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Abuter R, Allouche F, Amorim A, Bailet C, Berdeu A, Berger JP, Berio P, Bigioli A, Boebion O, Bolzer ML, Bonnet H, Bourdarot G, Bourget P, Brandner W, Cao Y, Conzelmann R, Comin M, Clénet Y, Courtney-Barrer B, Davies R, Defrère D, Delboulbé A, Delplancke-Ströbele F, Dembet R, Dexter J, de Zeeuw PT, Drescher A, Eckart A, Édouard C, Eisenhauer F, Fabricius M, Feuchtgruber H, Finger G, Förster Schreiber NM, Garcia P, Garcia Lopez R, Gao F, Gendron E, Genzel R, Gil JP, Gillessen S, Gomes T, Gonté F, Gouvret C, Guajardo P, Guieu S, Hackenberg W, Haddad N, Hartl M, Haubois X, Haußmann F, Heißel G, Henning T, Hippler S, Hönig SF, Horrobin M, Hubin N, Jacqmart E, Jocou L, Kaufer A, Kervella P, Kolb J, Korhonen H, Lacour S, Lagarde S, Lai O, Lapeyrère V, Laugier R, Le Bouquin JB, Leftley J, Léna P, Lewis S, Liu D, Lopez B, Lutz D, Magnard Y, Mang F, Marcotto A, Maurel D, Mérand A, Millour F, More N, Netzer H, Nowacki H, Nowak M, Oberti S, Ott T, Pallanca L, Paumard T, Perraut K, Perrin G, Petrov R, Pfuhl O, Pourré N, Rabien S, Rau C, Riquelme M, Robbe-Dubois S, Rochat S, Salman M, Sanchez-Bermudez J, Santos DJD, Scheithauer S, Schöller M, Schubert J, Schuhler N, Shangguan J, Shchekaturov P, Shimizu TT, Sevin A, Soulez F, Spang A, Stadler E, Sternberg A, Straubmeier C, Sturm E, Sykes C, Tacconi LJ, Tristram KRW, Vincent F, von Fellenberg S, Uysal S, Widmann F, Wieprecht E, Wiezorrek E, Woillez J, Zins G. A dynamical measure of the black hole mass in a quasar 11 billion years ago. Nature 2024; 627:281-285. [PMID: 38286342 DOI: 10.1038/s41586-024-07053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
Tight relationships exist in the local Universe between the central stellar properties of galaxies and the mass of their supermassive black hole (SMBH)1-3. These suggest that galaxies and black holes co-evolve, with the main regulation mechanism being energetic feedback from accretion onto the black hole during its quasar phase4-6. A crucial question is how the relationship between black holes and galaxies evolves with time; a key epoch to examine this relationship is at the peaks of star formation and black hole growth 8-12 billion years ago (redshifts 1-3)7. Here we report a dynamical measurement of the mass of the black hole in a luminous quasar at a redshift of 2, with a look back in time of 11 billion years, by spatially resolving the broad-line region (BLR). We detect a 40-μas (0.31-pc) spatial offset between the red and blue photocentres of the Hα line that traces the velocity gradient of a rotating BLR. The flux and differential phase spectra are well reproduced by a thick, moderately inclined disk of gas clouds within the sphere of influence of a central black hole with a mass of 3.2 × 108 solar masses. Molecular gas data reveal a dynamical mass for the host galaxy of 6 × 1011 solar masses, which indicates an undermassive black hole accreting at a super-Eddington rate. This suggests a host galaxy that grew faster than the SMBH, indicating a delay between galaxy and black hole formation for some systems.
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Affiliation(s)
- R Abuter
- European Southern Observatory, Garching, Germany
| | - F Allouche
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Amorim
- Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
| | - C Bailet
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Berdeu
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J-P Berger
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - P Berio
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - A Bigioli
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - O Boebion
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - M-L Bolzer
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Department of Physics, Technical University Munich, Garching, Germany
- Univ. Lyon, Univ. Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon UMR5574, Saint-Genis-Laval, France
| | - H Bonnet
- European Southern Observatory, Garching, Germany
| | - G Bourdarot
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - P Bourget
- European Southern Observatory, Santiago, Chile
| | - W Brandner
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - Y Cao
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - R Conzelmann
- European Southern Observatory, Garching, Germany
| | - M Comin
- European Southern Observatory, Garching, Germany
| | - Y Clénet
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - B Courtney-Barrer
- European Southern Observatory, Santiago, Chile
- Research School of Astronomy and Astrophysics, College of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - R Davies
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - D Defrère
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - A Delboulbé
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | | | - R Dembet
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J Dexter
- Department of Astrophysical & Planetary Sciences, JILA, University of Colorado Boulder, Boulder, CO, USA
| | | | - A Drescher
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - A Eckart
- Max Planck Institute for Radio Astronomy, Bonn, Germany
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - C Édouard
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - F Eisenhauer
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - M Fabricius
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - H Feuchtgruber
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - G Finger
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - P Garcia
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - R Garcia Lopez
- School of Physics, University College Dublin, Belfield, Dublin 4, Ireland
| | - F Gao
- Max Planck Institute for Radio Astronomy, Bonn, Germany
| | - E Gendron
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Genzel
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Departments of Physics, University of California, Berkeley, Berkeley, CA, USA
- Department of Astronomy, University of California, Berkeley, Berkeley, CA, USA
| | - J P Gil
- European Southern Observatory, Santiago, Chile
| | - S Gillessen
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - T Gomes
- CENTRA - Centro de Astrofísica e Gravitação, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - F Gonté
- European Southern Observatory, Garching, Germany
| | - C Gouvret
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - P Guajardo
- European Southern Observatory, Santiago, Chile
| | - S Guieu
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - W Hackenberg
- European Southern Observatory, Garching, Germany
| | - N Haddad
- European Southern Observatory, Santiago, Chile
| | - M Hartl
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - X Haubois
- European Southern Observatory, Santiago, Chile
| | - F Haußmann
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - G Heißel
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
- Advanced Concepts Team, European Space Agency, TEC-SF, ESTEC, Noordwijk, The Netherlands
| | - Th Henning
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S Hippler
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S F Hönig
- School of Physics and Astronomy, University of Southampton, Southampton, UK
| | - M Horrobin
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - N Hubin
- European Southern Observatory, Garching, Germany
| | - E Jacqmart
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - L Jocou
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Kaufer
- European Southern Observatory, Santiago, Chile
| | - P Kervella
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - J Kolb
- European Southern Observatory, Garching, Germany
| | - H Korhonen
- European Southern Observatory, Santiago, Chile
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - S Lacour
- European Southern Observatory, Garching, Germany
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - S Lagarde
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - O Lai
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - V Lapeyrère
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Laugier
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | | | - J Leftley
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - P Léna
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - S Lewis
- European Southern Observatory, Garching, Germany
| | - D Liu
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - B Lopez
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - D Lutz
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - Y Magnard
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - F Mang
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
- Department of Physics, Technical University Munich, Garching, Germany
| | - A Marcotto
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - D Maurel
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Mérand
- European Southern Observatory, Garching, Germany
| | - F Millour
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - N More
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - H Netzer
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - H Nowacki
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - M Nowak
- Institute of Astronomy, University of Cambridge, Cambridge, UK
| | - S Oberti
- European Southern Observatory, Garching, Germany
| | - T Ott
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - L Pallanca
- European Southern Observatory, Santiago, Chile
| | - T Paumard
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - K Perraut
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - G Perrin
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - R Petrov
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - O Pfuhl
- European Southern Observatory, Garching, Germany
| | - N Pourré
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - S Rabien
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - C Rau
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - M Riquelme
- European Southern Observatory, Garching, Germany
| | - S Robbe-Dubois
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - S Rochat
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - M Salman
- Institute of Astronomy, KU Leuven, Leuven, Belgium
| | - J Sanchez-Bermudez
- Max Planck Institute for Astronomy, Heidelberg, Germany
- Instituto de Astronomía, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - D J D Santos
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - S Scheithauer
- Max Planck Institute for Astronomy, Heidelberg, Germany
| | - M Schöller
- European Southern Observatory, Garching, Germany
| | - J Schubert
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - N Schuhler
- European Southern Observatory, Santiago, Chile
| | - J Shangguan
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - T T Shimizu
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany.
| | - A Sevin
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | - F Soulez
- Univ. Lyon, Univ. Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon UMR5574, Saint-Genis-Laval, France
| | - A Spang
- Université Côte d'Azur, Observatoire de la Côte d'Azur, CNRS, Laboratoire Lagrange, Nice, France
| | - E Stadler
- Université Grenoble Alpes, CNRS, IPAG, Grenoble, France
| | - A Sternberg
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
- Center for Computational Astrophysics, Flatiron Institute, New York, NY, USA
| | - C Straubmeier
- 1st Institute of Physics, University of Cologne, Cologne, Germany
| | - E Sturm
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - C Sykes
- School of Physics and Astronomy, University of Southampton, Southampton, UK
| | - L J Tacconi
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | | | - F Vincent
- LESIA - Observatoire de Paris, Université PSL, Sorbonne Université, Université Paris Cité, CNRS, Meudon, France
| | | | - S Uysal
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - F Widmann
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - E Wieprecht
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - E Wiezorrek
- Max Planck Institute for Extraterrestrial Physics, Garching, Germany
| | - J Woillez
- European Southern Observatory, Garching, Germany
| | - G Zins
- European Southern Observatory, Garching, Germany
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2
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Emery A, Moore S, Crowe J, Murray J, Peacock O, Thompson D, Betts F, Rapps S, Ross L, Rothschild-Rodriguez D, Arana Echarri A, Davies R, Lewis R, Augustine DX, Whiteway A, Afzal Z, Heaney J, Drayson MT, Turner JE, Campbell JP. The effects of short-term, progressive exercise training on disease activity in smouldering multiple myeloma and monoclonal gammopathy of undetermined significance: a single-arm pilot study. BMC Cancer 2024; 24:174. [PMID: 38317104 PMCID: PMC10840198 DOI: 10.1186/s12885-024-11817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly investigated the effects on MGUS/SMM disease activity. METHODS In this single-arm pilot study, N = 20 participants diagnosed with MGUS or SMM were allocated to receive a 16-week progressive exercise programme. Primary outcome measures were feasibility and safety. Secondary outcomes were pre- to post-exercise training changes to blood biomarkers of MGUS and SMM disease activity- monoclonal (M)-protein and free light chains (FLC)- plus cardiorespiratory and functional fitness, body composition, quality of life, blood immunophenotype, and blood biomarkers of inflammation. RESULTS Fifteen (3 MGUS and 12 SMM) participants completed the exercise programme. Adherence was 91 ± 11%. Compliance was 75 ± 25% overall, with a notable decline in compliance at intensities > 70% V̇O2PEAK. There were no serious adverse events. There were no changes to M-protein (0.0 ± 1.0 g/L, P =.903), involved FLC (+ 1.8 ± 16.8 mg/L, P =.839), or FLC difference (+ 0.2 ± 15.6 mg/L, P =.946) from pre- to post-exercise training. There were pre- to post-exercise training improvements to diastolic blood pressure (- 3 ± 5 mmHg, P =.033), sit-to-stand test performance (+ 5 ± 5 repetitions, P =.002), and energy/fatigue scores (+ 10 ± 15%, P =.026). Other secondary outcomes were unchanged. CONCLUSIONS A 16-week progressive exercise programme was feasible and safe, but did not reverse MGUS/SMM disease activity, contrasting a prior case study showing that five years of exercise training reversed SMM in a 44-year-old former athlete. Longer exercise interventions should be explored in a group of MGUS/SMM patients, with measurements of disease biomarkers, along with rates of disease progression (i.e., MGUS/SMM to MM). REGISTRATION https://www.isrctn.com/ISRCTN65527208 (14/05/2018).
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Affiliation(s)
- A Emery
- Department for Health, University of Bath, Bath, UK
| | - S Moore
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Crowe
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - J Murray
- Department for Haematology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - O Peacock
- Department for Health, University of Bath, Bath, UK
| | - D Thompson
- Department for Health, University of Bath, Bath, UK
| | - F Betts
- Department for Health, University of Bath, Bath, UK
| | - S Rapps
- Department for Health, University of Bath, Bath, UK
| | - L Ross
- Department for Health, University of Bath, Bath, UK
| | | | | | - R Davies
- Department for Health, University of Bath, Bath, UK
| | - R Lewis
- Department for Physiotherapy, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - D X Augustine
- Department for Health, University of Bath, Bath, UK
- Department for Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - A Whiteway
- Department for Haematology, North Bristol NHS Trust, Bristol, UK
| | - Z Afzal
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jlj Heaney
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M T Drayson
- Clinical Immunology Service, Institute of Immunity and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J E Turner
- Department for Health, University of Bath, Bath, UK
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - J P Campbell
- Department for Health, University of Bath, Bath, UK.
- School of Medical and Health Sciences, Edith Cowan University, WA, Joondalup, Australia.
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McArdle G, Davies R, Lerner IV, Yurkevich IV. Coulomb Blockade in a Nonthermalized Quantum Dot. Phys Rev Lett 2023; 131:206303. [PMID: 38039480 DOI: 10.1103/physrevlett.131.206303] [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: 06/06/2023] [Accepted: 10/12/2023] [Indexed: 12/03/2023]
Abstract
We investigate nonequilibrium transport properties of a quantum dot in the Coulomb blockade regime under the condition of negligible inelastic scattering during the dwelling time of the electrons in the dot. Using the quantum kinetic equation we show that the absence of thermalization leads to a double step in the distribution function of electrons on the dot, provided that it is symmetrically coupled to the leads. This drastically changes nonlinear transport through the dot resulting in an additional (compared to the thermalized case) jump in the conductance at voltages close to the charging energy, which could serve as an experimental manifestation of the absence of thermalization.
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Affiliation(s)
- G McArdle
- School of Physics and Astronomy, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - R Davies
- School of Computer Science and Digital Technologies, Aston University, Birmingham, B4 7ET, United Kingdom
| | - I V Lerner
- School of Physics and Astronomy, University of Birmingham, Birmingham, B15 2TT, United Kingdom
| | - I V Yurkevich
- School of Computer Science and Digital Technologies, Aston University, Birmingham, B4 7ET, United Kingdom
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Barrett JW, Williams J, Skene SS, Griggs JE, Bootland D, Leung J, Da Costa A, Ballantyne K, Davies R, Lyon RM. Head injury in older adults presenting to the ambulance service: who do we convey to the emergency department, and what clinical variables are associated with an intracranial bleed? A retrospective case-control study. Scand J Trauma Resusc Emerg Med 2023; 31:65. [PMID: 37908011 PMCID: PMC10619243 DOI: 10.1186/s13049-023-01138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Most older adults with traumatic brain injuries (TBI) reach the emergency department via the ambulance service. Older adults, often with mild TBI symptoms, risk being under-triaged and facing poor outcomes. This study aimed to identify whether sufficient information is available on the scene to an ambulance clinician to identify an older adult at risk of an intracranial haemorrhage following a head injury. METHODS This was a retrospective case-control observational study involving one regional ambulance service in the UK and eight emergency departments. 3545 patients aged 60 years and over presented to one regional ambulance service with a head injury between the 1st of January 2020 and the 31st of December 2020. The primary outcome was an acute intracranial haemorrhage on head computed tomography (CT) scan in patients conveyed to the emergency department (ED). A secondary outcome was factors associated with conveyance to the ED by the ambulance clinician. RESULTS In 2020, 2111 patients were conveyed to the ED and 162 patients were found to have an intracranial haemorrhage on their head CT scan. Falls from more than 2 m (adjusted odds ratio (aOR) 3.45, 95% CI 1.78-6.40), chronic kidney disease (CKD) (aOR 2.80, 95% CI 1.25-5.75) and Clopidogrel (aOR 1.98, 95% CI 1.04-3.59) were associated with an intracranial haemorrhage. Conveyance to the ED was associated with patients taking anticoagulant and antiplatelet medication or a visible head injury or head injury symptoms. CONCLUSION This study highlights that while most older adults with a head injury are conveyed to the ED, only a minority will have an intracranial haemorrhage following their head injury. While mechanisms of injury such as falls from more than 2 m remain a predictor, this work highlights that Clopidogrel and CKD are also associated with an increased odds of tICH in older adults following a head injury. These findings may warrant a review of current ambulance head injury guidelines.
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Affiliation(s)
- J W Barrett
- South East Coast Ambulance Service NHS FT, Crawley, UK.
- University of Surrey, Guildford, UK.
| | - J Williams
- South East Coast Ambulance Service NHS FT, Crawley, UK
- Paramedic Clinical Research Unit, University of Hatfield, Hatfield, UK
| | | | - J E Griggs
- University of Surrey, Guildford, UK
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
| | - D Bootland
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - J Leung
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - A Da Costa
- Medway Maritime Hospital NHS FT, Gillingham, UK
| | - K Ballantyne
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - R Davies
- South East Coast Ambulance Service NHS FT, Crawley, UK
| | - R M Lyon
- University of Surrey, Guildford, UK
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
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5
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Grocutt H, Davies R, Heales C. Ultrasound compared with projection radiography for the detection of soft tissue foreign bodies - A technical note. Radiography (Lond) 2023; 29:1007-1010. [PMID: 37666114 DOI: 10.1016/j.radi.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Soft tissue foreign bodies (STFBs) present a diagnostic challenge depending on their composition. Untreated complications can arise, namely infection through to loss of function. General (projection) radiography is recommended as the first line imaging examination. However, some STFBs are radiolucent, leading to false negative radiographs. The aim of this in vitro study was to compare ultrasound with projection radiographs for the detection of a range of different types of STFB. METHOD Ethical approval (for use of participants to evaluate images) was granted by the Higher Education Institute's departmental Ethics Committee. Seven hand phantoms were created from a water, gelatine and psyllium mix. A different STFB (radiolucent and radiopaque) was inserted into six phantoms, with the seventh being a control. Ultrasound and projection radiograph images were generated of each phantom. Participants (academics and radiography students) reviewed all images. RESULTS 50 responses were received from a study population of approximately 400, (10 academics, 40 students). The ability of ultrasound to detect radiolucent foreign bodies performs well compared with projection radiography: sensitivity 94% versus 9%, specificity 90% versus 88%. For radiopaque foreign bodies the data was more mixed: sensitivity 96% versus 99%, specificity 90% versus 88%. DISCUSSION These data suggest that ultrasound is superior to projection radiography for the detection of radiolucent STFBs. Limitations include the lack of formal postgraduate ultrasound training within the study population and a lack of simulated bony structure within the hand phantoms. IMPLICATIONS FOR PRACTICE Ultrasound has the potential to be a useful modality in the detection of STFBs, particularly radiolucent objects. There are associated challenges such as conducting ultrasound in the vicinity of a wound, but further exploration of this application of ultrasound is warranted.
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Affiliation(s)
- H Grocutt
- Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, United Kingdom.
| | - R Davies
- University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom.
| | - C Heales
- University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom.
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6
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McArdle G, Davies R, Lerner IV, Yurkevich IV. Coulomb staircase in an asymmetrically coupled quantum dot. J Phys Condens Matter 2023; 35:475302. [PMID: 37549677 DOI: 10.1088/1361-648x/acede0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
We investigate the Coulomb blockade in quantum dots asymmetrically coupled to the leads for an arbitrary voltage bias focusing on the regime where electrons do not thermalise during their dwell time in the dot. By solving the quantum kinetic equation, we show that the current-voltage characteristics are crucially dependent on the ratio of the Fermi energy to charging energy on the dot. In the standard regime when the Fermi energy is large, there is a Coulomb staircase which is practically the same as in the thermalised regime. In the opposite case of the large charging energy, we identify a new regime in which only one step is left in the staircase, and we anticipate experimental confirmation of this finding.
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Affiliation(s)
- G McArdle
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - R Davies
- School of Informatics and Digital Engineering, Aston University, Birmingham B4 7ET, United Kingdom
| | - I V Lerner
- School of Physics and Astronomy, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - I V Yurkevich
- School of Informatics and Digital Engineering, Aston University, Birmingham B4 7ET, United Kingdom
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Davies R, Carpanini J, Cross N, Stephenson BM. A 'provocative' MRI: the detective in ambiguous groin symptoms? Hernia 2023:10.1007/s10029-023-02787-y. [PMID: 37071378 DOI: 10.1007/s10029-023-02787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 04/19/2023]
Affiliation(s)
- R Davies
- Departments of Radiology and Surgery, St Joseph's Private Hospital, Newport, South Wales, UK
| | - J Carpanini
- Departments of Radiology and Surgery, St Joseph's Private Hospital, Newport, South Wales, UK
| | - N Cross
- Departments of Radiology and Surgery, St Joseph's Private Hospital, Newport, South Wales, UK
| | - B M Stephenson
- Departments of Radiology and Surgery, St Joseph's Private Hospital, Newport, South Wales, UK.
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Hernandez NB, Radel L, Butts R, Bano M, Lantz J, Davies R, Lacelle C, Ellimuttil T. New Desensitization Strategy: Daratumumab for Highly Sensitized Pediatric Heart Transplant Candidate. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1319] [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: 04/05/2023] Open
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Ramirez CB, Shezad M, VanderPluym C, Bleiweis M, Tunuguntla H, Joong A, Rosenthal D, Lorts A, Auerbach S, Adachi I, Davies R, O'Connor M. Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Outcomes Report. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.025] [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: 04/05/2023] Open
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Davies R, Wilson E, Richfield E, Mundy C, Wright B, Stratton E. 1230 PALLIATIVE CARE MOVEMENT DISORDERS MULTIDISCIPLINARY MEETING. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.091] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
It is well recognised that patients with Parkinson’s disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting.
Method
In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson’s practitioners and palliative care specialists. Referring clinicians all actively applied primary palliative care approaches within their existing services. Aims of the meeting were to facilitate holistic management of complex needs, support advance care planning (ACP) and consider referral to specialist palliative care services.
Result
37 patients in total were discussed over a 2-year period (although the service was limited for a time due to COVID pressures). On average 3 new patients were discussed per meeting. Reasons for referral included motor and non-motor symptoms, support with ACP, medication advice, caregiver concerns and emotional distress. Meeting outcomes included medication adjustments, expediting reviews, hospice support, carer support, and referral to other services. Since the meetings started 23 (62%) patients have died. Of these, 30% died in hospital compared with the national average of 43.4%. The average between discussion at the meeting and death was 139 days. The meeting has generated education opportunities, triggered joint assessments and a professionals’ framework for the palliative management of patients with a movement disorder.
Conclusions
We present the experience of an MDT embedded within an early integrated palliative care service for movement disorders. The MDT has strengthened partnership working and findings suggest that alongside active primary palliative care, specialist palliative care for PD can be sustainable and resource efficient in a UK setting.
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Affiliation(s)
- R Davies
- University Hospitals Bristol and Weston NHS Trust Dept of Elderly Care
| | - E Wilson
- Yeovil District Hospital Dept of Stroke Medicine
| | - E Richfield
- North Bristol NHS Trust Dept of Elderly Care
| | | | | | - E Stratton
- University Hospitals Bristol and Weston NHS Trust Dept of Elderly Care
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Lane SF, Harvey-Jones E, Ward O, Davies R. Renal replacement and extracorporeal therapies in critical care: current and future directions. Acute Med 2023; 22:154-162. [PMID: 37746685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
There are a wide number of indications for extracorporeal therapies in the critical care environment. A common indication seen by the acute physician is continuous renal replacement therapy (CRRT) in a proportion of patients with acute kidney injury. It is therefore important that acute physicians have a sound understanding of the principles of CRRT in the acutely unwell patient. This review will outline the indications for its use, commonly used methods and anticoagulation considerations. It will discuss when to start and stop CRRT as well as describing potential treatment complications. This review will also discuss the role of therapeutic plasma exchange in critical care and novel extracorporeal therapies including blood purification in sepsis and carbon dioxide removal in acute respiratory distress syndrome and acute exacerbations of obstructive lung disease. Extracorporeal membrane oxygenation is outside of the scope of this article.
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Affiliation(s)
- S F Lane
- MBBS BSc MRCP(UK) (2018) FRCA FFICM Registrar in Intensive Care Medicine & Anaesthesia, Imperial College Healthcare NHS Trust
| | - E Harvey-Jones
- MBChB, MRCP Registrar in Clinical Oncology, The Breast Cancer Now Research Unit, Guy's Hospital Cancer Centre, The City of London Cancer Research UK Centre, Kings College London
| | - O Ward
- MBChB, CT3 Anaesthetics, University Hospitals Sussex NHS Trust
| | - R Davies
- MBChB MRCP FRCA EDIC FFICM MD(Res) Consultant in Intensive Care Medicine & Anaesthesia, Chelsea & Westminster Hospital NHS Foundation Trust
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Hughes RK, Shiwani H, Rosmini S, Burke L, Pierce I, Castelletti S, Xue H, Kellman P, Lopes LR, Treibel T, Manisty C, Captur G, Davies R, Moon J. Improved diagnostic accuracy for apical hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1553] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The diagnosis of apical hypertrophic cardiomyopathy (ApHCM) is contingent on demonstrating apical maximum wall thickness (MWT) of ≥15mm; the same threshold as other HCM subtypes. However, the myocardium naturally tapers towards the apex in healthy individuals, so ≥15mm MWT is proportionately higher in the apex than in naturally thicker basal segments. Using cardiac magnetic resonance (CMR), relative ApHCM has been described (typical ECG features, loss of apical tapering, cavity obliteration but hypertrophy <15mm). Wall thickness measurement using machine learning now exceeds human performance.
Purpose
We aimed to redefine the optimal diagnostic threshold for ApHCM using segment-specific criteria based on a large cohort of healthy control subjects.
Methods
Segmental wall thickness was measured using healthy subjects from the UK Biobank using a clinically validated machine learning algorithm1,2. A normative reference range was established for all 16 segments, conditioned to body surface area (BSA), sex and age. Derived segment-specific wall thickness thresholds were used to define optimal disease thresholds for patients clinically managed with overt (MWT ≥15mm) and relative ApHCM (MWT <15mm, but typical ECG and imaging findings).
Results
4118 UK biobank subjects were used to define normal segmental thicknesses and reference ranges. These were applied to ApHCM (73 overt, 31 relative). There were no apical wall thickness age related differences. The upper limit of the 95% confidence interval corresponded to a combined maximum apical MWT for both males and females of 10.4mm using non-indexed measurement, or 5.6mm/m2 when indexed to BSA. Non-indexed segmental threshold identified 100% of ApHCM patients (true positives), 81% (25 of 31) relative ApHCM and 3% (115 of 4118) of healthy UK biobank subjects (false positives). Indexed segmental thresholds improved the diagnostic potential in relative ApHCM without an increase in false positives (100% of ApHCM patients, 84% (26 of 31) of relative ApHCM patients, and 3% healthy UK biobank (127 of 4118).
Conclusion
We propose new diagnostic criteria for ApHCM using segmental indexed apical wall thickness of >5.6 mm/m2 to better identify inappropriate apical hypertrophy in those whose wall thickness does not meet current criteria for diagnosis.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- R K Hughes
- Barts Heart Centre , London , United Kingdom
| | - H Shiwani
- Barts Heart Centre , London , United Kingdom
| | - S Rosmini
- King's College Hospital , London , United Kingdom
| | - L Burke
- University College London , London , United Kingdom
| | - I Pierce
- Barts Heart Centre , London , United Kingdom
| | - S Castelletti
- Italian Auxological Institute San Luca Hospital , Milan , Italy
| | - H Xue
- National Institutes of Health , Bethesda , United States of America
| | - P Kellman
- National Institutes of Health , Bethesda , United States of America
| | - L R Lopes
- Barts Heart Centre , London , United Kingdom
| | - T Treibel
- Barts Heart Centre , London , United Kingdom
| | - C Manisty
- Barts Heart Centre , London , United Kingdom
| | - G Captur
- University College London , London , United Kingdom
| | - R Davies
- University College London , London , United Kingdom
| | - J Moon
- Barts Heart Centre , London , United Kingdom
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Malcolmson JW, Hughes RK, Shiwani H, Husselbury T, Procter W, Godec T, Davies R, Omahony C, Moon J, Dhinoja MB, Petersen SE, Mohiddin SA. Cardiac magnetic resonance imaging predictors of ventricular arrhythmia in mid-cavity obstructive hypertrophic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.257] [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/Introduction
Left ventricular (LV) mid-cavity obstruction (LVMCO) in hypertrophic cardiomyopathy (HCM) is an uncommon phenotypic feature predisposed to the formation of myocardial fibrosis and apical aneurysms (LVAA). These features may be independently proarrhythmic, and LVAA is considered a class 2a indication for implantable cardioverter defibrillator (ICD) in current US, but not European guidelines for the primary prevention of sudden cardiac death (SCD). Cardiac magnetic resonance (CMR) imaging is the preferred modality for detecting these and other phenotypic features critical to SCD risk assessment.
Purpose
To assess the ability of CMR imaging parameters to predict occurrence of non-sustained ventricular tachycardia (NSVT) in HCM patients with Doppler-derived evidence of LVMCO.
Methods
Multi-modality imaging records were retrospectively assessed to identify HCM patients with Doppler-LVMCO and CMR scans. CMR images were assessed by an investigator blinded to clinical status. Late gadolinium enhancement (LGE) was quantified using the full-width, half-maximum technique. CMR imaging parameters were assessed for predictive ability using Cox proportional hazards during univariate and multivariate analyses, accounting for time to event (NSVT or censorship of follow-up).
Results
The study cohort included 58 patients (57±11 years, 74% male) with a median follow-up of 6.2 (IQR 4.3) years. Mean mid-cavity gradient was 33±23 mmHg. NSVT was detected in 27/58 (47%) patients, was 4 beats or longer in 23/27 (85%) and was monomorphic in 21/27 (77%).
On univariate analysis, predictors of NSVT during follow-up include LV mass index (HR 1.02, 95% CI 1.00–1.04, p=0.03), LGE in grams (HR 1.04, 95% CI 1.01–1.06, p=0.005), and LVAA (HR 2.57, 95% CI 1.14–5.79, p=0.023). After multivariate adjustment (Table 2), none were significantly associated.
Conclusions
In LVMCO, magnitude of LV hypertrophy, extent of LGE and the presence of an apical aneurysm may not be independent predictors of ventricular arrhythmias. SCD algorithms based on qualitative assessments of these features may overestimate risk.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Health Research (NIHR)
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Affiliation(s)
- J W Malcolmson
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - R K Hughes
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - H Shiwani
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - T Husselbury
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - W Procter
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - T Godec
- William Harvey Research Institute , London , United Kingdom
| | - R Davies
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - C Omahony
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - J Moon
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - M B Dhinoja
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - S E Petersen
- Barts Health NHS Trust, Cardiology , London , United Kingdom
| | - S A Mohiddin
- Barts Health NHS Trust, Cardiology , London , United Kingdom
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Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Ndirika S, Davies R, Kodera A, Yallapa S, Koo V. Closed-loop audit of antibiotic stewardship in ureteroscopic stone surgery. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00210-x] [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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McLaney E, Morassaei S, Hughes L, Davies R, Campbell M, Di Prospero L. A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours. Healthc Manage Forum 2022; 35:112-117. [PMID: 35057649 PMCID: PMC8873279 DOI: 10.1177/08404704211063584] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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] [Indexed: 11/15/2022]
Abstract
Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.
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Affiliation(s)
- Elizabeth McLaney
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, Ontario, Canada
| | - Sara Morassaei
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Leanne Hughes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robyn Davies
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Mikki Campbell
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Pitt L, Morgan M, Moffatt M, Edwards P, Davies R, Peach C, Littlewood C. Rehabilitation following shoulder arthroplasty: A survey of protocols. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodriguez VV, Tello CA, Piantoni L, Wilson IAF, Galareto E, Remondino RG, Bersusky SE, Davies R, Noel MA. Chiari 1: Is decompression always necessary previous to scoliosis surgery? Spine Deform 2021; 9:1253-1258. [PMID: 33792837 DOI: 10.1007/s43390-021-00336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
The association between Chiari 1 malformation and scoliosis is well known in the literature. Prevalence has increased after the advent of magnetic resonance imaging. In children with this association, prophylactic suboccipital decompression prior to scoliosis correction is a common surgical procedure although the rationale for this surgical management and whether not performing it may lead to spinal cord injury has not been clearly elucidated. We conducted a systematic review of the literature with the aim to obtain strong data to support the hypothesis that it is safe to proceed with scoliosis correction without prior prophylactic suboccipital decompression for Chiari 1 in an asymptomatic population. Using the Prisma methodology, we analyzed 3250 studies published between 1972 and 2018. Only four studies met the inclusion criteria. None of the studies had a level of evidence high enough to recommend prophylactic decompression previous to correction of the spinal deformity.
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Affiliation(s)
- V Vazquez Rodriguez
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - C A Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - L Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina.
| | - I A Francheri Wilson
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - E Galareto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - R G Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - S E Bersusky
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - R Davies
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - M A Noel
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
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Jiwan N, Ark A, Middup R, Rasaiah S, Davies R, Hyde TP, Keeling A. A Comparative study on the Effectiveness of Augmented Reality on Denture Tooth Selection. Eur J Prosthodont Restor Dent 2021; 29. [PMID: 33770423 DOI: 10.1922/ejprd_2132ark09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One of the most difficult aspects of providing removable dentures, for both the patient and the dentist, is the tooth selection process. The aim of this study was to assess the effectiveness of augmented reality (AR) on patient experience of the tooth selection process. MATERIALS AND METHODS 3D scanning of upper anterior teeth of various shapes and sizes allowed for the creation of a virtual library that were subsequently used to programme an AR software application, 'ToothPick'. Seventeen participants were recruited to a comparative study at Leeds Dental Institute, over two clinical appointments, to trial the app and complete a 10-question survey to assess the efficacy of AR simulation. The sample size response generated outcome variables for 'perceived usefulness' and 'perceived ease of use' from the perspectives of the patient, dentist and technician. RESULTS By the second appointment, 86% of participants preferred the app over the conventional methods for selection of denture teeth due to increased ease of use and accuracy that AR simulation had in replicating the wax try-in. CONCLUSION The sample population favoured the adoption of AR technology to select denture teeth from the perspective of both the patient and the clinician.
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Affiliation(s)
- N Jiwan
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
| | - A Ark
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
| | - R Middup
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
| | - S Rasaiah
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
| | - R Davies
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
| | - T P Hyde
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
| | - A Keeling
- Leeds Dental Institute, University of Leeds. Worsley Building, Clarendon Way, Woodhouse, Leeds LS2 9LU
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McCloskey M, Malpass J, Davies R, Mant M, Treasure P, Webster A. PD-0796 Auditing prescribing practice in Advanced Practitioner Therapeutic Radiographers (RTTs). Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07075-4] [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: 11/28/2022]
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Seraphim A, Knott K, Menacho K, Augusto J, Davies R, Joy G, Hui X, Treibel T, Cooper J, Petersen S, Fontana M, Hughes A, Moon J, Manisty C, Kellman P. Comparison of the prognostic value of stress and rest pulmonary transit time estimation using myocardial perfusion CMR. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Background
Pulmonary transit time (PTT) is a quantitative biomarker of cardiopulmonary status. Rest PTT was previously shown to predict outcomes in specific disease models, but clinical adoption is hindered but challenges in data acquisition. Whether evaluation of PTT during stress encodes incremental prognostic information has not been previously investigated as scale.
Objectives
To compare the prognostic value of stress and rest PTT derived from a fully automated, in-line method of estimation using perfusion CMR, in a large patient cohort.
Methods
A retrospective two-center study of patients referred clinically for adenosine stress myocardial perfusion assessment using CMR. Analysis of right and left ventricular cavity arterial input function curves from first pass perfusion was performed automatically, allowing the in-line estimation of both rest and stress PTT. Association with major adverse cardiovascular events (MACE) was evaluated. MACE was defined as a composite outcome of myocardial infarction, stroke, heart failure admission and ventricular tachycardia or appropriate ICD treatment (including ICD shock and/or anti-tachycardia pacing).
Results
985 patients (67% male, median age 62 years (IQR 52,71)) were included, with median left ventricular ejection fraction (LVEF) of 62% (IQR 54-69). Median stress PTT was shorter than rest PTT 6.2 (IQR 5.1, 7.7) seconds versus 7.7 (IQR, 6.4, 9.2) seconds. Stress and rest PTT were highly correlated (r = 0.69; p < 0.001). Stress PTT also correlated with LVEF (r=-0.37), stress MBF (r=-0.31), LVEDVi (r = 0.24), LA area index (r = 0.32) (p < 0.001 for all). Over a median follow-up period of 28.6 (IQR, 22.6 35,7) months, MACE occurred in 61 (6.2%) patients. After adjusting for prognostic factors, both rest and stress PTT, independently predicted MACE, but not all-cause mortality. For every 1xSD (2.39s) increase in rest PTT the adjusted hazard ratio (HR) for MACE was 1.43 (95% CI 1.10-1.85, p = 0.007). The hazard ratio for one standard deviation (2.64s) increase in stress PTT was 1.34 (95% CI 1.048-1.723; p = 0.020) after adjusting for age, LVEF, hypertension, diabetes, sex and presence of LGE
Conclusions
In this 2-center study of 985 patients, we deploy a fully automated method of PTT estimation using perfusion mapping with CMR and show that both stress and rest PTT are independently associated with adverse cardiovascular outcomes. In this patient cohort, there is no clear incremental prognostic value of stress PTT, over its evaluation during rest.
Figure 1. Stress and Rest Pulmonary Transit Time estimation using myocardial perfusion CMR
Figure 2. Event-free survival curves for major adverse cardiovascular events (Heart failure hospitalization, myocardial infarction, stroke and ventricular tachycardia/ICD treatment) according to mean rest PTT (8.05seconds) and mean stress PTT (6.7seconds). Log-rank for both p < 0.05
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Affiliation(s)
- A Seraphim
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Knott
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - K Menacho
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Augusto
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - G Joy
- St Bartholomew"s Hospital, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - X Hui
- National Institutes of Health, Bethesda, United States of America
| | - T Treibel
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Cooper
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Petersen
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - A Hughes
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- University College London, Institute of Cardiovascular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
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Joy G, Artico J, Kurdi H, Lau C, Adam RD, Menacho KM, Pierce I, Captur G, Davies R, Schelbert EB, Fontana M, Kellman P, Treibel TA, Manisty C, Moon JC. Prospective case-control study of cardiovascular abnormalities six months following mild COVID-19 in healthcare workers. Eur Heart J Cardiovasc Imaging 2021. [PMCID: PMC8344927 DOI: 10.1093/ehjci/jeab090.064] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Barts Charity UCLH Charity
OnBehalf
COVIDsortium
Background
Recent CMR studies have reported cardiac abnormalities after COVID-19 are common, even after mild, non-hospitalised illness with evidence of ongoing myocardial inflammation. Such a prevalence of chronic myocarditis after mild disease has prompted societal concerns in diverse domains, and suggests that screening should be considered post COVID-19, even in asymptomatic individuals. Cardiovascular magnetic resonance (CMR) has proven utility for diagnosis in patients with COVID-19 infection and elevated troponin from unclear causes by measuring cardiac structure, function, myocardial scar (late gadolinium enhancement) and oedema (T1 and T2 mapping).
Objectives
We aimed to determine the prevalence and extent of late cardiac and cardiovascular sequelae after mild non-hospitalised SARS-CoV-2 infection.
Methods
Participants were recruited from COVIDsortium, a three-hospital prospective study of 731 healthcare workers who underwent first wave weekly symptom, PCR and serology assessment over 4 months, with seroconversion in 21.5% (n = 157). At 6 months post infection, 74 seropositive and 75 age-, sex-, ethnicity-matched seronegative controls were recruited for cardiovascular phenotyping (comprehensive phantom-calibrated Cardiovascular Magnetic Resonance and blood biomarkers). Analysis was blinded, using objective AI analytics where available.
Results
149 subjects (mean age 37 years, range 18-63, 58% female) were recruited. Seropositive infections had been mild with case definition/non-case definition/asymptomatic disease in 45(61%), 18(24%) and 11(15%) with one person hospitalised (for 2 days). Between seropositive and seronegative groups, there were no differences in cardiac structure (left ventricular volumes, mass; atrial area), function (ejection fraction, global longitudinal shortening, aortic distensibility), tissue characterisation (T1, T2, ECV mapping, late gadolinium enhancement) or biomarkers (troponin, NT-proBNP). With abnormal defined by the 75 seronegatives (2 standard deviations from mean, e.g. EF < 54%, septal T1 > 1072ms, septal T2 > 52.4ms), individuals had abnormalities including reduced EF (n = 2, minimum 50%), T1 elevation (n = 6), T2 elevation (n = 9), LGE (n = 13, median 1%, max 5% of myocardium), biomarker elevation (borderline troponin elevation in 4; all NT-proBNP normal). These were distributed equally between seropositive and seronegative individuals.
Conclusions
Cardiovascular abnormalities are no more common in seropositive vs seronegative otherwise healthy, workforce representative individuals 6 months post mild SARS-CoV-2 infection. Our study provides societal reassurance for the cardiovascular health of working-aged individuals with convalescence from mild SARS-CoV-2. Screening asymptomatic individuals following mild diseases is not indicated.
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Affiliation(s)
- G Joy
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J Artico
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Kurdi
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Queen Mary University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - RD Adam
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - KM Menacho
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - I Pierce
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - G Captur
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- University College of London, London, United Kingdom of Great Britain & Northern Ireland
| | - EB Schelbert
- University of Pittsburgh, Pittsburgh, United States of America
| | - M Fontana
- Royal Free Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - TA Treibel
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - JC Moon
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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Benton S, Rier J, Davies R, Harvey J, Schuler B, Tolerico P, Hill A, Veillet-Chowdhury M. One-stop-shop Strategy For Concurrent Diagnosis And Treatment Of Ambulatory Patient With Stable Chest Pain: Feasibility, Case Example And Workflow Using A Hybrid Angio-CT System. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.176] [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: 10/20/2022]
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Whitfield C, Adamson M, Davies R. The effect of coincidental SARS-CoV-2 infection on pre-operative cardiopulmonary exercise testing. Anaesth Rep 2021; 9:122-126. [PMID: 34142086 PMCID: PMC8188990 DOI: 10.1002/anr3.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/11/2022] Open
Abstract
This case report demonstrates the significant impact active infection with SARS-CoV-2 can have on functional capacity evaluated by cardiopulmonary exercise testing, even in minimally symptomatic individuals. A 75-year-old man underwent cardiopulmonary exercise testing before a right hemicolectomy; SARS-CoV-2 was incidentally diagnosed following his test. The patient underwent a period of isolation and recovery before a second pre-operative cardiopulmonary exercise test 6 weeks later. His resting pulmonary function tests did not vary between tests but his peak work, anaerobic threshold, oxygen pulse, pulse oximetry nadir, ventilation perfusion matching and heart rate response to exercise all improved significantly after this recovery period. These are unique results that add to the existing knowledge of the pathophysiology and management of SARS-CoV-2 in the peri-operative setting. While our patient demonstrated dramatic improvement in his functional capacity following 6 weeks of recovery, he remained in a high-risk group for surgery according to our local guidelines. Cardiopulmonary exercise testing has a valuable role in individualised risk assessment and shared decision-making in complex, urgent surgical cases where the benefits of delaying surgery to recover from SARS-CoV-2 infection should be balanced against the potential risks.
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Affiliation(s)
- C Whitfield
- Department of Anaesthesia University Hospital of Wales Cardiff UK
| | - M Adamson
- Department of Anaesthesia University Hospital of Wales Cardiff UK
| | - R Davies
- Department of Anaesthesia University Hospital of Wales Cardiff UK
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Lauper K, Kearsley-Fleet L, Davies R, Watson K, Lunt M, Hyrich K. OP0241 SERIOUS INFECTION WITH TOCILIZUMAB COMPARED TO TNF-INHIBITORS AND OTHER BDMARDS IN RHEUMATOID ARTHRITIS PATIENTS: DOES LINE OF THERAPY MATTER? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In the real-world, tocilizumab is prescribed to a population of patients different from those prescribed TNF-inhibitors, often older with longer disease duration, worse functional status and more previous b- or tsDMARDs.Objectives:The aim of this study was to evaluate if and how the risk of serious infection on tocilizumab and other bDMARDs differs when stratifying by line of therapy in a real-world population of rheumatoid arthritis patients.Methods:We included patients registered in the BSRBR-RA treated with tocilizumab, etanercept, adalimumab, infliximab, certolizumab, abatacept or rituximab, including biosimilars. Primary outcome was the occurrence of a serious infection (defined as infection requiring hospitalisation, intravenous antibiotics or resulting in death). Primary covariate of interest was line of therapy (from first to fifth line of therapy). Every change to another b- or tsDMARD was considered a new line of therapy, but not a change between a bio-original and a biosimilar.Hazard ratios (HR) of serious infections were estimated using an inverse probability weighted Cox regression, based on a propensity score including baseline patient and disease characteristics, and adjusting for time in study (see Table). The reference group was etanercept, which included the highest number of patients. Treatment exposure was analysed without and with stratification by line of therapy.Table.NETNTCZADAIFXCERTRTXABAN33,91610,6552,6327,8394,4301,6165,5561,188Patient-years19,1294,34214,5048,1352,72612,0091,686Infections8071926814817443374Incidence per 100 patient-years (95%CI)4.2 (3.9-4.5)4.4 (3.8-5.1)4.7 (4.4-5.1)5.9 (5.4-6.6)2.7 (2.2-3.4)3.6 (3.3-4.0)4.0 (3.2-5.1)Unadjusted HR (95%CI)Ref.1.0 (0.9-1.2)1.1 (1.0-1.2)1.4 (1.2-1.6)0.6 (0.5-0.8)0.9 (0.8-1.0)0.9 (0.7-1.2)Adjusted HR* (95% CI)All lines of therapy33,916Ref.1.2 (1.0-1.5)1.1 (1.0-1.3)1.3 (1.1-1.6)0.8 (0.6-1.0)1.0 (0.8-1.1)1.2 (0.8-1.7)1stline16,152Ref.0.9 (0.5-1.5)1.1 (1.0-1.3)1.3 (1.1-1.6)0.6 (0.5-0.9)1.6 (1.2-2.2)-2ndline10,378Ref.1.4 (1.0-2.0)1.1 (0.9-1.4)1.1 (0.7-1.6)0.9 (0.4-2.2)1.0 (0.8-1.2)0.9 (0.5-1.9)3rdline4,676Ref.1.4 (0.9-2.3)1.3 (0.8-2.2)0.9 (0.4-1.9)0.9 (0.3-2.9)0.8 (0.5-1.2)1.5 (0.7-2.9)4thline1,947Ref.1.0 (0.5-2.3)1.3 (0.4-3.7)1.4 (0.5-4.4)0.2 (0.0—2.1)1.0 (0.5.-2.2)0.9 (0.4-2.3)5thline763Ref.0.9 (0.2-3.5)2.5 (0.5-12.4)0.7 (0.1-7.1)3.3 (0.6-18.4)0.9 (0.2-3.5)0.8 (0.2-3.5)ABA, abatacept; ADA, adalimumab; CERT, certolizumab; ETN, etanercept; HR, hazard ratio; IFX, infliximab; RTX, rituximab; TCZ, tocilizumab*Adjusted using inverse probably weighting (with age, gender, concomitant steroids, concomitant DMARDs, comorbidities, seropositivity, smoking, disease duration, HAQ and DAS28 at baseline in the model) and time since study entry (categorised from 0 to 4, 0 starting just before or at the moment of entering study, 1 starting during the first year, 2 starting during the second year until 4 for the fourth year and more)Results:A total of 33,916 treatment courses were included (Table) contributing to 62,532 years of follow-up. Compared to etanercept, participants starting abatacept, tocilizumab and rituximab were older, had more previous bDMARDs, longer disease duration and more comorbidities. The crude HR of serious infections were higher with infliximab and adalimumab, lower with certolizumab and rituximab, and not significantly different for abatacept and tocilizumab compared to etanercept. After adjustment, HR of serious infections were higher with tocilizumab, adalimumab and infliximab. However, when stratified by line of therapy, HR were no longer significantly different compared to etanercept for tocilizumab, adalimumab and infliximab for most lines of therapy.Conclusion:Whilst initially there appears to be a difference in rates of serious infection between biologic therapies, line of therapy may be a confounding factor when comparing the risk of serious infections between bDMARDs.Disclosure of Interests:Kim Lauper Consultant of: Gilead-galapagos, Grant/research support from: AbbVie, Lianne Kearsley-Fleet: None declared, Rebecca Davies: None declared, Kath Watson: None declared, Mark Lunt: None declared, Kimme Hyrich Consultant of: AbbVie, Grant/research support from: Pfizer, BMS
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De Lucia A, Card RM, Duggett N, Smith RP, Davies R, Cawthraw SA, Anjum MF, Rambaldi M, Ostanello F, Martelli F. Reduction in antimicrobial resistance prevalence in Escherichia coli from a pig farm following withdrawal of group antimicrobial treatment. Vet Microbiol 2021; 258:109125. [PMID: 34033985 DOI: 10.1016/j.vetmic.2021.109125] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
An important element in the control of antimicrobial resistance (AMR) is reduction in antimicrobial usage. In the veterinary sector individual antimicrobial treatment of livestock, rather than the use of group treatment, can help achieve this goal. The aim of this study was to investigate how cessation of group antimicrobial treatment impacted the prevalence of AMR in commensal Escherichia coli in pigs at one farm over an 11-month period. Minimum inhibitory concentrations of eight antimicrobials were determined for 259 E. coli isolates collected during the study. A significant reduction in the prevalence of multidrug resistance and a significant increase in the proportion of full susceptibility to the panel of nine antimicrobials tested was seen after 11 months. Whole genome sequencing of 48 multidrug resistant isolates revealed E. coli clones that persisted across multiple visits and provided evidence for the presence of plasmids harbouring AMR genes shared across multiple E. coli lineages. E. coli were also isolated from on-farm environmental samples. Whole genome sequencing of one multidrug resistant isolate obtained from cleaning tools showed it was clonal to pig-derived E. coli that persisted on the farm for 11 months. In this study we provide evidence that withdrawal of group antimicrobial use leads to significant reductions in key indicators for AMR prevalence and the importance of the farm environment as a reservoir of resistant bacteria. These findings support policy makers and producers in the implementation of measures to control AMR and reduce antimicrobial use.
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Affiliation(s)
- A De Lucia
- Dipartimento di Scienze Mediche Veterinarie Università di Bologna, Italy; Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - R M Card
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - N Duggett
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - R P Smith
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - R Davies
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - S A Cawthraw
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - M F Anjum
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
| | - M Rambaldi
- Dipartimento di Scienze Mediche Veterinarie Università di Bologna, Italy.
| | - F Ostanello
- Dipartimento di Scienze Mediche Veterinarie Università di Bologna, Italy.
| | - F Martelli
- Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, KT15 3NB, UK.
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Katsogridakis E, Lea T, Yap T, Batchelder A, Saha P, Diamantopoulos A, Saratzis N, Davies R, Zayed H, Bown MJ, Saratzis A. Acute kidney injury following endovascular intervention for peripheral artery disease. Br J Surg 2021; 108:152-159. [PMID: 33711140 DOI: 10.1093/bjs/znaa057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/21/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors. METHODS Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death. RESULTS Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality. CONCLUSION AKI is a common complication after intervention for PAD and is associated with medium-term mortality.
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Affiliation(s)
- E Katsogridakis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - T Lea
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - T Yap
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Batchelder
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - P Saha
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Diamantopoulos
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - N Saratzis
- Department of Vascular Surgery, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - R Davies
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - H Zayed
- Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - M J Bown
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - A Saratzis
- Department of Cardiovascular Sciences and National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.,Department of Vascular Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Sweat K, Power A, Dykes J, Ma M, Davies R, Hollander S, Profita E, Rosenthal D, Chen C, Almond C. UNOS Match Runs for Pediatric Heart Transplant Organ Allocation—How Well Do They Sequence Patients Based on Medical Urgency? J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1832] [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: 11/17/2022] Open
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Shezad M, Rosenthal D, Larkins C, Heile T, Zafar F, Jeewa A, Barnes A, Lorts A, Joong A, Kwiatkowski D, Sutcliffe D, Sparks J, Simpson K, Ploutz M, Ghanayem N, Niebler R, Davies R, Auerbach S. The Adjudication Process at ACTION - Providing Real-World High-Quality Data. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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Shirazian AA, Davies R. Dental school before or after core surgical training? Consideration for medically qualified junior trainees prior to embarking on - their second degree. Br J Oral Maxillofac Surg 2021; 60:34-35. [PMID: 34261607 DOI: 10.1016/j.bjoms.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Medical graduates who are interested in pursuing a career in oral and maxillofacial surgery require attainment of a degree in dental surgery (BDS). A common question facing this cohort of junior trainees is whether to study dentistry before or after core surgical training; both routes have advantages and disadvantages that must be considered. Here we provide our perspective into this common dilemma.
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Affiliation(s)
| | - R Davies
- King's College Hospital, United Kingdom
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32
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Antonelli M, Capdevila J, Chaudhari A, Granerod J, Canas LS, Graham MS, Klaser K, Modat M, Molteni E, Murray B, Sudre CH, Davies R, May A, Nguyen LH, Drew DA, Joshi A, Chan AT, Cramer JP, Spector T, Wolf J, Ourselin S, Steves CJ, Loeliger AE. Optimal symptom combinations to aid COVID-19 case identification: Analysis from a community-based, prospective, observational cohort. J Infect 2021; 82:384-390. [PMID: 33592254 PMCID: PMC7881291 DOI: 10.1016/j.jinf.2021.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/17/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 01/10/2023]
Abstract
Objectives Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health. Methods UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity. Findings UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC. Interpretation We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.
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Affiliation(s)
- M Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - A Chaudhari
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
| | - J Granerod
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
| | - L S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - M S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - K Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - M Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - E Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - B Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - C H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; MRC Unit for Lifelong Health and Ageing at UCL/Centre for Medical Image Computing, Department of Computer Science, UCL, London, United Kingdom
| | - R Davies
- Zoe Global, London, United Kingdom
| | - A May
- Zoe Global, London, United Kingdom
| | - L H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - D A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - A Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - A T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - J P Cramer
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
| | - T Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - J Wolf
- Zoe Global, London, United Kingdom
| | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom.
| | - A E Loeliger
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
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Antonelli M, Capdevila J, Chaudhari A, Granerod J, Canas LS, Graham MS, Klaser K, Modat M, Molteni E, Murray B, Sudre CH, Davies R, May A, Nguyen LH, Drew DA, Joshi A, Chan AT, Cramer JP, Spector T, Wolf J, Ourselin S, Steves CJ, Loeliger AE. Optimal symptom combinations to aid COVID-19 case identification: analysis from a community-based, prospective, observational cohort. medRxiv 2021:2020.11.23.20237313. [PMID: 33269364 PMCID: PMC7709185 DOI: 10.1101/2020.11.23.20237313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health. METHODS UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity. FINDINGS UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC. INTERPRETATION We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.
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Affiliation(s)
- M Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - A Chaudhari
- Coalition for Epidemic Preparedness Innovations, London, UK
| | - J Granerod
- Coalition for Epidemic Preparedness Innovations, London, UK
| | - L S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - K Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - E Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - B Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL/Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | - L H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - D A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - J P Cramer
- Coalition for Epidemic Preparedness Innovations, London, UK
| | - T Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - A E Loeliger
- Coalition for Epidemic Preparedness Innovations, London, UK
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Keating C, Bolton-Warberg M, Hinchcliffe J, Davies R, Whelan S, Wan AHL, Fitzgerald RD, Davies SJ, Ijaz UZ, Smith CJ. Temporal changes in the gut microbiota in farmed Atlantic cod (Gadus morhua) outweigh the response to diet supplementation with macroalgae. Anim Microbiome 2021; 3:7. [PMID: 33500003 PMCID: PMC7934267 DOI: 10.1186/s42523-020-00065-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aquaculture successfully meets global food demands for many fish species. However, aquaculture production of Atlantic cod (Gadus morhua) is just 2.5% of total market production. For cod farming to be a viable economic venture specific challenges on how to increase growth, health and farming productivity need to be addressed. Feed ingredients play a key role here. Macroalgae (seaweeds) have been suggested as a functional feed supplement with both health and economic benefits for terrestrial farmed animals and fish. The impact of such dietary supplements to cod gut integrity and microbiota, which contribute to overall fish robustness is unknown. The objective of this study was to supplement the diet of juvenile Atlantic cod with macroalgae and determine the impacts on fish condition and growth, gut morphology and hindgut microbiota composition (16S rRNA amplicon sequencing). Fish were fed one of three diets: control (no macroalgal inclusion), 10% inclusion of either egg wrack (Ascophyllum nodosum) or sea lettuce (Ulva rigida) macroalgae in a 12-week trial. RESULTS The results demonstrated there was no significant difference in fish condition, gut morphology or hindgut microbiota between the U. rigida supplemented fish group and the control group at any time-point. This trend was not observed with the A. nodosum treatment. Fish within this group were further categorised as either 'Normal' or 'Lower Growth'. 'Lower Growth' individuals found the diet unpalatable resulting in reduced weight and condition factor combined with an altered gut morphology and microbiome relative to the other treatments. Excluding this group, our results show that the hindgut microbiota was largely driven by temporal pressures with the microbial communities becoming more similar over time irrespective of dietary treatment. The core microbiome at the final time-point consisted of the orders Vibrionales (Vibrio and Photobacterium), Bacteroidales (Bacteroidetes and Macellibacteroides) and Clostridiales (Lachnoclostridium). CONCLUSIONS Our study indicates that U. rigida macroalgae can be supplemented at 10% inclusion levels in the diet of juvenile farmed Atlantic cod without any impact on fish condition or hindgut microbial community structure. We also conclude that 10% dietary inclusion of A. nodosum is not a suitable feed supplement in a farmed cod diet.
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Affiliation(s)
- C Keating
- Department of Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, H91 TK33, Ireland.
- Water and Environment Group, Infrastructure and Environment Division, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK.
| | - M Bolton-Warberg
- Carna Research Station, Ryan Institute, National University of Ireland Galway, Carna, Co, Galway, H91 V8Y1, Ireland
| | - J Hinchcliffe
- Department of Biological and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - R Davies
- AquaBioTech Group, Central Complex, Naggar Street, Targa Gap, Mosta, G.C, MST 1761, Malta
| | - S Whelan
- Carna Research Station, Ryan Institute, National University of Ireland Galway, Carna, Co, Galway, H91 V8Y1, Ireland
| | - A H L Wan
- Irish Seaweed Research Group, Ryan Institute and School of Natural Sciences, National University of Ireland Galway, Galway, H91 TK33, Ireland
- Aquaculture Nutrition and Aquafeed Research Unit, Carna Research Station, Ryan Institute and School of Natural Sciences, National University of Ireland Galway, Carna, Co, Galway, H91 V8Y1, Ireland
| | - R D Fitzgerald
- Carna Research Station, Ryan Institute, National University of Ireland Galway, Carna, Co, Galway, H91 V8Y1, Ireland
| | - S J Davies
- Department of Animal Production, Welfare and Veterinary Science, Harper Adams University, Newport, Shropshire, TF10 8NB, UK
| | - U Z Ijaz
- Water and Environment Group, Infrastructure and Environment Division, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK.
| | - C J Smith
- Department of Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, H91 TK33, Ireland.
- Water and Environment Group, Infrastructure and Environment Division, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8LT, UK.
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Affiliation(s)
- D Bodansky
- Alder Hey Children’s NHS Foundation Trust, UK
| | - L Thornton
- Liverpool University Hospitals NHS Foundation Trust, UK
| | - N Sargazi
- Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - M Philpott
- Alder Hey Children’s NHS Foundation Trust, UK
| | - R Davies
- Manchester University NHS Foundation Trust, UK
| | - J Banks
- Liverpool University Hospitals NHS Foundation Trust, UK
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Comber SDW, Gardner MJ, Constantino C, Firth S, Hargreaves A, Davies R. Modelling scenarios of environmental recovery after implementation of controls on emissions of persistent organic pollutants. Environ Sci Process Impacts 2020; 22:1865-1876. [PMID: 32794543 DOI: 10.1039/d0em00137f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Comparison of monitoring data with toxicologically-derived environmental quality standards (EQSs) forms the basis of assessments of the quality status of the water environment. Having established the status quo, the logical next step is to address instances of non-compliance with EQSs by applying remedial measures, including reducing the use or at least the emission of the substances of concern or by taking steps to reduce concentrations already present using technological solutions such as enhanced wastewater treatment. The selection of suitable remedial measures must be a compromise between cost, likely effectiveness and the timescale over which improvements might be acceptable. The decision on overall environmental management has also to take into account the need for demonstrable progress; this might mean that it is preferable to address some more readily achievable goal rather than to attempt to solve a more serious, but ultimately intractable problem. This paper describes the development and application of a generic modelling tool that provides a way of assessing the potential requirements for remedial actions and their likely outcomes over a timescale of up to forty years taking account of sediment partitioning, environmental degradation and biological accumulation. The tool was validated using a detailed UK wastewater treatment works effluent discharge dataset. Examples involving several chemicals that are of current concern are provided. Some substances (e.g. tributyltin, PFOS) are identified as likely to meet EQS values in sediments or biota in a relatively short timescale; others (PAHs, DEHP) appear to represent more intractable problems.
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Affiliation(s)
- S D W Comber
- Plymouth University, B531, Portland Square, Drake Circus, Plymouth, Devon, PL4 8AA UK.
| | - M J Gardner
- Oasis Business Park, Eynsham, Oxford OX29 4AH, UK
| | | | - S Firth
- Oasis Business Park, Eynsham, Oxford OX29 4AH, UK
| | - A Hargreaves
- Oasis Business Park, Eynsham, Oxford OX29 4AH, UK
| | - R Davies
- Oasis Business Park, Eynsham, Oxford OX29 4AH, UK
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Powell AGMT, Eley C, Abdelrahman T, Coxon AH, Chin C, Appadurai I, Davies R, Bailey DM, Lewis WG. Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery. BJS Open 2020; 4:840-846. [PMID: 32749071 PMCID: PMC7528531 DOI: 10.1002/bjs5.50328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma. METHODS Two hundred and twenty-five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake ( V ˙ o2peak ), anaerobic threshold and the ventilatory equivalent for carbon dioxide ( V ˙ e/ V ˙ co2 ). Cephalic venous blood was assayed for serum C-reactive protein (CRP) and albumin levels, and a full blood count was done. The primary outcome measure was the Morbidity Severity Score (MSS). RESULTS One hundred and ninety-eight patients had anatomical resection. A high MSS (Clavien-Dindo grade III or above) was found in 48 patients (24·2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0·62, P = 0·001) and lower V ˙ o2peak (AUC 0·36, P = 0·003). Dichotomization of CRP levels (above 10 mg/l) and V ˙ o2peak (below 18·6 ml per kg per min) yielded adjusted odds ratios (ORs) for a high MSS of 2·86 (P = 0·025) and 2·92 (P = 0·002) respectively. Compared with a cohort with a low Combined Inflammatory and Physiology Score (CIPS), the OR was 1·70 (95 per cent c.i. 0·85 to 3·39) for intermediate and 27·47 (3·12 to 241·69) for high CIPS (P < 0·001). CONCLUSION CRP and V ˙ o2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. A composite risk score identified a group of patients with a high risk of developing complications.
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Affiliation(s)
- A G M T Powell
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK.,Departments of Surgery, Cardiff, UK
| | - C Eley
- Departments of Surgery, Cardiff, UK
| | | | | | - C Chin
- Departments of Surgery, Cardiff, UK
| | - I Appadurai
- Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - R Davies
- Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - D M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Davies R, Vivekanantham A, Lunt M, Watson K, Hyrich K, Bluett J. SAT0103 THE EFFECT OF BODYWEIGHT ON RESPONSE TO INTRAVENOUS OR SUBCUTANEOUS TOCILIZUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tocilizumab is an IL-6 receptor humanised monoclonal antibody treatment option in rheumatoid arthritis (RA) who have not responded or are intolerant of disease modifying anti-rheumatic drugs (DMARDs) or other biologics. Tocilizumab was available initially as an intravenous (IV) preparation, dosed according to weight, and more recently as a subcutaneous (SC) preparation given at 162mg/weekly irrespective of bodyweight.Obesity is highly prevalent in RA and there has been concern that starting or switching patients to SC tocilizumab could reduce its effectiveness in those patients with a higher body weight when compared to IV tocilizumab.Objectives:To investigate the relationship between bodyweight and DAS28 response at 6 months in tocilizumab naïve RA patients starting IV or SC tocilizumab.Methods:The study population comprised RA subjects recruited to the BSRBR-RA up to 30/11/2018 commencing IV or SC tocilizumab for the first time. Patients had to be tocilizumab naïve and have at least one six monthly study follow-up recorded after starting tocilizumab. Baseline characteristics at point of starting tocilizumab are described. Linear regression, fully adjusted for relevant confounders, was used to investigate the relationship between change in DAS28 score from baseline to six months and body weight per ten kilograms (kg), and in a separate analysis, as BMI category. Multiple imputation was used to handle missing data.Results:1241 patients starting tocilizumab (902 IV, 339 SC) were eligible for analysis. The median age was 59 years, majority were female, and had median disease duration of 11 years at baseline. Over seventy percent had prior biologic exposure. Median weight was 77kg for IV and 76kg for SC starters, and the majority of patients were categorised as normal weight (30% IV, 37% SC) or pre-obesity (31% IV & SC) according to BMI. Median DAS28 score was 5.8 (IV) and 5.5 (SC) at start of treatment with median improvement after 6-months of 1.50 and 2.02 units respectively. The fully adjusted linear regression model showed no association between body weight or BMI and change in DAS28 score at six months for patients starting IV or SC tocilizumab. (Table).TableBaseline VariableIntravenous TCZ patients (n=902)Subcutaneous TCZ patients (n=339)Age, median (IQR)58 (50-67)60 (51-70)Gender, n (%) female708 (78)233 (74)Disease duration, median (IQR) years11 (4-21)11 (4-21)DAS28 score, median (IQR)5.8 (5.1-6.6)5.5 (4.7-6.5)Change in DAS28 score, median (IQR)-1.50 (-3.10 - -0.23)-2.02 (-3.72- -0.37)Weight in KGs, median (IQR)77 (64-91)76 (64-88)Change in DAS28, coefficient (95% CI)Body weight per 10kgs*0.04 (-0.01-0.09)-0.005 (-0.11-0.10)BMI category*Normal weightrefrefUnderweight-0.41 (-1.27-0.46)0.08 (-1.62-1.77)Pre-obesity-0.26 (-0.57-0.05)0.02 (-0.44-0.48)Obesity class I, II & III-0.03 (-0.35-0.29)0.08 (-0.40-0.55)*Fully adjusted for age, gender, disease duration, baseline DAS28 score, baseline HAQ score, co-morbidities, and number of previous biologicsConclusion:Data from this study show that body weight does not appear to affect initial response to IV or SC tocilizumab. This is reassuring given that patients are likely to be given SC tocilizumab due to ease of administration and reduced hospital costs.Disclosure of Interests:Rebecca Davies: None declared, Arani Vivekanantham: None declared, Mark Lunt: None declared, Kath Watson: None declared, Kimme Hyrich Grant/research support from: Pfizer, UCB, BMS, Speakers bureau: Abbvie, James Bluett: None declared
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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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Davies R, Hammond D, Ridout F, Hutchison I, Magennis P. British Association of Oral and Maxillofacial Surgeons' National Facial Injury Surveys: hard tissue facial injuries presenting to UK emergency departments. Br J Oral Maxillofac Surg 2019; 58:152-157. [PMID: 31866062 DOI: 10.1016/j.bjoms.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
The British Association of Oral and Maxillofacial Surgeons (BAOMS) and Saving Faces undertook two national prospective surveys 11 years apart. They recorded the facial injuries treated in UK emergency departments and collected data on 14872 patients. In this paper, which aims to act as a feasibility study for a third national survey of facial injuries, we have reviewed hard-tissue injuries and specifically focused on temporal changes in their morphology. The two sets of directly comparable, categorical, unpaired, cross-sectional data were evaluated independently for statistical significance. In 1997, there were 1977 hard-tissue facial injuries (33%) but in 2008 this had decreased to 1899 (22%) (p<0.05). In 1997, there were 1315 fractures (22%) and 662 dental injuries (11%) compared with 1462 (17%) fractures and 438 (5%) dental injuries in 2008 (p<0.05). There were proportional increases in orbital (21%), nasal (139%), and cranial fractures (340%) (p<0.05). The data showed a small reduction in the total number of hard-tissue injuries, but this was a considerable reduction as a proportion of the total injuries. Analysis of the type and subtype of injury generally pointed towards a reduction in their energy and severity, and to likely changes in mechanism. The project has proved the feasibility of a third national survey of facial injury.
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Affiliation(s)
- R Davies
- Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.
| | - D Hammond
- University of Central Lancashire, Preston PR1 2HE, UK
| | - F Ridout
- Saving Faces - The Facial Surgery Research Foundation, London E1 4DG, UK
| | - I Hutchison
- Saving Faces - The Facial Surgery Research Foundation, London E1 4DG, UK; The National Facial and Oral Research Centre (NFORC), London E1 4DG, UK
| | - P Magennis
- Aintree University Hospital NHS Foundation Trust, Liverpool L9 7AL, UK
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Lobenhofer E, Werner J, Giffin M, Engwall M, Davies R, Homann O, Lafleur M, Moffat G. P1.12-18 Nonclinical Safety Assessment of AMG 757, a DLL3 Bispecific T Cell Engager, in the Cynomolgus Monkey. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1131] [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: 11/30/2022]
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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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Patel K, Bachiller RE, Boubertakh R, Moir S, Kozor R, Davies R, Bhuva A, Scully P, Herrey AS, Manisty C, Moon JC, Treibel TA. P434Left ventricular mechanics reveals a benign reduction in ejection fraction after valve replacement in aortic stenosis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.021] [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: 11/14/2022] Open
Affiliation(s)
- K Patel
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | | | - R Boubertakh
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - S Moir
- Monash University, Melbourne, Australia
| | - R Kozor
- University of Sydney, Sydney, Australia
| | - R Davies
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bhuva
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - P Scully
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - A S Herrey
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - C Manisty
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
| | - T A Treibel
- Barts Health NHS Trust, Cardiac Imaging, London, United Kingdom of Great Britain & Northern Ireland
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Bhuva A, Bai W, Lau C, Davies R, Yang Y, Bulluck H, Mcalindon E, Cole GD, Petersen SE, Greenwood JP, Bucciarelli-Ducci C, Hughes AD, Rueckert D, Moon JC, Manisty CH. 349Fully automated left ventricular analysis matches clinician precision: a multi-centre, multi-vendor, multi-field strength, multi-disease scan:rescan CMR study. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez103.004] [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: 11/14/2022] Open
Affiliation(s)
- A Bhuva
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - W Bai
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Lau
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - R Davies
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - Y Yang
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - H Bulluck
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - E Mcalindon
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G D Cole
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S E Petersen
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, Institute of Cardiovasular Science, London, United Kingdom of Great Britain & Northern Ireland
| | - D Rueckert
- Imperial College London, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
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O'Connor M, Lorts A, Mascio C, Sutcliffe D, Davies R, Law S, Chai P, Rosenthal D, Maeda K, Nandi D, McConnell P, Morales D. Real World Data from the ACTION Quality Improvement Network - Preliminary Experience with a Magnetically Levitated Ventricular Assist Device in US Pediatric Centers. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.438] [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: 11/28/2022] Open
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Baez N, Kirk R, Davies R, Sutcliffe D, Bano M, Jaquiss R, Butts R. Standardized Donor Acceptance Criteria: Impact on Pediatric Waitlist and Heart Transplant Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Baez N, Davies R, Kirk R, Bano M, Sutcliffe D, Jaquiss R, Butts R. Transplant Center Refusal Rate and Waitlist Outcomes in Pediatric Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Affiliation(s)
- C Duffield
- Chelsea and Westminster Hospital, London, UK
| | - R Davies
- Chelsea and Westminster Hospital, London, UK
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Barnes MC, Haase AM, Scott LJ, Linton MJ, Bard AM, Donovan JL, Davies R, Dursley S, Williams S, Elliott D, Potokar J, Kapur N, Hawton K, O'Connor RC, Hollingworth W, Metcalfe C, Gunnell D. Correction to: The help for people with money, employment or housing problems (HOPE) intervention: pilot randomised trial with mixed methods feasibility research. Pilot Feasibility Stud 2018; 4:177. [PMID: 30505459 PMCID: PMC6260749 DOI: 10.1186/s40814-018-0374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s40814-018-0365-6.].
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Affiliation(s)
- M C Barnes
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK
| | - A M Haase
- 3School of Policy Studies, University of Bristol, Bristol, UK
| | - L J Scott
- 2National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, UH Bristol NHS Trust, UK/Population Health Sciences, University of Bristol, Bristol, UK
| | - M-J Linton
- 2National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, UH Bristol NHS Trust, UK/Population Health Sciences, University of Bristol, Bristol, UK
| | - A M Bard
- 4School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - J L Donovan
- 2National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, UH Bristol NHS Trust, UK/Population Health Sciences, University of Bristol, Bristol, UK
| | - R Davies
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK.,5Public Patient Involvement, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - S Dursley
- Psychiatric Liaison Team, UH Bristol NHS Trust, Bristol, UK
| | - S Williams
- Psychiatric Liaison Team, UH Bristol NHS Trust, Bristol, UK
| | - D Elliott
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK
| | - J Potokar
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK
| | - N Kapur
- 7Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - K Hawton
- 8Centre for Suicide Research, University of Oxford, Oxford, UK
| | - R C O'Connor
- 9Suicidal Behaviour Research Laboratory, University of Glasgow, Glasgow, UK
| | - W Hollingworth
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK
| | - C Metcalfe
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK
| | - D Gunnell
- 1Population Health Sciences, University of Bristol, Canynge Hall, Bristol, BS8 PS UK.,10NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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50
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Phillips D, Holmes J, Davies R, Geen J, Williams JD, Phillips AO. The influence of socioeconomic status on presentation and outcome of acute kidney injury. QJM 2018; 111:849-857. [PMID: 30137472 DOI: 10.1093/qjmed/hcy180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
AIM Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. DESIGN The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. METHODS Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. RESULTS Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. CONCLUSION This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.
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Affiliation(s)
- D Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - J Holmes
- Welsh Renal Clinical Network, Cwm Taf University Health Board, Merthyr, UK
| | - R Davies
- Welsh Renal Clinical Network, Cwm Taf University Health Board, Merthyr, UK
| | - J Geen
- Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - J D Williams
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - A O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
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