom
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Sinclair LA, Edwards R, Errington KA, Holdcroft AM, Wright M. Replacement of grass and maize silages with lucerne silage: effects on performance, milk fatty acid profile and digestibility in Holstein-Friesian dairy cows. Animal 2015; 9:1970-8. [PMID: 26242305 DOI: 10.1017/s1751731115001470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Indexed: 11/07/2022] Open
Abstract
In total, 20 multiparous Holstein-Friesian dairy cows received one of four diets in each of four periods of 28-day duration in a Latin square design to test the hypothesis that the inclusion of lucerne in the ration of high-yielding dairy cows would improve animal performance and milk fatty acid (FA) composition. All dietary treatments contained 0.55 : 0.45 forage to concentrates (dry matter (DM) basis), and within the forage component the proportion of lucerne (Medicago sativa), grass (Lolium perenne) and maize silage (Zea mays) was varied (DM basis): control (C)=0.4 : 0.6 grass : maize silage; L20=0.2 : 0.2 : 0.6 lucerne : grass : maize silage; L40=0.4 : 0.6 lucerne : maize silage; and L60=0.6 : 0.4 lucerne : maize silage. Diets were formulated to contain a similar CP and metabolisable protein content, with the reduction of soya bean meal and feed grade urea with increasing content of lucerne. Intake averaged 24.3 kg DM/day and was lowest in cows when fed L60 (P0.05) by dietary treatment. Digestibility of DM, organic matter, CP and fibre decreased (P<0.01) with increasing content of lucerne in the diet, although fibre digestibility was similar in L40 and L60. It is concluded that first cut grass silage can be replaced with first cut lucerne silage without any detrimental effect on performance and an improvement in the milk FA profile, although intake and digestibility was lowest and plasma urea concentrations highest in cows when fed the highest level of inclusion of lucerne.
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Affiliation(s)
- L A Sinclair
- Department of Animal Production,Welfare and Veterinary Sciences,Harper Adams University,Newport,Shropshire TF10 8NB,UK
| | - R Edwards
- Department of Animal Production,Welfare and Veterinary Sciences,Harper Adams University,Newport,Shropshire TF10 8NB,UK
| | - K A Errington
- Department of Animal Production,Welfare and Veterinary Sciences,Harper Adams University,Newport,Shropshire TF10 8NB,UK
| | - A M Holdcroft
- Department of Animal Production,Welfare and Veterinary Sciences,Harper Adams University,Newport,Shropshire TF10 8NB,UK
| | - M Wright
- Department of Animal Production,Welfare and Veterinary Sciences,Harper Adams University,Newport,Shropshire TF10 8NB,UK
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Prendecki M, Blacker E, Sadeghi-Alavijeh O, Edwards R, Montgomery H, Gillis S, Harber M. Improving outcomes in patients with Acute Kidney Injury: the impact of hospital based automated AKI alerts. Postgrad Med J 2015; 92:9-13. [PMID: 26512125 PMCID: PMC4717457 DOI: 10.1136/postgradmedj-2015-133496] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/25/2015] [Indexed: 01/14/2023]
Abstract
Background Acute kidney injury (AKI) is a significant cause of morbidity and mortality. Early identification may improve the outcome and in 2012 our hospital introduced an automated AKI alert system for early detection and management of AKI. Objectives Using an automated AKI alert system we analysed whether early review and intervention by the Critical Care and Outreach (CCOT) team improved patient outcomes in AKI and whether serum bicarbonate was useful in predicting outcomes in patients with AKI. Methods In a retrospective analysis we identified patients who triggered an AKI alert from 20 April 2012 to 20 September 2013 and collected data on mortality, length of stay, need for intensive care admission and renal replacement therapy (RRT). Results 994 AKI alerts were generated and analysed. Patients with bicarbonate outside the normal range had significantly higher mortality. Bicarbonate <22 mmol/L was associated with a mortality of 25.7% (49/191) compared with 16.9% (39/231) when 22–29 mmol/L (p=0.047, χ2). Those patients reviewed ≥1 day after AKI alert by CCOT compared with those seen on the day of the alert had a 2.4 times increase in mortality and were 7 times more likely to require RRT acutely. Conclusions Electronically identified AKI alerts identify patients at high risk of morbidity and mortality. In this group AKI alerts preceded CCOT review by a mean of 2 days. This represents a window for supportive interventions, which may explain improved outcomes in those reviewed earlier. The addition of serum bicarbonate offers a further method of risk stratifying patients at greater risk of death.
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Affiliation(s)
- M Prendecki
- Department of Nephrology, Whittington Hospital, London, UK
| | - E Blacker
- Department of Intensive Care, Whittington Hospital, London, UK
| | | | - R Edwards
- Department of Biochemistry, Whittington Hospital, London, UK
| | - H Montgomery
- Department of Intensive Care, Whittington Hospital, London, UK
| | - S Gillis
- Department of Intensive Care, Whittington Hospital, London, UK
| | - M Harber
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
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Edwards R. Vivian Byron John Edwards. Assoc Med J 2015. [DOI: 10.1136/bmj.h3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Caruso J, Barbosa A, Erickson L, Edwards R, Perry R, Learmonth L, Potter W. Intermittent Palm Cooling’s Impact on Resistive Exercise Performance. Int J Sports Med 2015; 36:814-21. [DOI: 10.1055/s-0035-1547264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. Caruso
- Exercise & Sport Sciences Program, University of Tulsa, Tulsa, United States
| | - A. Barbosa
- Exercise & Sport Sciences Program, University of Tulsa, Tulsa, United States
| | - L. Erickson
- Exercise & Sport Sciences Program, University of Tulsa, Tulsa, United States
| | - R. Edwards
- Exercise & Sport Sciences Program, University of Tulsa, Tulsa, United States
| | - R. Perry
- Exercise & Sport Sciences Program, University of Tulsa, Tulsa, United States
| | - L. Learmonth
- Exercise & Sport Sciences Program, University of Tulsa, Tulsa, United States
| | - W. Potter
- Chemistry and Biochemistry, The University of Tulsa, Tulsa, United States
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Haralambos K, Whatley S, Edwards R, Gingell R, Townsend D, Ashfield-Watt P, Lansberg P, Datta D, McDowell I. Clinical experience of scoring criteria for Familial Hypercholesterolaemia (FH) genetic testing in Wales. Atherosclerosis 2015; 240:190-6. [DOI: 10.1016/j.atherosclerosis.2015.03.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/15/2015] [Accepted: 03/05/2015] [Indexed: 11/16/2022]
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50
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Flanagan E, Thompson AJ, Colledge D, Edwards R, Littlejohn M, Walsh R, Warner N, Bowden DS, Iser DM. A novel hepatitis B virus S gene insertion associated with reduced humoral immunity and diagnostic escape. Intern Med J 2015; 44:709-10. [PMID: 25041776 DOI: 10.1111/imj.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/07/2014] [Indexed: 12/12/2022]
Affiliation(s)
- E Flanagan
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
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