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Jones C, Jakubowski BE, Stevens R, Roberts N, McManus RJ, Tucker KL. The diagnostic Accuracy of Visual versus automated dipstick proteinuria testing in Pregnancy: A systematic review and Meta-Analysis. Pregnancy Hypertens 2024; 35:73-81. [PMID: 38262144 DOI: 10.1016/j.preghy.2024.01.133] [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: 03/20/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of point-of-care (POC) tests for detecting proteinuria in pregnant women. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE and EMBASE databases were searched from inception to 13 November 2020. ELIGIBILITY CRITERIA AND DATA ANALYSIS Included studies measured the sensitivity and specificity ofPOC proteinuria testing compared to laboratory reference standards (protein-creatinine ratio (PCR), 24-hour urine collection). Bivariate meta-analyses determined pooled sensitivity and specificity. Random-effects inverse-variance model determinedheterogeneity. MAIN OUTCOME MEASURES The primary outcome was overall sensitivity and specificity, stratified by method of POC testing and reference standard. Secondary outcomes were sensitivity and specificity within thesubgroupstest brand, reference standard, and hypertension status. RESULTS 1078 studies were identified, 17 studies comprising 23 comparisons were included. The meta-analysis included 13 studies with 19 comparisons. Pooled sensitivity and specificity of visual dipsticks against PCR was 72 % (95 % CI: 56 % to 84 %) and 92 % (95 % CI: 76 % to 98 %), respectively. Pooled sensitivity and specificity of visual dipsticks against 24-hour collection was 69 % (55 % to 80 %) and 70 % (51 % to 84 %), respectively. Pooled sensitivity and specificity for automated readers against PCR was 73 % (53 % to 86 %) and 91 % (83 % to 95 %), respectively. Pooled sensitivity and specificity of automated readers against 24-hour collection was 65 % (42 % to 83 %) and 82 % (46 % to 96 %), respectively. CONCLUSION Visual dipsticks have comparable accuracy to automated readers, yet are notadequate as a rule-out test for proteinuria. Proteinuria POC testing maybe beneficial inantenatal care when repeatfollow-up tests are performed. PROSPERO Registration Number: CRD42021231914.
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Affiliation(s)
- C Jones
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - B E Jakubowski
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R Stevens
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - N Roberts
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R J McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - K L Tucker
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
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Tenaillon MI, Burban E, Huynh S, Wojcik A, Thuillet AC, Manicacci D, Gérard PR, Alix K, Belcram H, Cornille A, Brault M, Stevens R, Lagnel J, Dogimont C, Vigouroux Y, Glémin S. Crop domestication as a step towards reproductive isolation. Am J Bot 2023:e16173. [PMID: 37087742 DOI: 10.1002/ajb2.16173] [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: 02/01/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
Speciation, Darwin's mystery of mysteries, is a continuous process that results in genomic divergence accompanied by the gradual increment of reproductive barriers between lineages. Since the beginning of research on the genetics of speciation, several questions have emerged such as: What are the genetic bases of incompatibilities? How many loci are necessary to prevent hybridization and how are they distributed along genomes? Can speciation occur despite gene flow and how common is ecological speciation? Early stages of divergence are key to understand the ecology and genetics of speciation, and semi-isolated species where hybrids can still be produced are particularly relevant This article is protected by copyright. All rights reserved.
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Affiliation(s)
- M I Tenaillon
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - E Burban
- Laboratoire ECOBIO_UMR 6553 UR1-CNRS, Campus de Beaulieu, Rennes, France
| | - S Huynh
- UMR DIADE, Univ Montpellier, IRD, CIRAD, 911 avenue Agropolis, Montpellier, France
| | - A Wojcik
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - A-C Thuillet
- UMR DIADE, Univ Montpellier, IRD, CIRAD, 911 avenue Agropolis, Montpellier, France
| | - D Manicacci
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - P R Gérard
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - K Alix
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - H Belcram
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - A Cornille
- Université Paris-Saclay, INRAE, CNRS, AgroParisTech, GQE - Le Moulon, 12 route, 128, Gif-sur-Yvette, France
| | - M Brault
- GAFL - Génétique et Amélioration des Fruits et Légumes, INRAE, Allée des Chênes, Montfavet, France
| | - R Stevens
- GAFL - Génétique et Amélioration des Fruits et Légumes, INRAE, Allée des Chênes, Montfavet, France
| | - J Lagnel
- GAFL - Génétique et Amélioration des Fruits et Légumes, INRAE, Allée des Chênes, Montfavet, France
| | - C Dogimont
- GAFL - Génétique et Amélioration des Fruits et Légumes, INRAE, Allée des Chênes, Montfavet, France
| | - Y Vigouroux
- UMR DIADE, Univ Montpellier, IRD, CIRAD, 911 avenue Agropolis, Montpellier, France
| | - S Glémin
- Laboratoire ECOBIO_UMR 6553 UR1-CNRS, Campus de Beaulieu, Rennes, France
- Department of Ecology and Genetics, Evolutionary Biology Centre, Uppsala University, Sweden
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Stevens R, Machiyama K, Mavodza CV, Doyle AM. Misconceptions, Misinformation, and Misperceptions: A Case for Removing the "Mis-" When Discussing Contraceptive Beliefs. Stud Fam Plann 2023; 54:309-321. [PMID: 36753058 DOI: 10.1111/sifp.12232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Beliefs about contraception are commonly conceptualized as playing an important role in contraceptive decision-making. Interventions designed to address beliefs typically include counseling to dispel any "myths" or "misconceptions." These interventions currently show little evidence for impact in reducing beliefs. This commentary delves into the problems associated with using implicitly negative terminology to refer to contraceptive beliefs, which come laden with assumptions as to their validity. By conceptualizing women as getting it wrong or their beliefs as invalid, it sets the scene for dubious treatment of women's concerns and hampers the design of fruitful interventions to address them. To replace the multitude of terms used, we suggest using "belief" going forward to maintain value-free curiosity and remove any implicit assumptions about the origin or validity of a belief. We provide recommendations for measuring beliefs to help researchers understand the drivers and impacts of the belief they are measuring. Finally, we discuss implications for intervention design once different types of belief are better understood. We argue that tailored interventions by belief type would help address the root causes of beliefs and better meet women's broader contraceptive needs, such as the need for contraceptive autonomy and satisfaction.
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Affiliation(s)
- Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | - Kazuyo Machiyama
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Constancia Vimbayi Mavodza
- Department of Public Health and Policy, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Aoife M Doyle
- Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Sprumont J, Stevens R, Gilbert A, Khamis J, Philippet P. [An intracranial haemorrhage in a febrile newborn]. Rev Med Liege 2022; 77:689-691. [PMID: 36484743] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 15 days old newborn was admitted to the emergency room for a recent fever onset. In newborns, the priority is to rule out any bacterial infection and initiate broad spectrum antibiotics. The hemorrhagic appearance of the cerebrospinal fluid after lumbar puncture can sometimes be the only sign to suspect, other than obvious infectious aetiology, an intracranial haemorrhage.
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Affiliation(s)
- J Sprumont
- Service de Pédiatrie, CHC MontLégia, Liège, Belgique
| | - R Stevens
- Secteur de Neurologie pédiatrique, CHC MontLégia, Liège, Belgique
| | - A Gilbert
- Secteur des Urgences pédiatriques, CHC MontLégia, Liège, Belgique
| | - J Khamis
- Département d'Imagerie médicale, CHC MontLégia, Liège, Belgique
| | - P Philippet
- Service de Pédiatrie, CHC MontLégia, Liège, Belgique
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Stevens R, Malbos B, Gurmu E, Riou J, Alvergne A. Anemic Women are More at Risk of Injectable Contraceptive Discontinuation due to Side Effects in Ethiopia. Stud Fam Plann 2022; 53:193-208. [DOI: 10.1111/sifp.12186] [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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Pour H, Subramani K, Stevens R, Sinha P. An overview of orthodontic malpractice liability based on a survey and case assessment review. J Clin Exp Dent 2022; 14:e694-e704. [PMID: 36158769 PMCID: PMC9498637 DOI: 10.4317/jced.59785] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background The purpose of this survey study and case review was to identify 1) the common causes related to filing a malpractice claim against an orthodontist and, 2) the factors mitigating against a potential malpractice claim in the United States (U.S). The objectives of the case review were to examine the current state of orthodontic malpractice litigation from a cause and mitigating point of view.
Material and Methods Data for this research was collected and reviewed using the following two methods:
1) A survey questionnaire on aspects of malpractice liability was electronically distributed to 2,241 active U.S. members of the American Association of Orthodontists (AAO).
2) Legal cases were reviewed on the online legal research database Lexis Advance Research, and 35 cases were analyzed.
Results Survey questionnaire results and legal case review results are as follows:
1) 77 orthodontists completed the survey. 9.1% of the respondents reported a malpractice claim having been filed against them with periodontal issues accounting for most of the claims. Survey participants reported good doctor-patient communication as being the most relevant contributory factor and most relevant mitigating factor in malpractice claims.
2) Negligence is the main reason patients sue a doctor for clinically related litigation, and failure to obtain a proper informed consent from the patient is the main cause of action for non-clinically related litigation.
Conclusions Most respondents reported doctor-patient communication, periodontal issues, and a lack of informed consent as the main triggering elements of a lawsuit, which is similar to other studies and case review analysis. Good doctor-patient rapport was ranked as being most helpful in mitigating a potential claim, which is also similar to other studies. Another aspect of the survey questionnaire that was evaluated was whether a non-orthodontist can provide expert testimony against an orthodontist, with most respondents reporting that this is not possible. It has been ruled, though, that a general dentist can be an expert witness and provide expert testimony against an orthodontist in a lawsuit depending on the circumstances. Negligence was the most common cause of clinically related orthodontic litigation, and a failure of the practitioner to obtain a proper informed consent from the patient was the most common cause of non-clinically related orthodontic litigation. Key words:Orthodontist, malpractice, legal, lawsuit, liability, medicolegal.
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Acosta-Lenis C, Bollu P, Chaudhry K, Stevens R, Subramani K. Public Perceptions and Understanding of Risks Associated with Do-It-Yourself Orthodontics: A Survey Study. J Clin Exp Dent 2022; 14:e712-e718. [PMID: 36158777 PMCID: PMC9498639 DOI: 10.4317/jced.59911] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this study was to evaluate general public’s perception, knowledge and preferences on orthodontic treatment rendered by an orthodontist versus the “Do-It-Yourself” orthodontics (DIYO) concept without professional supervision. The secondary objective was to assess laypeople’s awareness on the risks and limitations of DIYO.
Material and Methods A 24-question online survey questionnaire was administered to 526 laypeople who had no professional experience or background in dentistry and orthodontics. All data was collected over 3 days (July 20-23, 2020) by Qualtrics server and forwarded to the principal investigator. Statistical analysis was done with statistical software SPSS® version 26.
Results The most important reason for laypeople to opt for DIYO is financial reason. People who have undergone orthodontic treatment know the difference between a general dentist and an orthodontist, whereas people who have not had orthodontic treatment are less likely to know the difference. Of the 285 people who did not receive orthodontic treatment before by a dental professional, 43 have considered DIYO. 122 of the 526 people considered DIYO, and 79 of the 122 had orthodontic treatment before. 26 of the 122 did not consider the clinical exam and diagnostic records important and would be comfortable without in-person supervision. 83 of the 122 would be comfortable not having in-person supervision, and still considered this treatment modality “Doctor-Directed”.
Conclusions The main reason laypeople utilize DIYO is the low cost. Some DIYO users do not consider risks involved and a small percentage consider their own dentist to be responsible if any issues arise with DIYO. One third of survey respondents will consider DIYO in the future. Key words:Do-It-Yourself (DIY), Direct-To-Consumer (DTC), Adult, Orthodontics, Dentistry, Surveys and Questionnaires.
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Yee CS, Gordon C, Akil M, Lanyon P, Edwards CJ, Isenberg D, Rahman A, Teh LS, Tosounidou S, Stevens R, Prabu A, Griffiths B, Mchugh N, Bruce IN, Ahmad Y, Khamashta M, Farewell V. POS0106 BILAG-2004 LDA AND BST LDA ARE VALID TREAT TO TARGET IN SLE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.10] [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: 11/03/2022]
Abstract
Background:Low disease activity state has been defined using SLEDAI and used as treatment target in SLE. However, there has not been any such definition using BILAG-2004 index (BILAG-2004).Objectives:This study was to determine if low disease activity state according to BILAG-2004 is valid for use as treatment target in SLE. We also assessed disease activity longitudinally using BILAG-2004 systems tally (BST). BST is an alternative way of representing BILAG-2004 scores that combines the flexibility and simplification of numerical scoring of BILAG-2004 with the clinical intuitiveness of BILAG-2004 structure.Methods:This was a prospective multi-centre longitudinal study in the UK of an inception cohort of SLE patients (recruited within 12 months of achieving 1997 ACR revised criteria for SLE). Data were collected on disease activity (BILAG-2004 and BILAG2004-Pregnancy Index during pregnancy), SLICC/ACR DI (SDI), cumulative drug exposure and death at every visit. This study ran from 1st January 2005 to 31st December 2017. Four low disease activity states (LDA) were defined using BILAG-2004: 1) BILAG-2004 LDA when all 9 systems had scores of C, D or E on assessment (no Grade A or B), 2) BST LDA when there was persistent score of C, D or E in all 9 systems between 2 consecutive visits (equivalent to 2 consecutive visits with BILAG-2004 LDA), 3) BILAG-2004 Remission when all 9 systems had scores of D or E on assessment and 4) Persistent Remission when there was persistent score of D or E in all 9 systems between 2 consecutive visits. Longitudinal analysis using Poisson regression with random effects model was used with development of new damage as the outcome of interest. Gender, cardiovascular risk factors, antiphospholipid syndrome status and most drugs (except hydroxychloroquine, glucocorticoids, mycophenolate and cyclophosphamide) were excluded from the model as they were not associated with development of damage in univariate analysis.Results:273 patients were recruited (91.2% female, 59.3% Caucasian, 17.2% African/Caribbean, 17.2% South Asian) with mean age at recruitment of 38.5 years (SD 14.8). 97.8% had no damage at recruitment (2.2% had SDI score of 1). Median follow-up was 73.4 months (range: 1.8, 153.8) with total follow-up of 1767 patient-years. There were 13 deaths and 114 new damage items occurred during follow-up. There were 6674 assessments with disease activity score: 319 assessments with Grade A activity in 95 patients (84.6% had only 1 system with grade A, range: 1 - 4) and 1704 assessments with Grade A or B activity in 239 patients (78.7% had only 1 system with Grade A or B, range: 1 - 5).BILAG-2004 LDA was achieved in 74.5% of assessments (from 271 patients). BILAG-2004 Remission occurred in 28.2% of assessments (from 234 patients).6401 observations with BST were available (1 observation derived from change in activity between 2 consecutive assessments) and 63.7% were in BST LDA. There was no observation with Persistent Remission between consecutive visits.Table 1 summarises multivariate analysis which showed BILAG-2004 LDA to be inversely associated with damage. Similar results were obtained with BILAG-2004 Remission (RR 0.60 with 95% CI 0.38, 0.96) and BST LDA (RR 0.65 with 95% CI 0.43, 0.99). Cumulative drug exposure since recruitment for mycophenolate was protective against new damage (RR 0.99 with 95% CI 0.99, 0.99).Table 1.VariableRelative Risk (95% CI) for New DamageEthnicityAfro-Caribbean1.22 (0.68, 2.18)South Asian1.81 (0.97, 3.38)Others2.22 (0.63, 7.85)Age at diagnosis1.06 (1.04, 1.08)Prior SDI score0.68 (0.43, 1.06)BILAG-2004 LDA0.60 (0.39, 0.94)Hydroxychloroquine since last visit (per g)0.99 (0.98, 0.99)Steroids since last visit (per 100mg)1.02 (1.01, 1.03)Cyclophosphamide since last visit (per g)1.67 (1.15, 2.41)Conclusion:BILAG-2004 LDA and BST LDA are valid treatment targets in SLE. BILAG-2004 Remission and Persistent Remission are uncommon, which make them unrealistic as a treatment target.References:[1]Yee C. S., et al. The BILAG-2004 systems tally – a novel way of representing the BILAG-2004 index scores longitudinally. Rheumatology (Oxford) 2012; 51[11]: 2099-2105.Acknowledgements :Versus Arthritis, Vifor PharmaDisclosure of Interests:Chee-Seng Yee Consultant of: Bristol Myers Squibb, ImmuPharma, Grant/research support from: Vifor Pharma, Caroline Gordon Speakers bureau: UCB, Consultant of: Center for Disease Control, Astra-Zeneca, MGP, Sanofi and UCB, Mohammed Akil: None declared, Peter Lanyon: None declared, Christopher John Edwards Consultant of: Glaxo Smith Kline, Roche, Grant/research support from: Glaxo Smith Kline, Roche, David Isenberg: None declared, Anisur Rahman: None declared, Lee-Suan Teh: None declared, Sofia Tosounidou: None declared, Robert Stevens: None declared, Ahtiveer Prabu: None declared, Bridget Griffiths: None declared, Neil McHugh: None declared, Ian N. Bruce: None declared, Yasmeen Ahmad: None declared, Munther Khamashta: None declared, Vernon Farewell: None declared
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Khamis K, Bradley C, Gunter HJ, Basevi G, Stevens R, Hannah DM. Calibration of an in-situ fluorescence-based sensor platform for reliable BOD 5 measurement in wastewater. Water Sci Technol 2021; 83:3075-3091. [PMID: 34185701 DOI: 10.2166/wst.2021.197] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reliance on biochemical oxygen demand (BOD5) as an indicator of wastewater quality has hindered the development of efficient process control due to the associated uncertainty and lag-times. Surrogate measurements have been proposed, with fluorescence spectroscopy a promising technique. Yet, assessment of in-situ fluorescence sensors across multiple wastewater treatment plants (WwTPs), and at different treatment stages, is limited. In this study a multi-parameter sonde (two fluorescence peaks, turbidity, temperature and electrical conductivity) was used to provide a BOD5 surrogate measurement. The sonde was deployed at three WwTPs, on post primary settlement tanks (PST) and final effluent (FE). Triplicate laboratory measurements of BOD5, from independent laboratories were used to calibrate the sensor, with high variability apparent for FE samples. Site and process specific sensor calibrations yielded the best results (R2cv = 0.76-0.86; 10-fold cross-validation) and mean BOD5 of the three laboratory measurements improved FE calibration. When combining PST sites a reasonable calibration was still achieved (R2cv = 0.67) suggesting transfer of sensors between WwTPs may be possible. This study highlights the potential to use online optical sensors as robust BOD5 surrogates in WwTPs. However, careful calibration (i.e. replicated BOD5 measurements) is required for FE as laboratory measurements can be associated with high uncertainty.
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Affiliation(s)
- K Khamis
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
| | - C Bradley
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
| | - H J Gunter
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail: ; RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - G Basevi
- RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - R Stevens
- RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - D M Hannah
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
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Yee CS, Farewell V, Akil M, Lanyon P, Edwards CJ, Isenberg D, Rahman A, Teh LS, Tosounidou S, Stevens R, Prabu A, Griffiths B, Mchugh N, Bruce IN, Ahmad Y, Khamashta M, Gordon C. POS0111 DEVELOPMENT OF DAMAGE AND MORTALITY IN AN INCEPTION COHORT OF SLE PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.8] [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:There had been very limited data on the development of damage and mortality in an inception cohort of SLE patients who were recruited very soon after diagnosis.Objectives:This study aimed to analyse the development of damage and death in an inception cohort of SLE patients recruited within 1 year of diagnosis with up to 13 years of follow-up.Methods:This was a prospective multi-centre longitudinal study in the UK of SLE patients recruited within 12 months of achieving 1997 ACR revised criteria for SLE. Data were collected on BILAG-2004, BILAG2004-Pregnancy Index (during pregnancy), SLICC/ACR DI (SDI), cumulative drug exposure and death at every visit. Information on cardiovascular risk factors and antiphospholipid syndrome status were also collected. This study ran from 1st January 2005 to 31st December 2017. Mortality and development of damage were analysed.Results:There were 273 patients recruited (91.2% female, 59.3% Caucasian, 17.2% African/Caribbean, 17.2% South Asian) with mean age at recruitment of 38.5 years (SD 14.8). 97.8% had no damage at recruitment (2.2% had SDI score of 1). Median follow-up was 73.4 months (range: 1.8, 153.8) with total follow-up of 1767 patient-years.There were 13 deaths (4.8%): 76.9% female, 84.6% Caucasian, 15.4% South Asian, mean age 62.6 years (± SD 15.8) and mean disease duration 3 years (± SD 1.8). Causes of death were cancer in 5 (38.5%), infection in 3 (23.1%), ischaemic heart disease in 1 (7.7%) and unknown in 4 (30.8%).114 new damage items in 83 patients occurred during follow-up. The distribution of damage was musculoskeletal (21, 18.4%), ophthalmic (18, 15.8%), neuropsychiatric (18, 15.8%), renal (14, 12.3%), malignancy (12, 10.5%), cutaneous (7, 6.1%), GIT (7, 6.1%), cardiac (6, 5.3%), pulmonary (4, 3.5%), diabetes mellitus (4, 3.5%) and vascular (3, 2.6%). The rate of development of damage appears to be higher in the first 3 years which subsequently stabilised (Table 1).Table 1.Incidence rate of development of damage over period of follow-up at 3 yearly intervalsPeriod of follow-up (year)Person-years at riskNumber of new items of damageIncidence rate, per 1000 person-years (95% CI)0 – 3753.46079.6 (61.8, 102.6)3 – 6534.03158.1 (40.8, 82.6)6 – 9321.21237.4 (21.2, 35.8)9 – 12152.5532.8 (13.6, 78.7)> 125.90-Conclusion:Mortality is uncommon during the first 12 years of follow-up for newly diagnosed SLE patients. However, development of damage appears to be higher in the first 3 years before stabilizing to a lower rate subsequently.Acknowledgements:Versus Arthritis, VIfor PharmaDisclosure of Interests:Chee-Seng Yee Consultant of: Bristol Myer Squibb, ImmuPharma, Grant/research support from: Vifor Pharma, Vernon Farewell: None declared, Mohammed Akil: None declared, Peter Lanyon: None declared, Christopher John Edwards Consultant of: Glaxo Smith Kline, Roche, Grant/research support from: Glaxo Smith Kline, Roche, David Isenberg: None declared, Anisur Rahman: None declared, Lee-Suan Teh: None declared, Sofia Tosounidou: None declared, Robert Stevens: None declared, Ahtiveer Prabu: None declared, Bridget Griffiths: None declared, Neil McHugh: None declared, Ian N. Bruce: None declared, Yasmeen Ahmad: None declared, Munther Khamashta: None declared, Caroline Gordon Speakers bureau: UCB, Consultant of: Center for Disease Control, Astra-Zeneca, MGP, Sanofi and UCB
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Yee CS, Farewell V, Akil M, Lanyon P, Edwards CJ, Isenberg D, Rahman A, Teh LS, Tosounidou S, Stevens R, Prabu A, Griffiths B, Mchugh N, Bruce IN, Ahmad Y, Khamashta M, Gordon C. POS0705 BILAG-2004 INDEX ACTIVE DISEASE PREDICTS DEVELOPMENT OF DAMAGE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.9] [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:BILAG-2004 Index (BILAG-2004) has undergone construct and criterion validity and is used to assess disease activity in SLE. However, its predictive validity has yet to be established.Objectives:This study was to determine if disease activity according to BILAG-2004 was predictive of development of damage in an inception cohort.Methods:This was a prospective multi-centre longitudinal study in the UK of an inception cohort of SLE patients (recruited within 12 months of achieving 1997 ACR revised criteria for SLE). Data were collected on disease activity (BILAG-2004 and BILAG2004-Pregnancy Index during pregnancy), SLICC/ACR DI (SDI), cumulative drug exposure and death at every visit. Information on cardiovascular risk factors (hypertension, diabetes mellitus, hypercholesterolaemia and smoking status) and antiphospholipid syndrome status were also collected. This study ran from 1st January 2005 to 31st December 2017. Longitudinal analysis using Poisson regression with random effects model was used to determine predictors of development of new damage. Death was not included in the analysis due to small numbers.Results:273 patients were recruited (91.2% female, 59.3% Caucasian, 17.2% African/Caribbean, 17.2% South Asian) with mean age at recruitment of 38.5 years (SD 14.8). 97.8% had no damage at recruitment (2.2% had SDI score of 1). Median follow-up was 73.4 months (range: 1.8, 153.8) with total follow-up of 1767 patient-years. Prevalence of risk factors during follow-up were: hypertension 23.1%, hypercholesterolaemia 35.5%, diabetes mellitus 5.5%, smoker or ex-smoker 44% and antiphospholipid syndrome 7%. There were 13 deaths and 114 new damage items occurred during follow-up.There were 6674 assessments with disease activity score: 293 assessments with Grade A activity in 95 patients (92.4% had only 1 system with grade A, range: 1 - 4) and 1704 assessments with Grade A or B activity in 239 patients (78.7% had only 1 system with Grade A or B, range: 1 - 5).Univariate analysis showed that gender, cardiovascular risk factors, antiphospholipid syndrome and most drug exposure (except hydroxychloroquine, glucocorticoids, mycophenolate and cyclophosphamide) were not associated with new damage (they were not included in the multivariate analysis).Table 1 summarises multivariate analysis. Similar results were obtained when the disease activity variable was changed to Number of Systems with Grade A per assessment (RR 2.04 with 95% CI: 1.05, 3.94). Analysis using BILAG-2004 systems tally showed that persistent minimal disease was protective of development of damage (RR 0.74 with 95% CI: 0.57, 0.95). Cumulative drug exposure since recruitment for mycophenolate was protective against new damage (RR 0.99 with 95% CI 0.99, 0.99) but not cumulative drug exposure since last visit.VariableRisk Ratio (95% CI) for New DamageEthnicity Afro-Caribbean1.21 (0.68, 2.17) South Asian1.81 (0.97, 3.36) Others2.37 (0.68, 8.20)Age at diagnosis1.06 (1.04, 1.08)Prior SDI score0.69 (0.44, 1.08)Constitutional A or Bunreliable estimate due to low numbersMucocutaneous A or B1.80 (1.04, 3.14)Neuropsychiatric A or B4.68 (1.68, 13.05)Musculoskeletal A or B0.76 (0.33, 1.73)Cardiorespiratory A or B0.35 (0.05, 2.59)GIT A or Bunreliable estimate due to low numbersOphthalmic A or Bunreliable estimate due to low numbersRenal A or B2.08 (0.99, 4.40)Haematological A or B4.37 (1.15, 16.65)Hydroxychloroquine since last visit (per g)0.99 (0.98, 0.99)Prednisolone since last visit (per 100mg)1.01 (1.00, 1.02)Cyclophosphamide since last visit (per g)1.42 (0.94, 2.14)Conclusion:Active disease (Grade A or B) according to BILAG-2004 index is predictive of development of new damage in SLE patients.References:[1]Yee C. S., et al. The BILAG-2004 systems tally – a novel way of representing the BILAG-2004 index scores longitudinally. Rheumatology (Oxford) 2012; 51[11]: 2099-2105.Acknowledgements:Versus Arthritis and Vifor PharmaDisclosure of Interests:Chee-Seng Yee Consultant of: Bristol Myers Squibb, ImmuPharma, Grant/research support from: Vifor Pharma, Vernon Farewell: None declared, Mohammed Akil: None declared, Peter Lanyon: None declared, Christopher John Edwards Consultant of: Glaxo Smith Kline, Roche, Grant/research support from: Glaxo Smith Kline, Roche, David Isenberg: None declared, Anisur Rahman: None declared, Lee-Suan Teh: None declared, Sofia Tosounidou: None declared, Robert Stevens: None declared, Ahtiveer Prabu: None declared, Bridget Griffiths: None declared, Neil McHugh: None declared, Ian N. Bruce: None declared, Yasmeen Ahmad: None declared, Munther Khamashta: None declared, Caroline Gordon Speakers bureau: UCB, Consultant of: Center for Disease Control, Astra-Zeneca, MGP, Sanofi and UCB
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Stevens R, Kelaiditi E, Myrissa K. Exploration of the dietary habits, lifestyle patterns and barriers to healthy eating in UK post‐partum women. NUTR BULL 2021. [DOI: 10.1111/nbu.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R. Stevens
- Faculty of Sport, Health and Applied Science St Mary’s University London UK
| | - E. Kelaiditi
- Faculty of Sport, Health and Applied Science St Mary’s University London UK
| | - K. Myrissa
- Faculty of Sport, Health and Applied Science St Mary’s University London UK
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Abstract
Numerous evolutionary mechanisms have been proposed for the origins, spread and maintenance of low fertility. Such scholarship has focused on explaining the adoption of fertility-reducing behaviour, especially the use of contraceptive methods. However, this work has yet to engage fully with the dynamics of contraceptive behaviour at the individual level. Here we highlight the importance of considering not just adoption but also discontinuation for understanding contraceptive dynamics and their impact on fertility. We start by introducing contemporary evolutionary approaches to understanding fertility regulation behaviours, discussing the potential for integrating behavioural ecology and cultural evolution frameworks. Second, we draw on family planning studies to highlight the importance of contraceptive discontinuation owing to side-effects for understanding fertility rates and suggest evolutionary hypotheses for explaining patterns of variation in discontinuation rates. Third, we sketch a framework for considering how individual flexibility in contraceptive behaviour might impact the evolution of contraceptive strategies and the demographic transition. We argue that integrating public health and evolutionary approaches to reproductive behaviour might advance both fields by providing (a) a predictive framework for comparing the effectiveness of various public health strategies and (b) a more realistic picture of behaviour by considering contraceptive dynamics at the individual level more explicitly when modelling the cultural evolution of low fertility.
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Affiliation(s)
- Alexandra Alvergne
- ISEM, Université de Montpellier, CNRS, IRD, EPHE, Montpellier, France
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
- Harris Manchester College, University of Oxford, Oxford, UK
| | - Rose Stevens
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
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Getty N, Brettin T, Jin D, Stevens R, Xia F. Deep medical image analysis with representation learning and neuromorphic computing. Interface Focus 2021; 11:20190122. [PMID: 33343872 DOI: 10.1098/rsfs.2019.0122] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 11/12/2022] Open
Abstract
Deep learning is increasingly used in medical imaging, improving many steps of the processing chain, from acquisition to segmentation and anomaly detection to outcome prediction. Yet significant challenges remain: (i) image-based diagnosis depends on the spatial relationships between local patterns, something convolution and pooling often do not capture adequately; (ii) data augmentation, the de facto method for learning three-dimensional pose invariance, requires exponentially many points to achieve robust improvement; (iii) labelled medical images are much less abundant than unlabelled ones, especially for heterogeneous pathological cases; and (iv) scanning technologies such as magnetic resonance imaging can be slow and costly, generally without online learning abilities to focus on regions of clinical interest. To address these challenges, novel algorithmic and hardware approaches are needed for deep learning to reach its full potential in medical imaging.
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Affiliation(s)
- N Getty
- Data Science and Learning Division, Argonne National Laboratory, Lemont, IL 60439, USA.,Computer Science Department, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - T Brettin
- Computing, Environment and Life Sciences Directorate, Argonne National Laboratory, Lemont, IL 60439, USA
| | - D Jin
- Computer Science Department, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - R Stevens
- Computing, Environment and Life Sciences Directorate, Argonne National Laboratory, Lemont, IL 60439, USA.,Department of Computer Science, University of Chicago, Chicago, IL 60637, USA
| | - F Xia
- Data Science and Learning Division, Argonne National Laboratory, Lemont, IL 60439, USA
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Stevens R, Hanson P, Tiseo P, Guedes K, Campbell J, Connolly J, Ruggiero S, Corliss M, Smith V, Conaghan PG. OP0187 DETERMINING OPTIMAL COOLING AND ADMINISTRATION METHODS FOR CNTX-4975 INTRA-ARTICULAR INJECTION IN SUBJECTS WITH MODERATE TO SEVERE OSTEOARTHRITIS KNEE PAIN. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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:CNTX-4975 is a highly purified, synthetic capsaicin being developed to provide long-term analgesia after a single intra-articular (IA) injection for patients with moderate to severe osteoarthritis (OA) knee pain. CNTX-4975 IA administration is associated with short-term post-procedural pain that can be attenuated with preemptive joint cooling.Objectives:To evaluate cooling and administration procedures for CNTX-4975 IA injection, with goals of balancing patient comfort and ease of use and assessing clinical response 8 weeks after injection.Methods:This phase 3, open-label, 8-week study (NCT03661996) enrolled subjects aged 40–95 y with Kellgren-Lawrence grade 1–4, BMI ≤45 kg/m2, and stable, moderate to severe OA knee pain and who failed ≥2 therapies. Subjects were assigned to unilateral/bilateral CNTX-4975 1 mg IA injections as determined by OA pain/joint replacement status, then randomized by study site to 1 of 5 treatment regimens (Figure). The primary outcome measure assessed Breg cooling control vs other cooling regimens on day 1 using a combined sum of 1) pain (0, none; 4, severe) 30 minutes after CNTX-4975 injection; 2) subject satisfaction (SS) with cooling/injection procedures; and 3) investigator satisfaction (IS) with procedures. SS and IS were measured on a 1–7 scale (1, completely dissatisfied; 7, completely satisfied); pain was reverse scored and normalized (1, severe; 7, none) for equal weighting. Geometric mean ratios (GMR) with 95% CIs were constructed for each regimen vs Breg control (ANCOVA); lower 95% CI >0.7 was considered clinically acceptable. Secondary endpoints included percentage of subjects by subject type meeting criteria for Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders 8 weeks after injection. Safety assessments included TEAEs.Results:The intent-to-treat population included 848 subjects. The primary combined outcome showed that all cooling and administration regimens were clinically acceptable, with the evaluated cold gel wraps being at least as effective as the Breg circulating ice-water wrap (Table). For subjects with unilateral OA, OMERACT-OARSI response rates were 67% in those with no/mild nonindex knee pain and 81% in those with nonindex knee single joint replacement. For subjects with bilateral knee OA receiving bilateral injections, response rates for index and nonindex knees were 73% and 79%. TEAEs were reported in 22% of subjects; <1% were serious. TEAEs occurring in >2% of subjects were procedural pain (2.9%), arthralgia (2.2%), and nausea (2.1%), with no meaningful differences across groups.Conclusion:All cooling regimens for CNTX-4975 IA administration were clinically acceptable and well tolerated, offering feasible options for use in routine practice. Importantly, high levels of clinical response were observed 8 weeks after unilateral or bilateral knee injections for moderate to severe OA knee pain.Primary Combined Endpoint Outcome in the Index Knee, Normalized Scale, by Cooling and Administration Procedure (ANCOVA Model)Breg Cooling ControlN=162Gel Pack CoolingN=179Shortened Gel Pack CoolingN=175Single Needle Injection,Gel Pack Cooling,2% LidocaineN=160Single Needle Injection,Gel Pack Cooling,1% LidocaineN=172Mean (SD)17.23 (2.660)18.23 (2.023)16.81 (2.891)17.57 (3.049)16.43 (3.138)Geometric LS Mean (SE)17.18 (1.016)18.26 (1.015)16.48 (1.016)17.40 (1.016)16.00 (1.015)95% CI16.66, 17.7217.74, 18.8015.99, 16.9916.87, 17.9515.53, 16.49Comparison vs Breg CoolingGMR (SE)1.06 (1.022)0.96 (1.022)1.01 (1.022)0.93 (1.022)95% CI1.02, 1.110.92, 1.000.97, 1.060.89, 0.97Clinically Acceptable?YesYesYesYesLS, least squares; SD, standard deviation; SE, standard error.GMR lower 95% CI >0.7 considered clinically equivalent.Disclosure of Interests:Randall Stevens Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, Peter Hanson Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, Paul Tiseo Employee of: Centrexion Therapeutics Corp, Kimberly Guedes Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, James Campbell Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, James Connolly Employee of: Centrexion Therapeutics Corp, Stephanie Ruggiero Employee of: Centrexion Therapeutics Corp, Meg Corliss Employee of: Centrexion Therapeutics Corp, Valerie Smith Consultant of: Centrexion Therapeutics Corp, Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer
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Vyas A, Creswell J, Codlin AJ, Stevens R, Rao VG, Kumar B, Khaparde S, Sahu S. Community-based active case-finding to reach the most vulnerable: tuberculosis in tribal areas of India. Int J Tuberc Lung Dis 2020; 23:750-755. [PMID: 31315709 DOI: 10.5588/ijtld.18.0741] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec> <title>BACKGROUND</title> India has the world's largest indigenous/tribal population. Many areas with large tribal populations suffer from weak infrastructure and services. Surveys have shown a high prevalence of TB among Saharia communities, who rarely access public services. We evaluated a community-based active TB case-finding intervention. </sec> <sec> <title>METHODS</title> Community health workers screened people for TB symptoms in Saharia communities, made referrals, collected sputum for transport to laboratories, and initiated and supported anti-tuberculosis treatment. Microscopy testing was performed at government laboratories. The intervention tracked the people screened, referrals, the people tested, laboratory results, treatment initiation and outcomes. </sec> <sec> <title>RESULTS</title> Community health workers verbally screened 65 230 people, 8723 (13%) of whom had symptoms. Of these, 5600 were tested, 964 (17%) of whom were smear-positive. During the intervention, we observed a +52% increase in people tested at laboratories and an +84% increase in TB case notifications. Pre-treatment loss to follow-up decreased and treatment success increased slightly. </sec> <sec> <title>CONCLUSIONS</title> In India, particularly among tribal populations, many people with TB are missed by current approaches due to poor access. Community-based active case-finding can help identify more people with TB in tribal and remote rural areas by addressing barriers to health seeking as well as help reach ambitious country and global notification targets. </sec>.
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Affiliation(s)
- A Vyas
- Asha Kalp, Gwalior, India
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
| | - A J Codlin
- Stop TB Partnership, Geneva, Switzerland
| | - R Stevens
- Independent Consultant, Manchester, UK
| | - V G Rao
- National Institute for Research in Tribal Health, Jabalpur
| | - B Kumar
- Global Coalition of TB Activists, New Delhi
| | - S Khaparde
- Central TB Division, Government of India, New Delhi, India
| | - S Sahu
- Stop TB Partnership, Geneva, Switzerland
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17
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Sheppard JP, Tucker KL, Davison WJ, Stevens R, Aekplakorn W, Bosworth HB, Bove A, Earle K, Godwin M, Green BB, Hebert P, Heneghan C, Hill N, Hobbs FDR, Kantola I, Kerry SM, Leiva A, Magid DJ, Mant J, Margolis KL, McKinstry B, McLaughlin MA, McNamara K, Omboni S, Ogedegbe O, Parati G, Varis J, Verberk WJ, Wakefield BJ, McManus RJ. Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis. Am J Hypertens 2020; 33:243-251. [PMID: 31730171 PMCID: PMC7162426 DOI: 10.1093/ajh/hpz182] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/04/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.
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Affiliation(s)
- J P Sheppard
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - K L Tucker
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - W J Davison
- Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, United Kingdom
| | - R Stevens
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - W Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Bangkok, Thailand
| | - H B Bosworth
- Center for Health Services Research in Primary Care, Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - A Bove
- Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - K Earle
- Thomas Addison Diabetes Unit, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - M Godwin
- Family Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - B B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - P Hebert
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - C Heneghan
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - N Hill
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - F D R Hobbs
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - I Kantola
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - S M Kerry
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - A Leiva
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Mallorca, Spain
| | - D J Magid
- Colorado School of Public Health, University of Colorado, Denver, Colorado, USA
| | - J Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - K L Margolis
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | - B McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - M A McLaughlin
- Icahn School of Medicine at Mount Sinai New York, New York, New York, USA
| | - K McNamara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | - S Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - O Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, Langone School of Medicine, New York University, New York, USA
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - J Varis
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - W J Verberk
- Cardiovascular Research Institute Maastricht and Departments of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - B J Wakefield
- Department of Veterans (VA) Health Services Research and Development Centre for Comprehensive Access and Delivery Research and Evaluation (CADRE), VA Medical Centre, Iowa City, USA
| | - R J McManus
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
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Brereton PA, Robb P, Sargent CM, Crews HM, Wood R, Caputi A, Carrington J, Chetaneau B, Cohen S, Davies RW, Davis WS, Dix E, Ennion; RA, Furniss S, Gardner JW, Griffin J, Hampton I, Harrison N, Heide C, Hollywood F, Hopkins J, Liddle P, Meagher J, Osborne PY, Piatt T, Postlethwaite K, Procter J, Reynolds EB, Robinson J, Smith M, Sparkes S, Stangroom SG, Stevens R, Sutton P, Swain S, Turnbull J, Vidal JP, Waller JM, Zaiger K. Determination of Lead in Wine by Graphite Furnace Atomic Absorption Spectrophotometry: Interlaboratory Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.6.1287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An interlaboratory study of a graphite furnace atomic absorption spectrophotometry (GFAAS) method for the determination of lead in wine was conducted. Seventeen laboratories from France, United States, and the United Kingdom, using a variety of GFAAS instruments, took part in the study. The method incorporated a novel matrix-matching procedure to minimize matrix effects between standards and samples. Six wine test materials were prepared and sent to participants as 12 blind duplicate or split level samples. There was good agreement between results obtained from participants and target values (24–279 μg/L) obtained with an inductively coupled plasma-mass spectrometry method. The precision of the GFAAS method was well within the range predicted by the Horwitz equation for the 6 test materials analyzed. Repeatability standard deviations ranged from 3 to 17%. Reproducibility standard deviations were in the range of 10 to 30%. The method is recommended for use for official purposes.
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Affiliation(s)
- Paul A Brereton
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Paul Robb
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Christine M Sargent
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Helen M Crews
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
| | - Roger Wood
- Ministry of Agriculture, Fisheries and Food, CSL Food Science Laboratory, Norwich Research Park, Colney, Norwich, NR4 7UQ, UK
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Thomas C, Stevens R, West L, Oliver E, Pang J, Griffiths H. Performance evaluation of the VITROS® TSH3* assay on the VITROS® 5600/XT7600 integrated and VITROS® 3600 and ECI/ECIQ immunodiagnostic systems. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.699] [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: 10/26/2022]
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Stevens R, Chandrasenan J, Ali F, Haslam P, Nicolau N. The reproducibility of manual and fixed tensioning in anterior cruciate ligament reconstruction. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.02.2018.05] [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: 11/05/2022]
Affiliation(s)
- R. Stevens
- Northern General Hospital, Sheffield, UK
| | | | - F. Ali
- Chesterfield Royal Hospital, Cheserfield, UK
| | - P. Haslam
- Doncaster Royal Infirmary, Doncaster, UK
| | - N. Nicolau
- Sheffield Children's Hospital, Sheffield, UK
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Wu P, Stayman JW, Sisniega A, Zbijewski W, Foos D, Wang X, Aygun N, Stevens R, Siewerdsen JH. Statistical weights for model-based reconstruction in cone-beam CT with electronic noise and dual-gain detector readout. ACTA ACUST UNITED AC 2018; 63:245018. [DOI: 10.1088/1361-6560/aaf0b4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wu P, Stayman JW, Mow M, Zbijewski W, Sisniega A, Aygun N, Stevens R, Foos D, Wang X, Siewerdsen JH. Reconstruction-of-difference (RoD) imaging for cone-beam CT neuro-angiography. Phys Med Biol 2018; 63:115004. [PMID: 29722296 DOI: 10.1088/1361-6560/aac225] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Timely evaluation of neurovasculature via CT angiography (CTA) is critical to the detection of pathology such as ischemic stroke. Cone-beam CTA (CBCT-A) systems provide potential advantages in the timely use at the point-of-care, although challenges of a relatively slow gantry rotation speed introduce tradeoffs among image quality, data consistency and data sparsity. This work describes and evaluates a new reconstruction-of-difference (RoD) approach that is robust to such challenges. A fast digital simulation framework was developed to test the performance of the RoD over standard reference reconstruction methods such as filtered back-projection (FBP) and penalized likelihood (PL) over a broad range of imaging conditions, grouped into three scenarios to test the trade-off between data consistency, data sparsity and peak contrast. Two experiments were also conducted using a CBCT prototype and an anthropomorphic neurovascular phantom to test the simulation findings in real data. Performance was evaluated primarily in terms of normalized root mean square error (NRMSE) in comparison to truth, with reconstruction parameters chosen to optimize performance in each case to ensure fair comparison. The RoD approach reduced NRMSE in reconstructed images by up to 50%-53% compared to FBP and up to 29%-31% compared to PL for each scenario. Scan protocols well suited to the RoD approach were identified that balance tradeoffs among data consistency, sparsity and peak contrast-for example, a CBCT-A scan with 128 projections acquired in 8.5 s over a 180° + fan angle half-scan for a time attenuation curve with ~8.5 s time-to-peak and 600 HU peak contrast. With imaging conditions such as the simulation scenarios of fixed data sparsity (i.e. varying levels of data consistency and peak contrast), the experiments confirmed the reduction of NRMSE by 34% and 17% compared to FBP and PL, respectively. The RoD approach demonstrated superior performance in 3D angiography compared to FBP and PL in all simulation and physical experiments, suggesting the possibility of CBCT-A on low-cost, mobile imaging platforms suitable to the point-of-care. The algorithm demonstrated accurate reconstruction with a high degree of robustness against data sparsity and inconsistency.
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Affiliation(s)
- P Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, United States of America
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Waller P, Cassell JA, Saunders MH, Stevens R. Governance and oversight of researcher access to electronic health data: the role of the Independent Scientific Advisory Committee for MHRA database research, 2006-2015. J R Coll Physicians Edinb 2018; 47:24-29. [PMID: 28569278 DOI: 10.4997/jrcpe.2017.106] [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] [Indexed: 11/19/2022] Open
Abstract
In order to promote understanding of UK governance and assurance relating to electronic health records research, we present and discuss the role of the Independent Scientific Advisory Committee (ISAC) for MHRA database research in evaluating protocols proposing the use of the Clinical Practice Research Datalink. We describe the development of the Committee's activities between 2006 and 2015, alongside growth in data linkage and wider national electronic health records programmes, including the application and assessment processes, and our approach to undertaking this work. Our model can provide independence, challenge and support to data providers such as the Clinical Practice Research Datalink database which has been used for well over 1,000 medical research projects. ISAC's role in scientific oversight ensures feasible and scientifically acceptable plans are in place, while having both lay and professional membership addresses governance issues in order to protect the integrity of the database and ensure that public confidence is maintained.
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Affiliation(s)
- P Waller
- P Waller, 153 Wolseley Road, Rugeley, Staffordshire WS15 2QT, UK.
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Alvergne A, Stevens R, Gurmu E. Side effects and the need for secrecy: characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods. Contracept Reprod Med 2017; 2:24. [PMID: 29201429 PMCID: PMC5683325 DOI: 10.1186/s40834-017-0052-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Contraceptive discontinuation is a major barrier to reducing global unmet needs for family planning, but the reasons why women discontinue contraception are poorly understood. Here we use data from Ethiopia to investigate (i) the magnitude of contraceptive discontinuation in 2005-2011, (ii) how the risk of discontinuation varies with method type and education level and (iii) the barriers to continuation. Our main hypothesis is that contraceptive discontinuation is driven by the experience of physiological side-effects associated with the use of hormonal contraception, rather than a lack of formal education. METHODS We used a mixed methods explanatory sequential design to explain the quantitative results in more details through the qualitative data. First, we analysed quantitative data from the 2011 Ethiopian Demographic and Health Survey to study patterns of contraceptive discontinuation and method choice using multilevel multiprocess models. Second, we conducted semi-structured interviews and focus group discussions in the 3 most populated regions of Ethiopia with individuals of reproductive age and health professionals. RESULTS The analysis of EDHS data shows that the rate of discontinuation has not reduced in the period 2005-2011 and remains high. Discontinuation mainly takes the form of abandonment, and is a function of method type, age and wealth but not of educational level. Interviews with women and health professionals reveal that the experience of debilitating physiological side effects, the need for secrecy and poverty are important barriers to continuation. CONCLUSIONS Our findings together suggest that physiological and social side-effects of contraceptive use, not a lack of formal education, are the root causes of contraceptive abandonment in Ethiopia.
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Affiliation(s)
- Alexandra Alvergne
- School of Anthropology & Museum Ethnography, University of Oxford, 51/53 Banbury road, Oxford, OX2 6PE UK
| | - Rose Stevens
- School of Anthropology & Museum Ethnography, University of Oxford, 51/53 Banbury road, Oxford, OX2 6PE UK
| | - Eshetu Gurmu
- Center for Population Studies and Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
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Koshiaris C, Aveyard P, Oke J, Ryan R, Szatkowski L, Stevens R, Farley A. Smoking cessation and survival in lung, upper aero-digestive tract and bladder cancer: cohort study. Br J Cancer 2017; 117:1224-1232. [PMID: 28898236 PMCID: PMC5674091 DOI: 10.1038/bjc.2017.179] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 01/23/2017] [Revised: 04/26/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022] Open
Abstract
Background: The aim was to examine the association between smoking cessation and prognosis in smoking-related cancer as it is unclear that cessation reduces mortality. Methods: In this retrospective cohort study from 1999 to 2013, we assessed the association between cessation during the first year after diagnosis and all-cause and cancer-specific mortality. Results: Of 2882 lung, 757 upper aero-digestive tract (UAT) and 1733 bladder cancer patients 27%, 29% and 21% of lung, UAT and bladder cancer patients quit smoking. In lung cancer patients that quit, all-cause mortality was significantly lower (HR: 0.82 (0.74–0.92), while cancer-specific mortality (HR: 0.89 (0.76–1.04) and death due to index cancer (HR: 0.90 (0.77–1.05) were non-significantly lower. In UAT cancer, all-cause mortality (HR: 0.81 (0.58–1.14), cancer-specific mortality (HR: 0.84 (0.48–1.45), and death due to index cancer (HR: 0.75 (0.42–1.34) were non-significantly lower. There was no evidence of an association between quitting and mortality in bladder cancer. The HRs were 1.02 (0.81–1.30) for all-cause, 1.23 (0.81–1.86) for cancer specific, and 1.25 (0.71–2.20) for death due to index cancer. These showed a non-significantly lower risk in sensitivity analyses. Conclusions: People with lung and possibly UAT cancer who quit smoking have a lower risk of mortality than people who continue smoking.
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Affiliation(s)
- C Koshiaris
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - J Oke
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - R Ryan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - L Szatkowski
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, UK
| | - R Stevens
- Nuffield Department of Primary Care Health Sciences, UK Centre for Tobacco and Alcohol Studies, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - A Farley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Stevens R, Hanson P, Wei N, Allen R, Guedes K, Burges R, Campbell J. (382) Safety and Tolerability of CNTX-4975 in Subjects with Chronic, Moderate to Severe Knee Pain Associated With Osteoarthritis (OA): A Pilot Study. The Journal of Pain 2017. [DOI: 10.1016/j.jpain.2017.02.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Blok L, Bakker MI, Straetemans M, Gerstel L, Brouwer M, Stevens R, Kamineni VV, Ramis O. Should active case-finding projects increase the number of tuberculosis cases notified at national level? Int J Tuberc Lung Dis 2017; 21:475. [PMID: 28284270 DOI: 10.5588/ijtld.17.0025-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- L Blok
- Royal Tropical Institute (KIT-Health), Amsterdam
| | - M I Bakker
- Royal Tropical Institute (KIT-Health), Amsterdam
| | | | - L Gerstel
- Royal Tropical Institute (KIT-Health), Amsterdam
| | - M Brouwer
- PHTB consult, Tilburg, The Netherlands
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Fatima R, Qadeer E, Enarson DA, Creswell J, Stevens RH, Stevens R, Hinderaker SG, Anwar K, ul Haq M. Success of active tuberculosis case detection among high-risk groups in urban slums in Pakistan. Int J Tuberc Lung Dis 2016; 18:1099-104. [PMID: 25189559 DOI: 10.5588/ijtld.14.0001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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 In Pakistan, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health care providers, many of whom do not notify cases to the National TB Programme (NTP). SETTING We evaluated an active case detection intervention in five randomly selected districts in urban slums of Sindh Province, Pakistan. OBJECTIVE To evaluate the increase in case notification of smear-positive TB by active case finding at community-based chest camps by engaging the private providers. DESIGN A cross-sectional study of TB case detection associated with a project using integrated intervention and chest camps. RESULTS From April 2011 to September 2012, the total number of clients seen in the camps was 165 280. Of all the attendees, 13 481 (12.7%) were examined by sputum smear microscopy. The proportion of smear-positive results was significantly higher among those from engaged private providers than among those referred from camps (OR 1.54, 95%CI 1.42-1.66). During the project, the total number of smear-positive TB notifications increased over the intervention period from 5158 to 8275. CONCLUSION Active case detection by engaging private providers and chest camps can significantly increase the number of smear-positive TB case notifications.
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Affiliation(s)
- R Fatima
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J Creswell
- TB REACH Stop TB Partnership, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - M ul Haq
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
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Khamis K, Sorensen JPR, Bradley C, Hannah DM, Lapworth DJ, Stevens R. In situ tryptophan-like fluorometers: assessing turbidity and temperature effects for freshwater applications. Environ Sci Process Impacts 2015; 17:740-752. [PMID: 25756677 DOI: 10.1039/c5em00030k] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Tryptophan-like fluorescence (TLF) is an indicator of human influence on water quality as TLF peaks are associated with the input of labile organic carbon (e.g. sewage or farm waste) and its microbial breakdown. Hence, real-time measurement of TLF could be particularly useful for monitoring water quality at a higher temporal resolution than available hitherto. However, current understanding of TLF quenching/interference is limited for field deployable sensors. We present results from a rigorous test of two commercially available submersible tryptophan fluorometers (ex ∼ 285, em ∼ 350). Temperature quenching and turbidity interference were quantified in the laboratory and compensation algorithms developed. Field trials were then undertaken involving: (i) an extended deployment (28 days) in a small urban stream; and, (ii) depth profiling of an urban multi-level borehole. TLF was inversely related to water temperature (regression slope range: -1.57 to -2.50). Sediment particle size was identified as an important control on the turbidity specific TLF response, with signal amplification apparent <150 NTU for clay particles and <650 NTU for silt particles. Signal attenuation was only observed >200 NTU for clay particles. Compensation algorithms significantly improved agreement between in situ and laboratory readings for baseflow and storm conditions in the stream. For the groundwater trial, there was an excellent agreement between laboratory and raw in situ TLF; temperature compensation provided only a marginal improvement, and turbidity corrections were unnecessary. These findings highlight the potential utility of real time TLF monitoring for a range of environmental applications (e.g. tracing polluting sources and monitoring groundwater contamination). However, in situations where high/variable suspended sediment loads or rapid changes in temperature are anticipated concurrent monitoring of turbidity and temperature is required and site specific calibration is recommended for long term, surface water monitoring.
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Affiliation(s)
- K Khamis
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham, B15 2TT, UK.
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Pylypchuk R, Stevens R, Jackson R, Poppe K. Beyond Framingham risk equations: How can cardiovascular risk be estimated when treatment changes over time? Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.04.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Joly P, Papp K, Reich K, Leonardi C, Kircik L, Chimenti S, Lacour JP, Hu C, Stevens R, Day R, Griffiths C. Résultats à 52 semaines de l’aprémilast, un inhibiteur oral de la phosphodiestérase 4 dans le psoriasis en plaques modéré à sévère : étude de phase III randomisée et contrôlée ESTEEM 1. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.149] [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: 11/29/2022]
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Stevens R, Fleming S, Spencer E, Thompson M, Ashdown H. OP08 Assessing accuracy of personal breathalysers and self-estimated alcohol consumption for driving decisions. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.11] [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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Truffault V, Gest N, Garchery C, Causse M, Duboscq R, Riqueau G, Sauvage C, Gautier H, Baldet P, Stevens R. VARIATION IN TOMATO FRUIT ASCORBATE LEVELS AND CONSEQUENCES OF MANIPULATION OF ASCORBATE METABOLISM ON DROUGHT STRESS TOLERANCE. ACTA ACUST UNITED AC 2014. [DOI: 10.17660/actahortic.2014.1048.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Quesada-Martínez M, Fernández-Breis JT, Stevens R, Mikroyannidi E. Prioritising lexical patterns to increase axiomatisation in biomedical ontologies. The role of localisation and modularity. Methods Inf Med 2014; 54:56-64. [PMID: 24993110 DOI: 10.3414/me13-02-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/17/2013] [Accepted: 05/07/2014] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This article is part of the Focus Theme of METHODS of Information in Medicine on "Managing Interoperability and Complexity in Health Systems". OBJECTIVES In previous work, we have defined methods for the extraction of lexical patterns from labels as an initial step towards semi-automatic ontology enrichment methods. Our previous findings revealed that many biomedical ontologies could benefit from enrichment methods using lexical patterns as a starting point.Here, we aim to identify which lexical patterns are appropriate for ontology enrichment, driving its analysis by metrics to prioritised the patterns. METHODS We propose metrics for suggesting which lexical regularities should be the starting point to enrich complex ontologies. Our method determines the relevance of a lexical pattern by measuring its locality in the ontology, that is, the distance between the classes associated with the pattern, and the distribution of the pattern in a certain module of the ontology. The methods have been applied to four significant biomedical ontologies including the Gene Ontology and SNOMED CT. RESULTS The metrics provide information about the engineering of the ontologies and the relevance of the patterns. Our method enables the suggestion of links between classes that are not made explicit in the ontology. We propose a prioritisation of the lexical patterns found in the analysed ontologies. CONCLUSIONS The locality and distribution of lexical patterns offer insights into the further engineering of the ontology. Developers can use this information to improve the axiomatisation of their ontologies.
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Affiliation(s)
- M Quesada-Martínez
- Manuel Quesada-Martínez, Universidad de Murcia, Departamento de Informática y Sistemas, Facultad de Informática, Campus de Espinardo, 30100 Murcia, Spain, E-mail:
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Mease P, Kavanaugh A, Gladman D, Adebajo A, Gomez-Reino J, Wollenhaupt J, Cutolo M, Schett G, Lespessailles E, Shah K, Hu C, Stevens R, Edwards C, Birbara C. SAT0408 Long-Term Safety and Tolerability of Apremilast, an Oral Phosphodiesterase 4 Inhibitor, in Patients with Psoriatic Arthritis: Pooled Safety Analysis of Three Phase 3, Randomized, Controlled Trials. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schett G, Mease P, Gladman D, Kavanaugh A, Adebajo A, Gomez-Reino J, Wollenhaupt J, Cutolo M, Lespessailles E, Hu C, Stevens R, Edwards C, Birbara C. AB0746 Apremilast, an Oral Phosphodiesterase 4 Inhibitor, and the Impact of Baseline Weight and BMI on ACR20 and HAQ-DI Response: Pooled Results from 3 Phase 3, Randomized, Controlled Trials. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1773] [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: 11/04/2022]
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Kavanaugh A, Cutolo M, Mease P, Gladman D, Adebajo A, Gomez-Reino J, Wollenhaupt J, Schett G, Lespessailles E, Hu C, Stevens R, Edwards C, Birbara C. OP0078 Apremilast, an Oral Phosphodiesterase 4 Inhibitor, is Associated with Long-Term (52-WEEK) Improvement in Measures of Disease Activity in Patients with Psoriatic Arthritis: Results from 3 Phase 3, Randomized, Controlled Trials. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1827] [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: 11/04/2022]
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Mease P, Gladman D, Kavanaugh A, Adebajo A, Gomez-Reino J, Wollenhaupt J, Schett G, Shah K, Hu C, Stevens R, Edwards C, Birbara C. AB0758 Change in Weight from Baseline during the Palace Clinical Trial Program with Apremilast, an Oral Phosphodiesterase 4 Inhibitor: Pooled Results from 3 Phase 3, Randomized, Controlled Trials. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Birbara C, Blanco FJ, Crowley JJ, Hu C, Stevens R, Edwards CJ. OP0104 Apremilast, an Oral Phosphodiesterase 4 Inhibitor, in Patients with Psoriatic Arthritis Including Current Skin Involvement: Results of a Phase 3, Randomized, Controlled Trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.309] [Citation(s) in RCA: 4] [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: 11/04/2022]
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Birbara C, Blanco FJ, Crowley JJ, Hu C, Stevens R, Edwards CJ. SAT0280 Efficacy of Apremilast, An Oral Phosphodiesterase 4 Inhibitor, on Physical Function and Pain in Patients with Psoriatic Arthritis, Including Current Skin Involvement: Results of a Phase 3, Randomized, Controlled Trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2005] [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: 11/04/2022]
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Tanguay J, Wheeler P, Button M, Stevens R, Shaw P, Brewster A, Hanna L, Lester J. 179 Limited stage small cell lung cancer (LS SCLC) – South East Wales experience. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70180-1] [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: 11/30/2022]
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Langhorne P, Fearon P, Ronning OM, Kaste M, Palomaki H, Vemmos K, Kalra L, Indredavik B, Blomstrand C, Rodgers H, Dennis MS, Salman RAS, Blomstrand C, Indredavik B, Kalra L, Kaste M, Palomaki H, Rodgers H, Ronning M, Vemmos K, Asplund K, Berman P, Blomstrand C, Britton M, Cabral N, Cavallini A, Dey P, Hamrin E, Hankey G, Indredavik B, Kalra L, Kaste M, Laursen S, Ma R, Patel N, Rodgers H, Ronning M, Sivenius J, Stevens R, Sulter G, Svensson A, Vemmos K, Wood-Dauphinee S, Yagura H. Stroke Unit Care Benefits Patients With Intracerebral Hemorrhage. Stroke 2013; 44:3044-9. [DOI: 10.1161/strokeaha.113.001564] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Langhorne
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Patricia Fearon
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Ole M. Ronning
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Markku Kaste
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Heikki Palomaki
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Kostos Vemmos
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Lalit Kalra
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Bent Indredavik
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Christian Blomstrand
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Helen Rodgers
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Martin S. Dennis
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
| | - Rustam Al-Shahi Salman
- From the Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, United Kingdom (P.L., P.F.); Department of Neurology, Akershus University Hospital, Norway (O.M.R.); Department of Neurology, Helsinki University Central Hospital, Finland (M.K., H.P.); Acute Stroke Unit, Department of Clinical Therapeutics, School of Medicine, University of Ioannina, Greece (K.V.); Department of Stroke Medicine, King’s College Hospital, London, United Kingdom (L.K.); Department of Neuroscience, Norwegian
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Affiliation(s)
- J Bakshi
- Rheumatology Department, Buckinghamshire Hospital NHS, Buckinghamshire, UK
| | - R Stevens
- Rheumatology Department, Buckinghamshire Hospital NHS, Buckinghamshire, UK
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Lief E, Marsden C, Ruff E, Gianadda R, Lee H, Stevens R. SU-E-T-183: Lateral Scattering Penumbra for Radiation Therapy with High Energy Electrons Using Small Cutouts. Med Phys 2013. [DOI: 10.1118/1.4814618] [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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Mease PJ, Kavanaugh A, Adebajo AO, Gomez-Reino JJ, Wollenhaupt J, Cutolo M, Schett G, Lespessailles E, Shah K, Hu C, Stevens R, Edwards CJ, Birbara CA. SAT0299 Apremilast: Pooled Safety Analysis of Three Phase 3, Randomized, Controlled Trials in patients with Psoriatic Arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2024] [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: 11/04/2022]
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Burton JS, Stevens R. CORRESPONDENCE. Journal of the Institute of Brewing 2013. [DOI: 10.1002/j.2050-0416.1963.tb01914.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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Findlay WPK, MacWilliam IC, Slaughter JC, Leedham PA, Lovett DA, Rainbow C, Stevens R, Woodward JD. ABSTRACTS. Journal of the Institute of Brewing 2013. [DOI: 10.1002/j.2050-0416.1976.tb03749.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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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