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Stephens CM, Mathieson SR, McNamara B, McSweeney N, O'Brien R, O'Mahony O, Boylan GB, Murray DM. Electroencephalography Quality and Application Times in a Pediatric Emergency Department Setting: A Feasibility Study. Pediatr Neurol 2023; 148:82-85. [PMID: 37690268 DOI: 10.1016/j.pediatrneurol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/06/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Status epilepticus is the most common neurological emergency presenting to pediatric emergency departments. Nonconvulsive status epilepticus can be extremely challenging to diagnose, however, requiring electroencephalographic (EEG) confirmation for definitive diagnosis. We aimed to determine the feasibility of achieving a good-quality pediatric EEG recording within 20 minutes of presentation to the emergency department. METHODS Single-center prospective feasibility study in Cork University Hospital, Ireland, between July 2021 and June 2022. Two-channel continuous EEG was recorded from children (1) aged <16 years and (2) with Glasgow Coma Scale <11 or a reduction in baseline Glasgow Coma Scale in the case of a child with a neurodisability. RESULTS Twenty patients were included. The median age at presentation was 65.8 months (interquartile range, 23.2 to 119.0); 50% had a background diagnosis of epilepsy. The most common reason for EEG monitoring was status epilepticus (85%) followed by suspected nonconvulsive status (10%) and reduced consciousness of unknown etiology (5%). The mean length of recording was 93.1 minutes (S.D. 47.4). The mean time to application was 41.3 minutes (S.D. 11.7). The mean percent of artifact in all recordings was 19.3% (S.D. 15.9). Thirteen (65%) EEGs had <25% artifact. Artifact was higher in cases in which active airway management was ongoing. CONCLUSIONS EEG monitoring can be achieved in a pediatric emergency department setting within one hour of presentation. Overall, artifact percentage was low outside of periods of airway manipulation. Future studies are required to determine its use in early seizure detection and its support role in clinical decision-making in these patients.
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Affiliation(s)
- Carol M Stephens
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
| | - Sean R Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Brian McNamara
- Department of Neurophysiology, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland; Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Rory O'Brien
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Olivia O'Mahony
- Department of Paediatric Neurology, Cork University Hospital, Cork, Ireland
| | - Geraldine B Boylan
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Deirdre M Murray
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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2
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O'Connor EE, Rednam N, O'Brien R, O'Brien S, Rock P, Levine A, Zeffiro TA. Effects of SARS-CoV-2 Infection on Attention, Memory, and Sensorimotor Performance. medRxiv 2022:2022.09.22.22280222. [PMID: 36172134 PMCID: PMC9516858 DOI: 10.1101/2022.09.22.22280222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Recovery after SARS-CoV-2 infection is extremely variable, with some individuals recovering quickly, and others experiencing persistent long-term symptoms or developing new symptoms after the acute phase of infection, including fatigue, poor concentration, impaired attention, or memory deficits. Many existing studies reporting cognitive deficits associated with SARS-CoV-2 infection are limited by the exclusive use of self-reported measures or a lack of adequate comparison groups. METHODS Forty-five participants, ages 18-70, (11 Long-COVID, 14 COVID, and 20 No-COVID) underwent behavioral testing with the NIH Toolbox Neuro-Quality of Life survey and selected psychometric tests, including a flanker interference task and the d2 Test of Attention. RESULTS We found greater self-reported anxiety, apathy, fatigue, emotional dyscontrol, sleep disturbance and cognitive dysfunction in COVID compared No-COVID groups. After categorizing COVID patients according to self-reported concentration problems, we observed declining performance patterns in multiple attention measures across No-COVID controls, COVID and Long-COVID groups. COVID participants, compared to No-COVID controls, exhibited worse performance on NIH Toolbox assessments, including the Eriksen Flanker, Nine-Hole Pegboard and Auditory Verbal Learning tests. CONCLUSION This study provides convergent evidence that previous SARS-CoV-2 infection is associated with impairments in sustained attention, processing speed, self-reported fatigue and concentration. The finding that some patients have cognitive and visuomotor dysfunction in the absence of self-reported problems suggests that SARS-CoV-2 infection can have unexpected and persistent subclinical consequences.
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3
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Hamza M, Ndoma-Egba B, Herlihy D, Sabbagha H, Ali RS, O'Brien R, Deasy C, Prager G. Journal update monthly top five. J Accid Emerg Med 2022; 39:235-236. [PMID: 35190392 DOI: 10.1136/emermed-2022-212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Mohammed Hamza
- Emergency Department, Cork University Hospital, Cork, Ireland
| | | | - David Herlihy
- Emergency Department, Cork University Hospital, Cork, Ireland
| | | | - Raja Shahid Ali
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Rory O'Brien
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Conor Deasy
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Gabrielle Prager
- Emergency Department, Royal Manchester Children's Hospital, Manchester, UK
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4
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Stanton JAL, O'Brien R, Hall RJ, Chernyavtseva A, Ha HJ, Jelley L, Mace PD, Klenov A, Treece JM, Fraser JD, Clow F, Clarke L, Su Y, Kurup HM, Filichev VV, Rolleston W, Law L, Rendle PM, Harris LD, Wood JM, Scully TW, Ussher JE, Grant J, Hore TA, Moser TV, Harfoot R, Lawley B, Quiñones-Mateu ME, Collins P, Blaikie R. Uncoupling Molecular Testing for SARS-CoV-2 From International Supply Chains. Front Public Health 2022; 9:808751. [PMID: 35141190 PMCID: PMC8818800 DOI: 10.3389/fpubh.2021.808751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022] Open
Abstract
The rapid global rise of COVID-19 from late 2019 caught major manufacturers of RT-qPCR reagents by surprise and threw into sharp focus the heavy reliance of molecular diagnostic providers on a handful of reagent suppliers. In addition, lockdown and transport bans, necessarily imposed to contain disease spread, put pressure on global supply lines with freight volumes severely restricted. These issues were acutely felt in New Zealand, an island nation located at the end of most supply lines. This led New Zealand scientists to pose the hypothetical question: in a doomsday scenario where access to COVID-19 RT-qPCR reagents became unavailable, would New Zealand possess the expertise and infrastructure to make its own reagents onshore? In this work we describe a review of New Zealand's COVID-19 test requirements, bring together local experts and resources to make all reagents for the RT-qPCR process, and create a COVID-19 diagnostic assay referred to as HomeBrew (HB) RT-qPCR from onshore synthesized components. This one-step RT-qPCR assay was evaluated using clinical samples and shown to be comparable to a commercial COVID-19 assay. Through this work we show New Zealand has both the expertise and, with sufficient lead time and forward planning, infrastructure capacity to meet reagent supply challenges if they were ever to emerge.
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Affiliation(s)
- Jo-Ann L. Stanton
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- *Correspondence: Jo-Ann L. Stanton
| | - Rory O'Brien
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- MicroGEM NZ Ltd., Dunedin, New Zealand
| | - Richard J. Hall
- Animal Health Laboratory, Ministry for Primary Industries—Manatu Ahu Matua, Upper Hutt, New Zealand
| | - Anastasia Chernyavtseva
- Animal Health Laboratory, Ministry for Primary Industries—Manatu Ahu Matua, Upper Hutt, New Zealand
| | - Hye Jeong Ha
- Animal Health Laboratory, Ministry for Primary Industries—Manatu Ahu Matua, Upper Hutt, New Zealand
| | - Lauren Jelley
- Clinical Virology, Institute of Environmental Science and Research Limited (ESR), Upper Hutt, New Zealand
| | - Peter D. Mace
- Department of Biochemistry, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Alexander Klenov
- Hudak Lab, Department of Biology, York University, Toronto, ON, Canada
| | - Jackson M. Treece
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - John D. Fraser
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fiona Clow
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lewis Clarke
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yongdong Su
- School of Fundamental Sciences, Massey University, Palmerston North, New Zealand
| | | | | | | | - Lee Law
- South Pacific Sera, Timaru, New Zealand
| | - Phillip M. Rendle
- Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - Lawrence D. Harris
- Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - James M. Wood
- Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - Thomas W. Scully
- Ferrier Research Institute, Victoria University of Wellington, Lower Hutt, New Zealand
| | - James E. Ussher
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Molecular Pathology, Southern Community Laboratories, Dunedin, New Zealand
| | - Jenny Grant
- Molecular Pathology, Southern Community Laboratories, Dunedin, New Zealand
| | - Timothy A. Hore
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Tim V. Moser
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Rhodri Harfoot
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Blair Lawley
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Miguel E. Quiñones-Mateu
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | | | - Richard Blaikie
- Research and Enterprise, University of Otago, Dunedin, New Zealand
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5
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Daly T, O'Brien R, Murphy A. Pre-Hospital Parental Administration of Analgesia. Ir Med J 2022; 115:528. [PMID: 35279062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- T Daly
- University College Cork, College Road, Cork, Ireland
| | - R O'Brien
- University College Cork, College Road, Cork, Ireland
- Cork University Hospital, Wilton Road, Cork, Ireland
| | - A Murphy
- University College Cork, College Road, Cork, Ireland
- Cork University Hospital, Wilton Road, Cork, Ireland
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6
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Jansen L, Meyer GP, Curtin G, Lynch B, O'Brien R. Quality improvement project to decrease unnecessary investigations in infants with bronchiolitis in Cork University Hospital. BMJ Open Qual 2021; 10:bmjoq-2021-001428. [PMID: 34782359 PMCID: PMC8593756 DOI: 10.1136/bmjoq-2021-001428] [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] [Received: 02/27/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Bronchiolitis is a common reason for infants to present to the emergency department (ED). Clear evidence-based guidelines exist that recommend against routine radiological and laboratory investigations in this cohort. Despite this, preintervention audit showed that children below 12 months of age with bronchiolitis in the ED during November 2018–January 2019 were receiving unnecessary investigations. Our aim was to improve patient care by decreasing unnecessary investigations in bronchiolitis infants. Methods Baseline assessment comprised a preintervention audit of children less than 12 months of age with a diagnosis of bronchiolitis that presented to ED during November 2018–January 2019. The outcome measure was average weekly hospital length of stay (LOS), process measures were average weekly chest X-ray (CXR) and laboratory investigation rate. The balancing measure was the average weekly representation rate. Intervention A multimodal intervention was implemented comprising a locally agreed flowchart enhanced by regular feedback on performance using run charts and in-person sessions. Results A postintervention audit of November 2019–January 2020 was undertaken. There was a 57% reduction in the mean average weekly CXR rate (from 25% to 11%, p value 0.009974 significant at p<0.05); there was an improvement by 56% in the mean average weekly laboratory investigation rate (from 29% to 13%, p value 0.005475, significant at p<0.05) in the preintervention and postintervention periods, respectively. The mean average weekly representations remained at 4% preintervention and postintervention (p value 0.737). There was no significant difference in hospital LOS (from 25.3 hours to 20.7 hours, p value 0.270549). Conclusion An evidence-based protocol improved physicians’ ability in diagnosing and managing infants with bronchiolitis. This led to a reduction in unnecessary and potential harmful investigations, thereby improving patient quality of care. This improvement will contribute to decreased healthcare cost and appropriate use of resources during the high-pressured winter period.
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Affiliation(s)
- Lizeri Jansen
- Emergency Department, Cork University Hospital, Cork, Ireland .,University of Manchester, Manchester, UK
| | - Gideon-Phil Meyer
- Emergency Department, Cork University Hospital, Cork, Ireland.,University of Manchester, Manchester, UK
| | - Glenn Curtin
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Bryan Lynch
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Rory O'Brien
- Emergency Department, Cork University Hospital, Cork, Ireland
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7
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Lee K, Bularga A, O'Brien R, Ferry A, Doudesis D, Fujisawa T, Stewart S, Wereski R, Cranley D, Van Beek E, Lowe D, Newby DE, Williams MC, Gray AJ, Mills NL. Troponin to risk stratify patients with suspected acute coronary syndrome for computed tomography coronary angiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1184] [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
Patients with suspected acute coronary syndrome in whom myocardial infarction has been ruled-out are at risk of future adverse cardiac events. However, the optimal approach to risk stratify and investigate these patients is uncertain.
Methods
We performed a prospective cohort study of 250 patients presenting to the Emergency Department with suspected acute coronary syndrome and troponin concentrations below the sex-specific 99th centile (16 ng/L for women and 34 ng/L for men). Patients were recruited in a 2:1 fashion stratified by peak high-sensitivity cardiac troponin I concentration above and below the early rule-out threshold of 5 ng/L (167 patients with intermediate troponin concentrations between 5 ng/L and the sex-specific 99th centile threshold and 83 patients with troponin concentrations <5 ng/L). All patients underwent computed tomography coronary angiography after they were discharged from hospital.
Results
Overall, 37.6% (94/250) of patients had normal coronary arteries whilst 36.0% (90/250) and 26.4% (66/250) had non-obstructive and obstructive coronary artery disease, respectively. Patients with intermediate troponin concentrations were more likely to have coronary artery disease than those with troponin concentrations <5 ng/L (71.9% [120/167] versus 43.4% [36/83]; odds ratio 3.33 [95% confidence interval 1.92–5.78]). This association persisted irrespective of whether patients had anginal symptoms. Conversely, there was no difference in the prevalence of coronary artery disease between those with and without anginal symptoms (63.2% [67/106] and versus 61.8% [89/144]; odds ratio 0.92 [0.48–1.76]). The majority of patients found to have coronary artery disease did not have a prior diagnosis and were not on optimal preventative medical therapy prior to undergoing computed tomography coronary angiography (50.8% [61/120] and 61.0% [22/36], versus 61.7% [74/120] and 69.4% [25/36] in patients with intermediate versus low troponin concentrations, respectively).
Conclusions
In patients with suspected acute coronary syndrome who have myocardial infarction ruled out, those with intermediate cardiac troponin concentrations are three-times more likely to have coronary artery disease than those with low troponin concentrations. Conversely anginal symptoms did not discriminate between those with and without coronary artery disease. Further studies are required to determine if targeting computed tomography coronary angiography to those with intermediate cardiac troponin concentrations can improve the use of preventative medical therapies and clinical outcomes.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Odds ratio of coronary artery diseaseCumulative proportion with CAD
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Affiliation(s)
- K Lee
- University of Edinburgh, Edinburgh, United Kingdom
| | - A Bularga
- University of Edinburgh, Edinburgh, United Kingdom
| | - R O'Brien
- Royal Infirmary of Edinburgh, Department of Emergency Medicine, Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - A Ferry
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Doudesis
- University of Edinburgh, Edinburgh, United Kingdom
| | - T Fujisawa
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Stewart
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Wereski
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Cranley
- University of Edinburgh, Edinburgh Clinical Trials Unit, Usher Institute, Edinburgh, United Kingdom
| | - E Van Beek
- University of Edinburgh, Edinburgh, United Kingdom
| | - D Lowe
- University of Glasgow, Glasgow, United Kingdom
| | - D E Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | - M C Williams
- University of Edinburgh, Edinburgh, United Kingdom
| | - A J Gray
- Royal Infirmary of Edinburgh, Department of Emergency Medicine, Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - N L Mills
- University of Edinburgh, Edinburgh, United Kingdom
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8
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Korotchikova I, Al Khalaf S, Sheridan E, O'Brien R, Bradley CP, Deasy C. Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study. BMJ Paediatr Open 2021; 5:e000862. [PMID: 33665372 PMCID: PMC7893646 DOI: 10.1136/bmjpo-2020-000862] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/06/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years. DESIGN This is a retrospective observational study that used a large administrative dataset. SETTING The study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive. PARTICIPANTS Children aged 0-15 years who attended CUH ED during the study period of 6 years (2012-2018) were included in this study (n=76 831). INTERVENTIONS Free GP care was expanded to all children aged 0-5 years in July 2015. MAIN OUTCOME MEASURES Paediatric attendances to CUH ED were examined before (Time Period 1: July 2012-June 2015) and after (Time Period 2: July 2015-June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated. RESULTS Paediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0-5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%. CONCLUSION The expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.
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Affiliation(s)
- Irina Korotchikova
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.,Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Sukainah Al Khalaf
- School of Public Health, University College Cork, Cork, Munster, Ireland.,INFANT Centre, Cork University Hospital, Cork, Ireland
| | - Ewa Sheridan
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Rory O'Brien
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Conor Deasy
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.,Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
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9
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Carter K, Engel A, Kutcher M, O'Brien R, Creswell L, Kogon B, Levine D, Hayanaga J, Copeland H. Time from Organ Donation Referral to Procurement Does Not Affect Survival in Lung Transplant Recipients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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10
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Bates A, O'Brien R, Liggett S, Griffin F. Control of Mycobacterium avium subsp. paratuberculosis infection on a New Zealand pastoral dairy farm. BMC Vet Res 2019; 15:266. [PMID: 31358004 PMCID: PMC6664707 DOI: 10.1186/s12917-019-2014-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background Johne’s disease is a major production limiting disease of dairy cows caused by infection with Mycobacterium avium subsp. paratuberculosis in calf-hood. The disease is chronic, progressive, contagious and widespread with no treatment and no cure. Economic losses arise from decreased productivity through reduced growth, milk yield, fertility and also capital losses due to premature culling or death. Control chiefly centers upon removing those animals which actively shed bacteria and protecting calves from infection. A prolonged pre-clinical shedding phase, lack of test sensitivity, organism persistence and abundance in the environment as well as management systems that expose susceptible calves to infection make control challenging, particularly in pastoral, seasonal dairy systems. Combining a novel testing strategy to remove infected cows along with limited measures to protect vulnerable calves at pasture, this study reports the successful reduction over a four-year period of seroprevalence of cows testing positive for MAP infection in a New Zealand pastoral dairy herd. Results For all age groups considered the apparent seroprevalence of cows testing positive decreased from 297 / 1,122 (26%) in 2013–2014, to 24 / 1,030 (2.3%) in 2016–2017. Over the same period, the apparent seroprevalence in primiparous cows decreased from 39 / 260 (15%) to 7 / 275 (2.5%) and in multiparous cows from 258 / 862 (29.9%) to 17 / 755 (2.3%). The reported proportion of calved cows culled annually from suspected clinical Johne’s disease fell from 55 / 1,201 (5%) in the year preceding the control program to 5 / 1,283 (0.4%) in the final year of the study. Conclusions On this farm, reduction in the prevalence of infection was achieved by reducing the infectious pressure through targeted culling of heavily shedding animals together with limited measures to protect calves at pasture from exposure to Mycobacterium avium subsp. paratuberculosis. Whilst greater protection of young animals through separation from infected cows and their colostrum and milk would have reduced the risk of neonatal infection, this study demonstrates, in this case, that these management measures while prudent were not essential for effective reduction in the prevalence of MAP infection.
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Affiliation(s)
- Andrew Bates
- Vetlife Centre for Dairy Excellence, Vetlife Scientific, 1 Waitohi-Temuka Road, Temuka, 20 Wilson Street, Geraldine, New Zealand.
| | - Rory O'Brien
- Disease Research Limited, Invermay Agricultural Centre, Mosgiel, New Zealand
| | - Simon Liggett
- Disease Research Limited, Invermay Agricultural Centre, Mosgiel, New Zealand
| | - Frank Griffin
- Department of Microbiology & Immunology, University of Otago, Dunedin, New Zealand
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11
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Keall P, Nguyen D, O'Brien R, Hewson E, Ball H, Poulsen P, Booth J, Greer P, Hunter P, Wilton L, Bromley R, Kipritidis J, Eade T, Kneebone A, Hruby G, Moodie T, Hayden A, Turner S, Arumugam S, Sidhom M, Hardcastle N, Siva S, Tai K, Gebski V, Martin J. PO-0842 Real-Time tracking improves treatment: The TROG Stereo Prostate Ablative Radiotherapy with KIM trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31262-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Booth J, Caillet V, Briggs A, Hardcastle N, Jayamanne D, Szymura K, O'Brien R, Harris B, Eade T, Keall P. First-in-Human Clinical Experience with Real-Time Tumor Targeting Via MLC Tracking for Stereotactic Radiation Therapy of Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Hewson E, Nguyen D, O'Brien R, Poulsen P, Booth J, Bromley R, Kipritidis J, Moodie T, Greer P, Eade T, Kneebone A, Martin J, Hayden A, Hruby G, Hunter P, Wilton L, Turner S, Gebski V, Keall P. Kilovoltage Intrafraction Monitoring (KIM) Real-Time Tracking Improves Patient Dose Distributions: Interim Primary Hypothesis Results from the First 20 Patients on the TROG 15.01 Stereotactic Prostate Ablative Radiation Therapy SPARK Trial. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.318] [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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14
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Balmer M, Alsaaod M, Boesiger M, Studer E, O'Brien R, Schuepbach-Regula G, Steiner A. Short communication: Risk factors for sonographically detectable udder edema in overbagged cows at dairy shows. J Dairy Sci 2018; 102:660-665. [PMID: 30343925 DOI: 10.3168/jds.2018-15150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/29/2018] [Indexed: 11/19/2022]
Abstract
At dairy cow shows, the appearance of the udder is very important. To show cows at their best, udders are often presented in an overbagged state by extending milking intervals before the show. This practice represents an animal welfare issue because it is associated with behavior changes (e.g., excessive abduction and decreased eating time) and may affect the health of the animal. The aim of the current study was to determine the association between various parameters (e.g., milk yield, days in milk, milking procedures, or administration of nonsteroidal anti-inflammatory drugs, steroids, or diuretics) and the sonographically detectable udder edema score. Data were collected from the show catalogs, by interviewing the exhibitors, by analyzing official veterinary treatment protocols and official milking data, via laboratory analysis of blood samples, and by sonographic examinations of the udders at the show. For sonographically detectable udder edema scoring, 3 scans were taken, 1 on each fore quarter and 1 incorporating both rear quarters at the level of the median suspensory ligament. For grading the scans, a scoring system of 4 grades (score 0 = no edema, 1 = slight edema, 2 = moderate edema, 3 = severe edema) was used. Data from 321 cows of different breeds were collected at 4 highly competitive Swiss dairy shows (shows A-D) between January and September 2017. To determine risk factors for sonographically detectable udder edema, data were analyzed with 2 different logistic regression models. In model 1, the odds ratios were 3.33 (milking intervals of ≥16 h vs. <14 h), 3.84 (show A vs. show C), and 7.39 (dairy breeds vs. dual-purpose breeds). Milking intervals of dairy breeds were significantly higher than those of dual-purpose breeds. In model 2, milking interval was the only significant risk factor with an odds ratio of 9.00 for milking intervals of ≥16 h. Only the milking intervals represented a relevant risk factor in both models; therefore, we concluded that the previously described sonographic udder edema scoring is a useful technique for detecting overbagged udders at dairy shows. Its routine implementation may improve cow welfare at dairy shows.
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Affiliation(s)
- M Balmer
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, 3001 Bern, Switzerland
| | - M Alsaaod
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, 3001 Bern, Switzerland
| | - M Boesiger
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, 3001 Bern, Switzerland
| | - E Studer
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, 3001 Bern, Switzerland
| | | | - G Schuepbach-Regula
- Veterinary Public Health Institute, Vetsuisse-Faculty, University of Bern, 3097 Liebefeld, Switzerland
| | - A Steiner
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, 3001 Bern, Switzerland.
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Liu PZY, Nguyen DT, Feain I, O'Brien R, Keall PJ, Booth JT. Technical Note: Real-time image-guided adaptive radiotherapy of a rigid target for a prototype fixed beam radiotherapy system. Med Phys 2018; 45:4660-4666. [DOI: 10.1002/mp.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- P. Z. Y. Liu
- ACRF Image X Institute; University of Sydney Central Clinical School; Sydney NSW Australia
| | - D. T. Nguyen
- ACRF Image X Institute; University of Sydney Central Clinical School; Sydney NSW Australia
| | - I. Feain
- Leo Cancer Care Pty Ltd.; Eveleigh NSW Australia
| | - R. O'Brien
- ACRF Image X Institute; University of Sydney; Sydney NSW Australia
| | - P. J. Keall
- ACRF Image X Institute; University of Sydney; Sydney NSW Australia
| | - J. T. Booth
- Northern Sydney Cancer Centre; Royal North Shore Hospital; St. Leonards NSW Australia
- School of Physics; University of Sydney; Sydney NSW Australia
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Balmer M, Alsaaod M, Boesiger M, O'Brien R, Steiner A. Technical note: Evaluation of a sonographic overbagging edema scoring system for show cows: Comparison with visual inspection. J Dairy Sci 2018; 101:7494-7499. [DOI: 10.3168/jds.2018-14462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/30/2018] [Indexed: 11/19/2022]
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17
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Nguyen D, Bertholet J, Kim J, O'Brien R, Booth J, Poulsen P, Keall P. PO-0948: Use of an interdimensional correlation framework to estimate real-time intrafraction 6DoF motions. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Bates A, O'Brien R, Liggett S, Griffin F. The effect of sub-clinical infection with Mycobacterium avium subsp. paratuberculosis on milk production in a New Zealand dairy herd. BMC Vet Res 2018. [PMID: 29540214 PMCID: PMC5853068 DOI: 10.1186/s12917-018-1421-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Johne’s disease is a major production limiting disease of dairy cows. The disease is chronic, progressive, contagious and widespread; there is no treatment and there is no cure. Economic losses arise from decreased productivity through reduced growth, milk yield and fertility and capital losses due to premature culling or death. This study attempts to address the effect of subclinical JD on milk production under New Zealand pastoral dairy farming conditions using a new testing approach. Blood samples were taken from all lactating animals from a single seasonally calving New Zealand dairy herd in the autumn of 2013 and 2014. Samples were subject to serological assay for antibodies to Mycobacterium avium subsp. paratuberculosis using a combination of four ELISA tests in parallel followed by selective quantitative fecal PCR to confirm the fecal shedding characteristics of ELISA positive cows. ELISA status was classified as Not-Detected, Low, Moderate or High and fecal PCR status as Not-Detected, Moderate or High. Results A mixed generalized regression model indicated that, compared to cows where MAP was not detected, daily milk solids production was 4% less for high ELISA positive cows (p = 0.004), 6% less for moderate fPCR cows (p = 0.036) and 12% less for high fPCR cows (p < 0.001). Conclusions This study confirms that sub-clinical JD can have a significant impact on milk production and that the testing methodology used stratified the animals in this herd on their likely impact on production and disease spread. This allowed the farmer to prioritize removal of heavily shedding, less-productive animals and so reduce the risk of infection of young stock. This is the first longitudinal study based in New Zealand looking at the effect of Johne’s infection status on daily milk production allowing for intermediary and confounding factors.
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Affiliation(s)
- Andrew Bates
- Vetlife, Centre for Dairy Excellence, Wilson Street, Geraldine, New Zealand.
| | - Rory O'Brien
- Disease Research Limited, Invermay Agricultural Centre, Mosgiel, New Zealand
| | - Simon Liggett
- Disease Research Limited, Invermay Agricultural Centre, Mosgiel, New Zealand
| | - Frank Griffin
- Department of Microbiology & Immunology, University of Otago, Dunedin, New Zealand
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19
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Nguyen DT, Bertholet J, Kim JH, O'Brien R, Booth JT, Poulsen PR, Keall PJ. An interdimensional correlation framework for real-time estimation of six degree of freedom target motion using a single x-ray imager during radiotherapy. Phys Med Biol 2017; 63:015010. [PMID: 29106377 DOI: 10.1088/1361-6560/aa986f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Increasing evidence suggests that intrafraction tumour motion monitoring needs to include both 3D translations and 3D rotations. Presently, methods to estimate the rotation motion require the 3D translation of the target to be known first. However, ideally, translation and rotation should be estimated concurrently. We present the first method to directly estimate six-degree-of-freedom (6DoF) motion from the target's projection on a single rotating x-ray imager in real-time. This novel method is based on the linear correlations between the superior-inferior translations and the motion in the other five degrees-of-freedom. The accuracy of the method was evaluated in silico with 81 liver tumour motion traces from 19 patients with three implanted markers. The ground-truth motion was estimated using the current gold standard method where each marker's 3D position was first estimated using a Gaussian probability method, and the 6DoF motion was then estimated from the 3D positions using an iterative method. The 3D position of each marker was projected onto a gantry-mounted imager with an imaging rate of 11 Hz. After an initial 110° gantry rotation (200 images), a correlation model between the superior-inferior translations and the five other DoFs was built using a least square method. The correlation model was then updated after each subsequent frame to estimate 6DoF motion in real-time. The proposed algorithm had an accuracy (±precision) of -0.03 ± 0.32 mm, -0.01 ± 0.13 mm and 0.03 ± 0.52 mm for translations in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) directions respectively; and, 0.07 ± 1.18°, 0.07 ± 1.00° and 0.06 ± 1.32° for rotations around the LR, SI and AP axes respectively on the dataset. The first method to directly estimate real-time 6DoF target motion from segmented marker positions on a 2D imager was devised. The algorithm was evaluated using 81 motion traces from 19 liver patients and was found to have sub-mm and sub-degree accuracy.
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Affiliation(s)
- D T Nguyen
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, Australia
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Keall P, Booth J, Nguyen D, O'Brien R, Poulsen P, Caillet V, Bromley R, Alfieri F, Bell L, Eade T, Kneebone A, Martin J. The First Clinical Implementation of Real-time Adaptive Radiation Therapy Using a Standard Linear Accelerator. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- R. J. Miller
- Senior Clinical Psychologist, St. Helens and Knowsley A.H.A
| | - B. Cullen
- Senior Occupational Therapist, St. Helens and Knowsley A.H.A
| | - R. O'Brien
- Sister in Charge, Dudley Wallis Day Unit, St. Helens and Knowsley A.H.A
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Thomas RR, Brooks HJL, O'Brien R. Prevalence of Shiga toxin-producing and enteropathogenic Escherichia coli marker genes in diarrhoeic stools in a New Zealand catchment area. J Clin Pathol 2016; 70:81-84. [PMID: 27698249 DOI: 10.1136/jclinpath-2016-203882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/22/2016] [Accepted: 08/03/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shiga toxin-producing (STEC) and enteropathogenic (EPEC) Escherichia coli are gastrointestinal pathogens causing diarrhoeal and extraintestinal disease. Due to lack of EPEC screening and use of Sorbitol-MacConkey (SMAC) agar in faecal screening, the true prevalence of EPEC and non-O157 STEC in New Zealand diarrhoeal cases is unknown. METHODS Diarrhoeic stools sourced from Dunedin hospital were pre-enriched, DNA extracted with Chelex-100 resin and screened using a multiplex TaqMan quantitative PCR assay amplifying stx1, sxt2 and EPEC (eae) gene markers. RESULTS Of the 522 diarrhoeic samples surveyed, 8 (1.53%) were PCR positive for stx1/stx2 and 23 (4.41%) were positive for eae. Six (75%) of the stx+ samples were uncommon non-O157 serotypes, and the remainder were found to be positive for both O103 and O157 STEC somatic antigens. CONCLUSIONS Results revealed shortcomings in current screening protocols for pathogenic E. coli; SMAC is not sufficiently discriminatory to detect emergent STEC serotypes and EPEC likely has an unappreciated role in cases of diarrhoea in New Zealand.
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Affiliation(s)
- Rowan R Thomas
- Department of Microbiology and Immunology, University of Otago, Dunedin, Otago, New Zealand
| | - Heather J L Brooks
- Department of Microbiology and Immunology, University of Otago, Dunedin, Otago, New Zealand
| | - Rory O'Brien
- Disease Research Laboratory, Department of Microbiology and Immunology, University of Otago, Dunedin, Otago, New Zealand
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Booth J, Caillet V, Hardcastle N, Haddad C, Harris B, Szymura K, Crasta C, O'Brien R, Eade T, Keall P. First Clinical Implementation of Electromagnetic Transponder-Guided MLC Tracking for Lung Stereotactic Ablative Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kohler P, Alsaaod M, Dolf G, O'Brien R, Beer G, Steiner A. A single prolonged milking interval of 24h compromises the well-being and health of dairy Holstein cows. J Dairy Sci 2016; 99:9080-9093. [PMID: 27592425 DOI: 10.3168/jds.2015-10839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 07/16/2016] [Indexed: 12/16/2022]
Abstract
Cows are often shown at dairy shows with overfilled udders to achieve a better show placing. However, it is unclear to what degree "over-bagging" affects the health and well-being of show cows. The goal of this study was to assess the effect of a single prolonged milking interval (PMI) of 24h on the measurable signs of health and well-being in dairy cows in early and mid-lactation and to assess the effect of a nonsteroidal anti-inflammatory drug (NSAID) on well-being during a PMI. Fifteen Holstein cows were studied in early lactation (89.5±2.7d in milk) and were given an NSAID or physiological saline in a crossover design. Ten cows were studied again in mid-lactation (151.6±4.0d in milk). Data on clinical signs of cows' health, behavior, and well-being were collected at 1 or 2h intervals before and during a PMI of 24h. Data from the last 6h of a 12h milking interval were compared with the last 6h of the PMI. Compared with that of a cow in the last 6h of a 12-h milking interval, the behavior of cows in early lactation (saline group) changed during the last 6h of the PMI: we observed decreased eating time (22.4 vs. 16.2min/h), increased ruminating time (13.3 vs. 25.0min/h), and increased hind limb abduction while walking (score 41.7 vs. 62.6) and standing (31.2 vs. 38.9cm). Udder firmness was increased (2.9 vs. 4.5kg) during this period and more weight was placed on the hind limbs (46.4 vs. 47.0%). We also found pathological signs at the end of the PMI: all cows showed milk leaking, and 10 of 15 cows developed edema in the subcutaneous udder tissue. Somatic cell count was significantly increased from 12h to 72h after the PMI. Administration of an NSAID had no influence on measured variables, except that the occurrence of edema was not significantly increased during PMI in the flunixin group (10 of 15 and 6 of 15 cows for the saline and flunixin groups, respectively). In the cows in mid-lactation, different variables were not significantly changed in the PMI compared with baseline values (e.g., eating and ruminating time, occurrence of edema, and abduction). We conclude that the cows' health and well-being were compromised by a single PMI of 24h, because their behavior changed and pathological signs were recorded. Administration of an NSAID had a slight effect on cows' well-being during a PMI. The stage of lactation had more effect on the cows' health and well-being, because fewer variables were changed in mid-lactation.
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Affiliation(s)
- P Kohler
- Clinic for Ruminants, University of Bern, 3001 Bern, Switzerland.
| | - M Alsaaod
- Clinic for Ruminants, University of Bern, 3001 Bern, Switzerland
| | - G Dolf
- Institute of Genetics, Vetsuisse-Faculty, University of Bern, 3001 Bern, Switzerland
| | - R O'Brien
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 61820
| | - G Beer
- Clinic for Ruminants, University of Bern, 3001 Bern, Switzerland
| | - A Steiner
- Clinic for Ruminants, University of Bern, 3001 Bern, Switzerland
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25
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Hardcastle N, Booth J, Caillet V, O'Brien R, Haddad C, Crasta C, Szymura K, Keall P. MO-FG-BRA-06: Electromagnetic Beacon Insertion in Lung Cancer Patients and Resultant Surrogacy Errors for Dynamic MLC Tumour Tracking. Med Phys 2016. [DOI: 10.1118/1.4957299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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O'Brien R, Stankovic U, Keall P, Sonke J. WE-AB-207A-11: Respiratory Motion Guided 4DCBCT - A Step Towards Controlling 4DCBCT Image Quality. Med Phys 2016. [DOI: 10.1118/1.4957764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Pollock S, Tse R, Martin D, McLean L, Pham M, Tait D, Estoesta R, Whittington G, Turley J, Kearney C, Cho G, Hill R, Pickard S, Aston P, Makhija K, O'Brien R, Keall P. SU-F-J-136: Impact of Audiovisual Biofeedback On Interfraction Motion Over a Course of Liver Cancer Stereotactic Body Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956044] [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: 11/07/2022] Open
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28
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Ipsen S, Bruder R, O'Brien R, Keall P, Schweikard A, Poulsen P. TH-AB-202-05: BEST IN PHYSICS (JOINT IMAGING-THERAPY): First Online Ultrasound-Guided MLC Tracking for Real-Time Motion Compensation in Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4958069] [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: 11/07/2022] Open
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Kim J, Nguyen D, Huang C, O'Brien R, Caillet V, Poulsen P, Booth J, Keall P. TH-AB-202-10: Quantifying the Accuracy and Precision of Six Degree-Of-Freedom Motion Estimation for Use in Real-Time Tumor Motion Monitoring During Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4958074] [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: 11/07/2022] Open
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Nguyen D, Kim J, O'Brien R, Huang C, Booth J, Greer P, Legge K, Poulsen P, Martin J, Keall P. TH-AB-202-12: The First Clinical Implementation of a Real-Time Six Degree of Freedom Tracking System During Radiation Therapy. Med Phys 2016. [DOI: 10.1118/1.4958076] [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: 11/07/2022] Open
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31
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Caillet V, O'Brien R, Colvill E, Poulsen P, Moore D, Booth J, Sawant A, Keall P. SU-G-JeP1-12: Head-To-Head Performance Characterization of Two Multileaf Collimator Tracking Algorithms for Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956987] [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: 11/07/2022] Open
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32
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Feain I, Shieh C, White P, O'Brien R, Counter W, Jackson M, Downes S, Keall P. EP-1928: The Nano-X image-guided adaptive gantry-less linac: imaging and dosimetry under phantom rotation. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33179-6] [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: 11/30/2022]
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33
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Pollock S, Tse R, Martin D, McLean L, Pham M, Martin D, Tait D, Estoesta P, Whittington G, Turley J, Kearney C, Cho G, Hill R, Pickard S, Aston P, Makhija K, O'Brien R, Keall P. EP-1742: The first clinical implementation of audiovisual biofeedback in liver cancer SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32993-0] [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: 12/01/2022]
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34
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Williams KH, Sullivan DR, Veillard AS, O'Brien R, George J, Jenkins AJ, Young S, Ehnholm C, Duffield A, Twigg SM, Keech AC. Low alanine aminotransferase levels and higher number of cardiovascular events in people with Type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabet Med 2016; 33:356-64. [PMID: 26433207 DOI: 10.1111/dme.12972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 12/24/2022]
Abstract
AIMS To determine whether alanine aminotransferase or gamma-glutamyltransferase levels, as markers of liver health and non-alcoholic fatty liver disease, might predict cardiovascular events in people with Type 2 diabetes. METHODS Data from the Fenofibrate Intervention and Event Lowering in Diabetes study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (non-fatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years. RESULTS Alanine aminotransferase measure had a linear inverse relationship with the first cardiovascular event occurring in participants during the study period. After adjustment, for every 1 sd higher baseline alanine aminotransferase measure (13.2 U/l), the risk of a cardiovascular event was 7% lower (95% CI 4-13; P = 0.02). Participants with alanine aminotransferase levels below and above the reference range 8-41 U/l for women and 9-59 U/l for men, had hazard ratios for a cardiovascular event of 1.86 (95% CI 1.12-3.09) and 0.65 (95% CI 0.49-0.87), respectively (P = 0.001). No relationship was found for gamma-glutamyltransferase. CONCLUSIONS The data may indicate that in people with Type 2 diabetes, which is associated with higher alanine aminotransferase levels because of prevalent non-alcoholic fatty liver disease, a low alanine aminotransferase level is a marker of hepatic or systemic frailty rather than health.
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Affiliation(s)
- K H Williams
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - D R Sullivan
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - A S Veillard
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - R O'Brien
- Austin Hospital, Melbourne, VIC, Australia
| | - J George
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, Sydney, NSW, Australia
| | - A J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Young
- Diabetes Clinic, Northshore Hospital, Auckland, New Zealand
| | - C Ehnholm
- Biomedicum Helsinki, Helsinki, Finland
| | - A Duffield
- Clinical Research Centre, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - S M Twigg
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A C Keech
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
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Mackintosh CG, Griffin JFT, Scott IC, O'Brien R, Stanton JL, MacLean P, Brauning R. SOLiD SAGE sequencing shows differential gene expression in jejunal lymph node samples of resistant and susceptible red deer (Cervus elaphus) challenged with Mycobacterium avium subsp. paratuberculosis. Vet Immunol Immunopathol 2016; 169:102-10. [PMID: 26620077 DOI: 10.1016/j.vetimm.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 09/28/2015] [Accepted: 10/28/2015] [Indexed: 02/05/2023]
Affiliation(s)
| | - J F T Griffin
- Disease Research Laboratory, University of Otago, Dunedin, New Zealand
| | - I C Scott
- AgResearch Invermay, Mosgiel, New Zealand
| | - R O'Brien
- Disease Research Laboratory, University of Otago, Dunedin, New Zealand
| | - J L Stanton
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - P MacLean
- AgResearch Ruakura, Hamilton, New Zealand
| | - R Brauning
- AgResearch Invermay, Mosgiel, New Zealand
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Wisotzky E, O'Brien R, Keall P. TH-AB-303-04: A Novel Leaf Sequencing Optimization Algorithm Which Considers Previous Underdose and Overdose Events for MLC Tracking Radiotherapy. Med Phys 2015. [DOI: 10.1118/1.4926159] [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: 11/07/2022] Open
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O'Brien R, Lyon J, Ng J, Bergman A, Booth J, Keall P. TH-CD-303-09: Respiratory Motion Guided 4DCBCT On a Linear Accelerator with Lung Cancer Patient Breathing Traces. Med Phys 2015. [DOI: 10.1118/1.4926244] [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: 11/07/2022] Open
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Booth J, Ng J, O'Brien R, Keall P, Poulsen P, Calliet V, Juneja P, Eade T, Kneebone A. TH-AB-303-09: Gated Prostate Radiotherapy: Accuracy and Dosimetric Results From First Clinical Study with Kilovoltage Intrafraction Monitoring. Med Phys 2015. [DOI: 10.1118/1.4926164] [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: 11/07/2022] Open
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Ge Y, Booth J, Colvill E, O'Brien R, Keall P. SU-E-J-57: First Development of Adapting to Intrafraction Relative Motion Between Prostate and Pelvic Lymph Nodes Targets. Med Phys 2015. [DOI: 10.1118/1.4924144] [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: 11/07/2022] Open
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Brennan L, O'Brien R, Griffin F. Genetic markers for resilience and susceptibility to Johne's disease In red deer ( Cervus elaphus) (VET1P.1120). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.146.8] [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] [Indexed: 01/05/2023]
Abstract
Abstract
Mycobacterium avium subspecies paraturberculosis is the causative agent of Johne’s disease, an enteritis infection that affects ruminants.This disease has been studied in deer, but there is little information regarding immunity or disease immunopathology. There is evidence that host genetics contribute to resilience or susceptibility to the disease. This study sought to identify genes in the innate and adaptive immune systems as biomarkers for resilient (R) or susceptible (S) phenotypes in red deer. We have bred over 60 animals from sires with a confirmed R or S phenotype. Animals were bled routinely and monocyte derived macrophages (MDMs) or whole PBMCs were obtained and cultured in vitro. Gene expression was determined using qPCR. The 15 most informative gene targets were chosen from a panel of 60 using GenEx software MDMs showed higher levels of expression of immune genes such as IL1A, TNFA, IL23A and IL12A in S animals, as well as genes not typically associated with the immune system, such as PKLR that exhibit this pattern. Conversely, PBMC samples from these animals exhibit higher levels of expression of immune genes such as IFNY, IL17A and IL2 in R animals. These results have been reproduced in animals bred from different sires over several years. We intend to incorporate these gene markers into diagnostic tests to identify R and S animals at an early age. These genes may also provide deeper insights into immune parameters that determine disease outcome in an animal.
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Affiliation(s)
- Liam Brennan
- 1Microbiology & Immunology, University of Otago, Dunedin, New Zealand
| | - Rory O'Brien
- 1Microbiology & Immunology, University of Otago, Dunedin, New Zealand
| | - Frank Griffin
- 1Microbiology & Immunology, University of Otago, Dunedin, New Zealand
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Denholm JT, Amon JJ, O'Brien R, Narain A, Kim SJ, El Sony A, Edginton ME. Attitudes towards involuntary incarceration for tuberculosis: a survey of Union members. Int J Tuberc Lung Dis 2014; 18:155-9. [PMID: 24429306 DOI: 10.5588/ijtld.13.0609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policies involving the use of involuntary incarceration for tuberculosis (TB) are highly ethically controversial. To encourage ethical reflection within the International Union Against Tuberculosis and Lung Disease (The Union), the Ethics Advisory Group (EAG) surveyed members regarding their attitudes and values relating to involuntary incarceration for TB. METHODS Members of the Union TB section were invited to respond to an anonymous web-based survey. The survey included both multiple choice questions describing a range of scenarios regarding involuntary incarceration, and free-text fields inviting respondents to provide general comments on ethical issues. RESULTS The survey was completed by 194 participants, 33 (17%) of whom were opposed to involuntary incarceration on principle. The age and sex of the respondents was not associated with likelihood of principled opposition; respondents from North America were least likely to be opposed to involuntary incarceration (P = 0.02). Respondents were most likely to consider involuntary incarceration for persons with known multidrug-resistant TB or a history of previous treatment default, and least likely where people lived alone, were university-educated or the main income provider for their families. CONCLUSION This survey found a wide range of viewpoints regarding involuntary incarceration, and highlights a number of key elements in ethical engagement with the tensions surrounding involuntary incarceration. We provide commentary on approaches to ethical policy making in the light of these findings.
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Affiliation(s)
- J T Denholm
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France; Victorian Infectious Disease Service, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - J J Amon
- Health and Human Rights Division, Human Rights Watch, New York, New York, USA
| | - R O'Brien
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Narain
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S J Kim
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A El Sony
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France; The Epidemiology Laboratory (Epi-Lab), Khartoum, Sudan
| | - M E Edginton
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
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Booth J, Colvill E, Eade T, Kneebone A, O'Brien R, Keall P. First Clinical Implementation of Electromagnetic Transponder-Guided MLC Tracking. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hammond A, Prior Y, O'Brien R, Woodbridge S, Radford K. FRI0592-HPR Work Rehabilitation in Inflammatory Arthritis: A Pilot Randomised Controlled Trial:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5378] [Citation(s) in RCA: 2] [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: 11/03/2022]
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Voss J, Graff C, Schwartz A, Hyland D, Argiriadi M, Camp H, Dowding L, Friedman M, Frank K, George J, Goedken E, Lo Schiavo G, Morytko M, O'Brien R, Padley R, Rozema M, Rosebraugh M, Stewart K, Wallace G, Wishart N, Murtaza A, Olson L. THU0127 Pharmacodynamics of A Novel JAK1 Selective Inhibitor in Rat Arthritis and Anemia Models and in Healthy Human Subjects. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3823] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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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Ravkilde T, O'Brien R, Keall P, Poulsen P. SP-0435: Real-time dose reconstruction during volumetric modulated arc therapy with dynamic MLC tracking. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30540-5] [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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Edginton ME, Ornstein T, Denholm J, El Sony A, Kim SJ, Narain A, O'Brien R. Research ethics in The Union: an 8-year review of the Ethics Advisory Group. Public Health Action 2013; 3:346-50. [PMID: 26393060 PMCID: PMC4463154 DOI: 10.5588/pha.13.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING The Ethics Advisory Group (EAG) of the International Union Against Tuberculosis and Lung Disease (The Union) was established in 2004 to provide ethical guidance and promote ethical standards within The Union, including reviews of proposed research projects associated with The Union. OBJECTIVES To describe research proposal reviews conducted by the EAG in the period 2005-2012 in terms of 1) annual numbers, 2) the Union departments in which the proposals originated, 3) study designs, 4) regions and countries where studies were to be conducted, 5) study topics, 6) problems encountered by the EAG, and 7) review outcomes. DESIGN Descriptive study of application records of the EAG. RESULTS A total of 292 applications were reviewed; 79% were proposals for operational research; 85% were from Africa and Asia, with 64% from India, South Africa, Malawi, Kenya and Zimbabwe. Tuberculosis was the topic in 68%; only three studies in the 8 years were on other lung diseases. Several problems encountered are highlighted. All applications were approved except six, either immediately or after modification. CONCLUSION The proposal review process of the EAG serves to maintain ethical standards of research within The Union. Ideas for expanding the scope of the EAG are discussed.
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Affiliation(s)
- M E Edginton
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - T Ornstein
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J Denholm
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A El Sony
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - S J Kim
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Narain
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R O'Brien
- Ethics Advisory Group, International Union Against Tuberculosis and Lung Disease, Paris, France
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Marfell BJ, O'Brien R, Griffin JFT. Global gene expression profiling of monocyte-derived macrophages from red deer (Cervus elaphus) genotypically resistant or susceptible to Mycobacterium avium subspecies paratuberculosis infection. Dev Comp Immunol 2013; 40:210-217. [PMID: 23454067 DOI: 10.1016/j.dci.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/10/2013] [Accepted: 02/12/2013] [Indexed: 06/01/2023]
Abstract
Mycobacterium avium subspecies paratuberculosis (MAP) can cause a chronic inflammatory bowel disease, Johne's disease (JD), in ruminant animals. This study has explored the molecular basis of resistance and susceptibility to this disease in red deer breeds previously confirmed to express polarised phenotypes by experimental infection trials and following natural infection. Monocyte-derived macrophage cultures were obtained from uninfected red deer selected for either a resistant or susceptible phenotype. Cells were infected with MAP in vitro and gene expression analysed by RNA-Seq. Transcriptome analysis revealed a more disrupted gene expression profile in macrophages from susceptible animals compared with cells from resistant animals in terms of the number of genes up- or downregulated. Highly upregulated genes were related to chemotaxis (CXCL10, CSF3, and CCL8) and type 1 interferon signalling (RSAD2, IFIT1, IFIT2, ISG12, ISG15, USP18, and HERC6). Upregulation of these genes was observed to be greater in macrophages from susceptible animals compared to cells from resistant animals in response to in vitro MAP infection. These data support the use of transcriptomic approaches to enable the identification of markers associated particularly with susceptibility to MAP infection.
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Affiliation(s)
- Brooke J Marfell
- Disease Research Laboratory, Department of Microbiology and Immunology, 720 Cumberland St., Dunedin 9016, New Zealand.
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O'Brien R, Hughes A, Liggett S, Griffin F. Composite testing for ante-mortem diagnosis of Johne's disease in farmed New Zealand deer: correlations between bacteriological culture, histopathology, serological reactivity and faecal shedding as determined by quantitative PCR. BMC Vet Res 2013; 9:72. [PMID: 23574863 PMCID: PMC3639118 DOI: 10.1186/1746-6148-9-72] [Citation(s) in RCA: 14] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/01/2013] [Indexed: 11/16/2022] Open
Abstract
Background In the absence of overt clinical signs of Johne’s Disease (JD), laboratory based tests have largely been limited to organism detection via faecal culture or PCR and serological tests for antibody reactivity. In this study we describe the application of quantitative faecal PCR for the detection of Mycobacterium avium subsp. paratuberculosis (MAP) in New Zealand farmed deer to quantify the bacterial load in cervine faecal samples as an adjunct to an existing serodiagnostic test (Paralisa™) tailored for JD diagnosis in deer. As ELISA has potential as a cheap, high throughput screening test for JD, an attempt was made to assess the sensitivity, specificity and positive/negative predictive (PPV/NPV) values of Paralisa™ for estimating levels of faecal shedding of MAP as a basis for JD management in deer. Results Correlations were made between diagnostic tests (ELISA, qPCR, culture and histopathology) to establish the precision and predictive values of individual tests. The findings from this study suggest there is strong correlation between bacterial shedding, as determined by faecal qPCR, with both culture (r = 0.9325) and histopathological lesion severity scoring (r = 0.7345). Correlation between faecal shedding and ELISA reactivity in deer was weaker with values of r = 0.4325 and r = 0.4006 for Johnin and Protoplasmic antigens, respectively. At an ELISA Unit (EU) cutoff of >50 (Johnin antigen) the PPV of Paralisa™ for significant faecal shedding in deer (>104 organisms/g) was moderate (0.55) while the NPV was higher (0.89). At an EU cutoff of ≥150, the PPV for shedding >105 organisms/g rose to 0.88, with a corresponding NPV of 0.85. Conclusions The evidence available from this study suggests that Paralisa™ used at a cutoff of 50EU could be used to screen deer herds for MAP infection with sequential qPCR testing used to cull all Paralisa™ positive animals that exhibit significant MAP faecal shedding.
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Affiliation(s)
- Rory O'Brien
- Disease Research Laboratory, Department of Microbiology & Immunology, University of Otago, Dunedin, New Zealand.
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Santana-Vaz N, Tallowin S, Lewis H, Park D, O'Brien R, Patel JM. Towards safer airway management in the critically ill: lessons from National Audit Project 4. Crit Care 2013. [PMCID: PMC3642414 DOI: 10.1186/cc12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Patel JM, Couper K, Melody T, O'Brien R, Parekh D. Prevalence and impact of invasive fungal infections in intensive care. Crit Care 2013. [PMCID: PMC3643093 DOI: 10.1186/cc12026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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