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Pemovska T, Loizou S, Appleton R, Spain D, Stefanidou T, Kular A, Cooper R, Greenburgh A, Griffiths J, Barnett P, Foye U, Baldwin H, Minchin M, Brady G, Saunders KRK, Ahmed N, Jackson R, Olive RR, Parker J, Timmerman A, Sapiets S, Driskell E, Chipp B, Parsons B, Totsika V, Mandy W, Pender R, Clery P, Lloyd-Evans B, Simpson A, Johnson S. Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis. Psychol Med 2024:1-31. [PMID: 38757186 DOI: 10.1017/s0033291724001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
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Affiliation(s)
- Tamara Pemovska
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sofia Loizou
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | | | - Theodora Stefanidou
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ariana Kular
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Anna Greenburgh
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Matilda Minchin
- Division of Psychiatry, University College London, London, UK
| | - Gráinne Brady
- Division of Psychiatry, University College London, London, UK
| | | | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Robin Jackson
- Lancaster and Morecambe Child and Adolescent Mental Health Services, Lancashire and South Cumbria NHS Foundation Trust, Morecambe, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- School of Health and Psychological Sciences, City, University of London, London, UK
- Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Amanda Timmerman
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Suzi Sapiets
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | | | - Vaso Totsika
- Division of Psychiatry, University College London, London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Richard Pender
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Philippa Clery
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Forrest CB, Chen CP, Perrin EM, Stille CJ, Cooper R, Harris K, Luo Q, Maltenfort MG, Parlett LE. Pediatric Medical Subspecialist Use in Outpatient Settings. JAMA Netw Open 2024; 7:e2350379. [PMID: 38175643 PMCID: PMC10767594 DOI: 10.1001/jamanetworkopen.2023.50379] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Importance A first step toward understanding whether pediatric medical subspecialists are meeting the needs of the nation's children is describing rates of use and trends over time. Objectives To quantify rates of outpatient pediatric medical subspecialty use. Design, Setting, and Participants This repeated cross-sectional study of annual subspecialist use examined 3 complementary data sources: electronic health records from PEDSnet (8 large academic medical centers [January 1, 2010, to December 31, 2021]); administrative data from the Healthcare Integrated Research Database (HIRD) (14 commercial health plans [January 1, 2011, to December 31, 2021]); and administrative data from the Transformed Medicaid Statistical Information System (T-MSIS) (44 state Medicaid programs [January 1, 2016, to December 31, 2019]). Annual denominators included 493 628 to 858 551 patients younger than 21 years with a general pediatric visit in PEDSnet; 5 million beneficiaries younger than 21 years enrolled for at least 6 months in HIRD; and 35 million Medicaid or Children's Health Insurance Program beneficiaries younger than 19 years enrolled for any amount of time in T-MSIS. Exposure Calendar year and type of medical subspecialty. Main Outcomes and Measures Annual number of children with at least 1 completed visit to any pediatric medical subspecialist in an outpatient setting per population. Use rates excluded visits in emergency department or inpatient settings. Results Among the study population, the proportion of girls was 51.0% for PEDSnet, 51.1% for HIRD, and 49.3% for T-MSIS; the proportion of boys was 49.0% for PEDSnet, 48.9% for HIRD, and 50.7% for T-MSIS. The proportion of visits among children younger than 5 years was 37.4% for PEDSnet, 20.9% for HIRD, and 26.2% for T-MSIS; most patients were non-Hispanic Black (29.7% for PEDSnet and 26.1% for T-MSIS) or non-Hispanic White (44.9% for PEDSnet and 43.2% for T-MSIS). Annual rates for PEDSnet ranged from 18.0% to 21.3%, which were higher than rates for HIRD (range, 7.9%-10.4%) and T-MSIS (range, 7.6%-8.6%). Subspecialist use increased in the HIRD commercial health plans (annual relative increase of 2.4% [95% CI, 1.6%-3.1%]), but rates were essentially flat in the other data sources (PEDSnet, -0.2% [95% CI, -1.1% to 0.7%]; T-MSIS, -0.7% [95% CI, -6.5% to 5.5%]). The flat PEDSnet growth reflects a balance between annual use increases among those with commercial insurance (1.2% [95% CI, 0.3%-2.1%]) and decreases in use among those with Medicaid (-0.9% [95% CI, -1.6% to -0.2%]). Conclusions and Relevance The findings of this cross-sectional study suggest that among children, 8.6% of Medicaid beneficiaries, 10.4% of those with commercial insurance, and 21.3% of those whose primary care is received in academic health systems use pediatric medical subspecialty care each year. There was a small increase in rates of subspecialty use among children with commercial but not Medicaid insurance. These data may help launch innovations in the primary-specialty care interface.
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Affiliation(s)
- Christopher B. Forrest
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Candice P. Chen
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Eliana M. Perrin
- Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland
| | - Christopher J. Stille
- Deparment of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Ruth Cooper
- Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | | | - Qian Luo
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Mitchell G. Maltenfort
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Moncrieff J, Crellin N, Stansfeld J, Cooper R, Marston L, Freemantle N, Lewis G, Hunter R, Johnson S, Barnes T, Morant N, Pinfold V, Smith R, Kent L, Darton K, Long M, Horowitz M, Horne R, Vickerstaff V, Jha M, Priebe S. Antipsychotic dose reduction and discontinuation versus maintenance treatment in people with schizophrenia and other recurrent psychotic disorders in England (the RADAR trial): an open, parallel-group, randomised controlled trial. Lancet Psychiatry 2023; 10:848-859. [PMID: 37778356 DOI: 10.1016/s2215-0366(23)00258-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Maintenance antipsychotic medication is recommended for people with schizophrenia or recurrent psychosis, but the adverse effects are burdensome, and evidence on long-term outcomes is sparse. We aimed to assess the benefits and harms of a gradual process of antipsychotic reduction compared with maintenance treatment. Our hypothesis was that antipsychotic reduction would improve social functioning with a short-term increase in relapse. METHODS RADAR was an open, parallel-group, randomised trial done in 19 National Health Service Trusts in England. Participants were aged 18 years and older, had a diagnosis of recurrent, non-affective psychotic disorder, and were prescribed an antipsychotic. Exclusion criteria included people who had a mental health crisis or hospital admission in the past month, were considered to pose a serious risk to themselves or others by a treating clinician, or were mandated to take antipsychotic medication under the Mental Health Act. Through an independent, internet-based system, participants were randomly assigned (1:1) to gradual, flexible antipsychotic reduction, overseen by treating clinicians, or to maintenance. Participants and clinicians were aware of treatment allocations, but assessors were masked to them. Follow-up was for 2 years. Social functioning, assessed by the Social Functioning Scale, was the primary outcome. The principal secondary outcome was severe relapse, defined as requiring admission to hospital. Analysis was done blind to group identity using intention-to-treat data. The trial is completed and has been registered with ISRCTN registry (ISRCTN90298520) and with ClinicalTrials.gov (NCT03559426). FINDINGS 4157 people were screened, of whom 253 were randomly allocated, including 168 (66%) men, 82 (32%) women, and 3 (1%) transgender people, with a mean age of 46 years (SD 12, range 22-79). 171 (67%) participants were White, 52 (21%) were Black, 16 (6%) were Asian, and 12 (5%) were of other ethnicity. The median dose reduction at any point during the trial was 67% in the reduction group and zero in the maintenance group; at 24 months it was 33% versus zero. At the 24-month follow-up, we assessed 90 of 126 people assigned to the antipsychotic dose reduction group and 94 of 127 assigned to the maintenance group, finding no difference in the Social Functioning Scale (β 0·19, 95% CI -1·94 to 2·33; p=0·86). There were 93 serious adverse events in the reduction group affecting 49 individuals, mainly comprising admission for a mental health relapse, and 64 in the maintenance group, relating to 29 individuals. INTERPRETATION At 2-year follow-up, a gradual, supported process of antipsychotic dose reduction had no effect on social functioning. Our data can help to inform decisions about the use of long-term antipsychotic medication. FUNDING National Institute for Health Research.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK.
| | | | - Jacki Stansfeld
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Thomas Barnes
- Division of Psychiatry, Imperial College, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | | | | | | | - Maria Long
- Division of Psychiatry, University College London, London, UK; Department of Health Services Research and Management, City University, London, UK
| | - Mark Horowitz
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Mithilesh Jha
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Morant N, Long M, Jayacodi S, Cooper R, Akther-Robertson J, Stansfeld J, Horowitz M, Priebe S, Moncrieff J. Experiences of reduction and discontinuation of antipsychotics: a qualitative investigation within the RADAR trial. EClinicalMedicine 2023; 64:102135. [PMID: 37936655 PMCID: PMC10626156 DOI: 10.1016/j.eclinm.2023.102135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 11/09/2023] Open
Abstract
Background Antipsychotics are a core treatment for psychosis, but the evidence for gradual dose reductions guided by clinicians is under-developed. The RADAR randomised controlled trial (RCT) compared antipsychotic reduction and possible discontinuation with maintenance treatment for people with recurrent psychotic disorders. The current study explored participants' experiences of antipsychotic reduction or discontinuation within this trial. Methods This qualitative study was embedded within the RADAR RCT (April 2017-March 2022) that recruited 253 participants from specialist community mental health services in 19 public healthcare localities in England. Participants were adults with recurrent non affective psychosis who were taking antipsychotic medication. Semi-structured interviews, lasting 30-90 min, were conducted after the trial final 24-month follow-up with 26 people who reduced and/or discontinued antipsychotics within the trial, sampled purposively for diversity in sociodemographic characteristics, trial variables, and pre-trial medication and clinical factors. Data were analysed using thematic analysis and findings are reported qualitatively. Findings Most participants reported reduced adverse effects of antipsychotics with dose reductions, primarily in mental clouding, emotional blunting and sedation, and some positive impacts on social functioning and sense of self. Over half experienced deteriorations in mental health, including psychotic symptoms and intolerable levels of emotional intensity. Nine had a psychotic relapse. The trial context in which medication reduction was explicitly part of clinical care provided various learning opportunities. Some participants were highly engaged with reduction processes, and despite difficulties including relapses, developed novel perspectives on medication, dose optimisation, and how to manage their mental health. Others were more ambivalent about reduction or experienced less overall impact. Interpretation Experiences of antipsychotic reductions over two years were dynamic and diverse, shaped by variations in dose reduction profiles, reduction effects, personal motivation and engagement levels, and relationships with prescribers. There are relapse risks and challenges, but some people experience medication reduction done with clinical guidance as empowering. Clinicians can use findings to inform and work flexibly with service users to establish optimal antipsychotic doses. Funding National Institute for Health Research.
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Affiliation(s)
- Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Maria Long
- Division of Psychiatry, University College London, London, UK
- Health Services Research & Management, City University, London, UK
- Research & Development Department, North East London NHS Foundation Trust, London, UK
| | | | - Ruth Cooper
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Jacki Stansfeld
- Research & Development Department, North East London NHS Foundation Trust, London, UK
| | - Mark Horowitz
- Division of Psychiatry, University College London, London, UK
- Research & Development Department, North East London NHS Foundation Trust, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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Kirchheiner K, Zaharie AT, Smet S, Spampinato S, Chargari C, Mahantshetty UM, Segedin B, Bruheim K, Rai B, Cooper R, Van der Steen-Banasik E, Wiebe EM, Potter R, Kirisits C, Schmid M, Haie-Meder C, Tanderup K, De Leeuw A, Jurgenliemk-Schulz I, Nout RA. Association between Regular Vaginal Dilation and/or Sexual Activity and Long-Term Vaginal Morbidity in Cervical Cancer Survivors. Int J Radiat Oncol Biol Phys 2023; 117:S2-S3. [PMID: 37784450 DOI: 10.1016/j.ijrobp.2023.06.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the association between regular vaginal dilation and/or sexual activity and vaginal morbidity in locally advanced cervical cancer patients after definitive radiochemotherapy and image-guided adaptive brachytherapy from the EMBRACE I study. MATERIALS/METHODS Physician-assessed vaginal morbidity (CTCAE v.3), vaginal dilation and patient-reported sexual activity (EORTC QLQ CX24) were assessed at baseline, every 3 months in the 1st year, every 6 months in the 2nd and 3rd year and yearly thereafter. For this longitudinal analysis, a subgroup of patients was selected with at least 3 follow-ups with information on vaginal dilation and/or sexual activity. Vaginal penetration summarized either the use of vaginal dilators or sexual activity or both. Regular vaginal penetration was defined if reported in ≥50%, infrequent if reported in <50% and absent if reported in 0% of follow-ups. Actuarial estimates of vaginal morbidity were calculated with Kaplan-Meier method and included the individual symptoms: vaginal dryness, stenosis, mucositis and bleeding. Group comparisons were evaluated with the log-rank test. RESULTS The EMBRACE I study included 1416 patients overall (2008-2015); the subgroup of patients for this longitudinal evaluation consists of 882 patients, with a median follow-up of 60 months (IQR 47-77). Of those, 565 (64%) reported regular, 205 (23%) infrequent and 112 (13%) no penetration. Reporting regular penetration was associated with a significantly lower risk of vaginal stenosis G≥2 of 23% at 5 years, compared to reporting of infrequent (37%) and no penetration (36%, p≤0.001). However, reporting regular penetration was associated with a significantly higher risk for vaginal dryness G≥1 (72% vs. 69% vs. 62%, respectively, p = 0.038) and bleeding G≥1 (61% vs. 40% vs. 25%, respectively, p≤0.001). No associations were seen for G≥1 vaginal stenosis, G≥2 dryness, G≥2 bleeding and G≥1/G≥2 mucositis. CONCLUSION Regular penetration (defined as vaginal dilation and/or sexual activity) was associated with lower risk for vaginal stenosis G≥2, but higher risk for vaginal dryness G≥1 and bleeding G≥1. Mild vaginal dryness seems to become apparent in particular for patients experiencing vaginal penetration. Minor vaginal blood loss during dilation and/or sexual activity is commonly reported by patients, resulting from atrophy of the vaginal mucosa and/or telangiectasia. While both of these G≥1 symptoms can be managed with lubricants, moisturizer and/or hormonal replacement therapy, G≥2 vaginal stenosis represents an irreversible fibrotic adverse event that can cause dyspareunia in many cancer patients. These long-term data support clinical recommendations for dilation and/or sexual activity after radiotherapy.
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Affiliation(s)
- K Kirchheiner
- Department Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Vienna, Austria
| | - A T Zaharie
- Department Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Vienna, Austria
| | - S Smet
- Department of Radiation Oncology, AZ Turnhout, Iridium Cancer Network, Antwerp, Turnhout, Belgium
| | - S Spampinato
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - C Chargari
- Department of Radiotherapy, Gustave-Roussy, Villejuif, Villejuif, France
| | - U M Mahantshetty
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai & Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam, India
| | - B Segedin
- Department of Radiotherapy and Faculty of Medicine, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - K Bruheim
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - B Rai
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R Cooper
- Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom
| | | | - E M Wiebe
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
| | - R Potter
- Department for Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C Kirisits
- Department for Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - M Schmid
- Department Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - C Haie-Meder
- Department of Radiotherapy, Gustave-Roussy, Villejuif, Villejuif, France
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A De Leeuw
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - I Jurgenliemk-Schulz
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - R A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
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Norris T, Johnson W, Cooper R, Pereira SMP. Associations between diabetes status and grip strength trajectory sub-groups in adulthood: findings from over 16 years of follow-up in the MRC National Survey of Health and Development. BMC Geriatr 2023; 23:213. [PMID: 37016329 PMCID: PMC10074704 DOI: 10.1186/s12877-023-03871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/03/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Cross-sectional studies suggest a relationship between diabetes status and weaker grip strength (GS) in adulthood and limited evidence from longitudinal studies has focussed on the association with average change in GS. We aimed to investigate whether diabetes status was related to membership of distinct GS trajectories in mid-to-late adulthood in 2,263 participants in the Medical Research Council National Survey of Health and Development. METHODS Grip strength (kg) was measured at 53, 60-64 and 69 years. Pre-/diabetes was defined at 53 years based on HbA1c > 5.6% and/or doctor-diagnosis of diabetes. Sex-specific latent class trajectory models were developed and multinomial logistic regression was used to investigate the association between pre-/diabetes status and membership into GS trajectory classes. RESULTS For both males and females, a 3-class solution ('High', 'Intermediate', 'Low') provided the best representation of the GS data and the most plausible solution. There was no evidence that pre-/diabetes status was associated with class membership in either sex: e.g., adjusted odds ratios of being in the 'Low' class (vs. 'High') for males with pre-/diabetes (vs. no-diabetes) was 1.07 (95% CI:0.45,2.55). CONCLUSION Using a flexible data-driven approach to identify GS trajectories between 53 and 69 years, we observed three distinct GS trajectories, all declining, in both sexes. There was no association between pre-/diabetes status at 53 years and membership into these GS trajectories. Understanding the diabetes status-GS trajectories association is vital to ascertain the consequences that projected increases in pre-/diabetes prevalence's are likely to have.
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Affiliation(s)
- T Norris
- Institute of Sport, Exercise and Health, Division of Surgery & Interventional Science, University College London, London, UK
| | - W Johnson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - R Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - S M Pinto Pereira
- Institute of Sport, Exercise and Health, Division of Surgery & Interventional Science, University College London, London, UK.
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Cooper R, Leon-Andrews L, Yuille F, Newby J, Tharmalingham H, Lumsden G, Campbell A, Pasha N, Gibson R. The New Clinical Oncology Curriculum - Tailored for the UK and Beyond. Clin Oncol (R Coll Radiol) 2023; 35:209-212. [PMID: 36702669 DOI: 10.1016/j.clon.2023.01.003] [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] [Received: 10/04/2022] [Revised: 12/08/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Affiliation(s)
- R Cooper
- Royal College of Radiologists, London, UK.
| | | | - F Yuille
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - J Newby
- Royal Free London NHS Foundation Trust, London, UK
| | | | - G Lumsden
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Campbell
- Royal College of Radiologists, London, UK
| | - N Pasha
- Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - R Gibson
- Royal College of Radiologists, London, UK
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Bhatia R, Malhotra A, MacLachlan H, Gati S, Kasiakogias A, Marwaha S, Chatrath N, Fyyaz S, Cooper R, Rakhit D, Varnava A, Esteban M, Finocchiaro G, Papadakis M, Sharma S. Prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Identification of athletes with cardiac inflammation following COVID-19 can prevent exercise fatalities. The efficacy of pre and post COVID-19 infection electrocardiograms (ECGs) for detecting athletes with myopericarditis has never been reported. We aimed to assess the prevalence and diagnostic significance of novel 12-lead ECG patterns following COVID-19 infection in elite soccer players.
Methods
We conducted a multicentre study over a 2-year period involving 5 centres and 34 clubs and compared pre COVID and post COVID ECG changes in 455 consecutive athletes. ECGs were reported in accordance with the International recommendations for ECG interpretation in athletes. The following patterns were considered abnormal if they were not detected on the pre COVID-19 infection ECG: (a) biphasic T-waves; (b) reduction in T-wave amplitude by 50% in contiguous leads; (c) ST-segment depression; (d) J-point and ST-segment elevation >0.2 mV in the precordial leads and >0.1 mV in the limb leads; (e) tall T-waves ≥1.0 mV (f) low QRS-amplitude in >3 limb leads and (g) complete right bundle branch block. Athletes exhibiting novel ECG changes underwent cardiovascular magnetic resonance (CMR) scans. One club mandated CMR scans for all 28 (6%) athletes, despite the absence of cardiac symptoms or ECG changes.
Results
Athletes were aged 22±5 years (89% male and 57% white). 65 (14%) athletes reported cardiac symptoms. The mean duration of illness was 3±4 days. The post COVID ECG was performed 14±16 days following a positive PCR. 440 (97%) athletes had an unchanged post COVID-19 ECG. Of these, 3 (0.6%) had cardiac symptoms and CMRs resulted in a diagnosis of pericarditis. 15 (3%) athletes demonstrated novel ECG changes following COVID-19 infection. Among athletes who demonstrated novel ECG changes, 10 (67%) reported cardiac symptoms. 13 (87%) athletes with novel ECG changes were diagnosed with inflammatory cardiac sequelae; pericarditis (n=6), healed myocarditis (n=3), definitive myocarditis (n=2), and possible/probable myocarditis (n=2). The overall prevalence of inflammatory cardiac sequelae based on novel ECG changes was 2.8%. None of the 28 (6%) athletes, who underwent a CMR, in the absence of cardiac symptoms or novel ECG changes revealed any abnormalities. Athletes revealing novel ECG changes, had a higher prevalence of cardiac symptoms (67% v 12% p<0.0001) and longer symptom duration (8±8 days v 2±4 days; p<0.0001) compared with athletes without novel ECG changes. Among athletes without cardiac symptoms, the additional yield of novel ECG changes to detect cardiac inflammation was 20% (n=3).
Conclusions
3% of elite soccer players demonstrated novel ECG changes post COVID-19 infection, of which almost 90% were diagnosed with cardiac inflammation during subsequent investigation. Most athletes with novel ECG changes exhibited cardiac symptoms. Novel ECGs changes contributed to a diagnosis of cardiac inflammation in 20% of athletes without cardiac symptoms.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Bhatia
- St George's University of London , London , United Kingdom
| | - A Malhotra
- Manchester University NHS Foundation Trust , Manchester , United Kingdom
| | - H MacLachlan
- St George's University of London , London , United Kingdom
| | - S Gati
- Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - A Kasiakogias
- Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - S Marwaha
- St George's University of London , London , United Kingdom
| | - N Chatrath
- St George's University of London , London , United Kingdom
| | - S Fyyaz
- St George's University of London , London , United Kingdom
| | - R Cooper
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - D Rakhit
- University Hospital Southampton NHS Foundation Trust , Southampton , United Kingdom
| | - A Varnava
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - M Esteban
- St George's University of London , London , United Kingdom
| | - G Finocchiaro
- St George's University of London , London , United Kingdom
| | - M Papadakis
- St George's University of London , London , United Kingdom
| | - S Sharma
- St George's University of London , London , United Kingdom
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Zappacosta H, Bandek G, Yalzadeh D, Yassine I, Raffman E, Cooper R, Mower W. 107 Systematic Review of Ionizing Radiation Dose Exposure for Commonly Performed Chest Imaging Techniques in the Emergency Department Setting. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Gujral T, Rana S, Bui K, Factora R, Ma P, Cooper R, Mower W. 211 Traumatic Injury to the Posterior Fossa: A Secondary Analysis of Demographics, Clinical Characteristics, Computed Tomography Imaging, and Outcomes. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Watson R, Taylor C, Tong O, Cooper R, Nassiri I, Jungkurth E, Sharma P, Verge de los Aires A, Ieremia E, Middleton M, Fairfax B. 734MO Deep sequencing of the T-cell receptor reveals common and reproducible CD8 T-cell receptor signatures of response to checkpoint immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.860] [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: 11/01/2022] Open
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Dodds RM, Bunn JG, Hillman S, Granic A, Murray J, Witham MD, Robinson SM, Cooper R, Sayer AA. 1055 SIMPLE APPROACHES TO CHARACTERISING MULTIPLE LONG-TERM CONDITIONS (MULTIMORBIDITY) AND RATES OF HOSPITAL ADMISSION IN UK BIOBANK. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Multiple approaches are used to describe MLTC, including counts and indices (weighted counts). However, few studies have directly compared different approaches which would be helpful for the design of future MLTC studies. We therefore aimed to compare the prevalence of MLTC and association with emergency hospital admission characterised using different approaches within the same dataset.
Method
We used baseline data from 501,596 UK Biobank participants (age 37-73y) combined with linked hospital episode statistics to characterise MLTC using four approaches: count of body systems affected (CB); count of 43 conditions (CC); Byles index (BI); and Charlson comorbidity index (CCI). For each we performed survival analyses to test associations to a combined endpoint of first emergency admission or death over five years from baseline interview, adjusting for age and sex. We used Harrell’s C-index to compare the discriminant value of the four approaches for the combined endpoint.
Results
Prevalence of two or more positive responses (indicating the presence of MLTC) was 45% for CB, 33% for CC, 6% for BI and 2% for CCI. 95,812 (19%) participants had one or more emergency admission or died in the first five years. All four approaches were associated with greater rates of admission/death. For example, using CC, compared to those with zero conditions those with one had 1.42 (95% CI 1.39,1.45), those with two 1.94 (95% CI 1.90,1.98), and those with 3+ conditions had 3.11 (95% CI 3.05,3.17) times greater rates. The predictive value of the four approaches was modest (C-indices ranging from 0.60 to 0.63).
Conclusion
The counts classified a greater proportion of the sample as having MLTC than the indices, highlighting that prevalence estimates of MLTC may vary depending on the approach used. All approaches had strong statistical associations with admission, but only moderate ability to identify individual participants at risk.
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Affiliation(s)
- R M Dodds
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - J G Bunn
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - S Hillman
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - A Granic
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - J Murray
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - M D Witham
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - S M Robinson
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
| | - R Cooper
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
- Department of Sport and Exercise Sciences , Musculoskeletal Science and Sports Medicine Research Centre,
- Manchester Metropolitan University , Musculoskeletal Science and Sports Medicine Research Centre,
| | - A A Sayer
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research
- www.admissioncollab.org
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Witkam R, Verstappen S, Gwinnutt J, Cook M, O’neill T, Cooper R, Humphreys J. POS0325 THE ASSOCIATION BETWEEN OBESITY, SOCIOECONOMIC POSITION AND KNEE JOINT REPLACEMENT SURGERY IN PATIENTS WITH OSTEOARTHRITIS: RESULTS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2750] [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
BackgroundEvidence suggests that associations of lower socioeconomic position (SEP) with increased incidence of osteoarthritis (OA) are partially mediated by obesity. Obesity and lower SEP are also associated with increased symptoms in OA (i.e. pain/function). However, few studies have investigated whether obesity and lower SEP are also associated with increased risk of knee joint replacement surgeries (kJRS).ObjectivesTo investigate the relationships of obesity and SEP at time of diagnosis with kJRS at follow-up in people with knee OA (kOA).MethodsThe English Longitudinal Study of Ageing is a nationally representative panel study of adults aged ≥50 years with biannual waves of data collection (2002–2019). Participants who self-reported OA diagnosis for the first time in waves 2–8 and knee pain in the same or previous wave of diagnosis were defined as having kOA (baseline). Participants with at least one body mass index (BMI) measurement and one follow-up assessment were included. Underweight/normal weight, overweight and obesity were defined using BMI <25 kg/m2, 25–30 kg/m2 and ≥30kg/m2, respectively. Education, occupation (current or last occupation if retired), wealth quintiles (all individual-based) and index of multiple deprivation quintiles (area-based) were used as SEP indicators. Outcome was the first self-reported kJRS (left or right knee) in waves 3–9. Cox proportional hazards models were used to investigate the associations of obesity and SEP with kJRS, controlling for baseline covariates. Person year follow up was calculated from baseline to either a) date of self-reported kJRS, b) loss to follow-up, c) end of follow-up (wave 9).ResultsThe analysis sample included 1499 people who reported kOA and had ≥1 BMI measure (62.3% female; mean age 66.5y (SD 9.4); 96% white; 47.4% obese). Number of person-years included in the analysis was 8427. Over a mean follow-up of 4.7 years (SD 2.8), 144 (9.6%) reported having kJRS. Obese kOA patients were more likely to report kJRS than non-obese patients (adjHR 1.89 (95% CI 1.33, 2.68)), independent of age, gender, SEP, cardiovascular disease (self-reported) and HbA1c values (measured from collected blood samples). Education and occupation were not associated with kJRS. However, those living in the most deprived areas and with the least amount of wealth were less likely to undergo kJRS compared with the least deprived and wealthiest (HRs adjusted for age and gender 0.37 (95% CI 0.19, 0.73) and 0.55 (95% CI 0.33, 0.93), respectively). There was no evidence of interactions between obesity and SEP indicators.ConclusionObesity increased the likelihood of undergoing kJRS in kOA patients. Therefore, reducing obesity in kOA patients may help to reduce the need for kJRS. Area-deprivation and lower wealth were associated with lower likelihood of kJRS. Taken together with findings from other studies which report associations between lower SEP and worse OA symptoms, our results suggest that there may be social inequalities in the provision of kJRS in England.Table 1.The relationships between obesity at baseline and rates of knee joint replacement surgery over a mean of 4.7 (SD 2.8) years in follow-up in those with knee OA at baseline in the English Longitudinal Study of AgeingPredictorsHR (95% CI)UnadjustedAdjusted for age and genderAdjusted for age, gender and SEPAdjusted for age, gender, SEP, CVD and HbA1cObesity1.56 (1.12, 2.17)1.63 (1.17, 2.28)1.77 (1.26, 2.50)1.89 (1.33, 2.68)Non-obesityrefrefrefrefObesity3.53 (1.77, 7.02)3.58 (1.80, 7.12)4.01 (2.01, 8.03)4.35 (2.16, 8.74)Overweight2.91 (1.43, 5.91)2.81 (1.38, 5.73)2.93 (1.44, 5.98)2.98 (1.46, 6.09)Underweight/normal weightrefrefrefrefBMI per 1 kg/m2 increment1.05 (1.02, 1.07)1.05 (1.03, 1.08)1.06 (1.04, 1.09)1.07 (1.04, 1.10)HR, hazard ratio; CI, confidence interval; SEP, socioeconomic position; CVD, cardiovascular disease; ref, reference category; BMI, body mass index.Disclosure of InterestsNone declared
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Spampinato S, Tanderup K, Nout R, Smet S, Lindegaard J, Fokdal L, Pötter R, Sturdza A, Segedin B, Jürgenliemk-Schulz I, Bruheim K, Mahantshetty U, Chargari C, Rai B, Cooper R, van der Steen-Banasik E, Sundset M, Wiebe E, Villafranca E, Van Limbergen E, Chopra S, Kirchheiner K. OC-0588 Impact of persistent symptoms on long-term quality of life of cervical cancer survivors in EMBRACE I. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Hurst C, Murray JC, Granic A, Hillman SJ, Cooper R, Sayer AA, Robinson SM, Dodds RM. 684 LONG-TERM CONDITIONS, MULTIMORBIDITY, LIFESTYLE FACTORS AND GRIP STRENGTH CHANGE OVER 9 YEARS IN 44,315 UK BIOBANK PARTICIPANTS. Age Ageing 2022. [DOI: 10.1093/ageing/afac036.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Weak grip strength is associated with a range of adverse health outcomes, and an accelerated decline in grip strength confers an even greater risk. To date there has been limited research into the factors associated with change in grip strength in mid-life. Using data from UK Biobank our aim was to investigate the associations of long-term conditions (LTCs), multimorbidity and lifestyle factors with patterns of change in grip strength.
Methods
We used data from 44,315 UK Biobank participants with grip strength measured at baseline (2006–10) and a subsequent study visit around nine years later. At baseline, participants’ LTCs were self-reported and categorised against a hierarchy. Multimorbidity was characterised by the number of LTC categories present (0, 1, 2 and 3+). Lifestyle factors (body mass index (BMI), smoking, diet and physical activity) were also assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression models.
Results
Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% Confidence Interval [CI] 1.49–1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change: those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18;95% CI 1.08–1.28) compared to those with no LTCs. Low physical activity was associated with adverse patterns of grip strength, while raised BMI had divergent associations (both the decline and stable high patterns of grip strength change).
Conclusion
Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of loss of strength over time.
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Affiliation(s)
- C Hurst
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
| | - J C Murray
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
| | - A Granic
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
| | - S J Hillman
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
| | - R Cooper
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, UK
| | - A A Sayer
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
| | - S M Robinson
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
| | - R M Dodds
- AGE Research Group, Newcastle University, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, UK
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Rovirosa A, Zhang Y, Chargari C, Cooper R, Wojcieszek P, Stankiewicz M, Hoskin P, van der Steen-Banas E, Segedin B, Najjari D, Potter R, Tanderup K, van Limbergen E. 3D Image-Guided Brachytherapy as Only Treatment for Stage-I Inoperable Endometrial Cancer: Retrospective Analysis of the Gynecological Cancer GEC-ESTRO Working Group. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Cooper R, Nassiri I, Watson R, Taylor C, Tong O, Sharma PK, Verge de los Aires A, Mahé E, Danielli S, Fairfax B. 1761MO Defining subset-wise myeloid responses to immune checkpoint blockade in melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cooper R, David A, Kudoh T, Tyler CR. Seasonal variation in oestrogenic potency and biological effects of wastewater treatment works effluents assessed using ERE-GFP transgenic zebrafish embryo-larvae. Aquat Toxicol 2021; 237:105864. [PMID: 34118774 DOI: 10.1016/j.aquatox.2021.105864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
Effluents from wastewater treatment works (WwTW) exhibit both temporal and spatial variation in oestrogenicity, however few studies have attempted to quantify how this variation affects biological responses in fish. Here we used an oestrogen-responsive green fluorescent protein (ERE-GFP) transgenic zebrafish (Danio rerio) to quantify oestrogenic activity and health effects for exposure to three different WwTW effluents. Endpoints measured included survival/hatching rate, GFP induction (measured in target tissues or gfp mRNA induction in whole embryos) and vtg mRNA induction in whole embryos. Exposure to one of the study effluents (at 100%), resulted in some mortality, and exposure to all three effluents (at 50% and 100%) caused decreases in hatching rates. Higher levels of vtg mRNA corresponded with higher levels of steroidal oestrogens in the different effluents, with lowest-observed-effect concentrations (LOECs) between 31 ng/L and 39 ng/L oestradiol equivalents (EEQs). Tissue patterns of GFP expression for all three WwTWs effluents reflected the known targets for steroidal oestrogens and for some other oestrogenic chemicals likely present in those effluents (i.e. nonylphenol or bisphenolic compounds). GFP induction was similarly responsive to vtg mRNA induction (a well-established biomarker for oestrogen exposure). We thus demonstrate the ERE-GFP transgenic zebrafish as an effective model for monitoring the oestrogenic potency and health effects for exposure to complex mixtures of chemicals contained within WwTW effluents.
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Affiliation(s)
- Ruth Cooper
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Arthur David
- School of Life Sciences, University of Sussex, Brighton BN1 9QJ, United Kingdom; Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, University of Rennes, F-35000 Rennes, France
| | - Tetsuhiro Kudoh
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Charles R Tyler
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom.
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Obeidat M, Cooper R, Fairburn T, Pettemerides V, Waktare J, Todd D. Diagnosing arrhythmogenic ventricular cardiomyopathy: a re-appraisal of the role and normal range of the signal-averaged ECG. Europace 2021. [DOI: 10.1093/europace/euab116.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The 2010 Task Force Criteria (TFC) for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (A(R)VC) in 1st degree relatives includes an abnormality in a single parameter of the signal averaged ECG (SAECG). SAECG normal ranges were derived predominately from ischaemic heart disease patients, so may not be applicable in an A(R)VC population. There remain concerns that the SAECG is not specific enough and its role in the diagnosis of A(R)VC is under scrutiny.
Purpose
to improve the diagnostic utility of the SAECG
Methods
Patients with an A(R)VC diagnosis and 1st degree family members (FM) under follow-up at a single inherited cardiac conditions (ICC) centre were included. All cases were independently reviewed by 3 cardiologists experienced in the diagnosis and management of A(R)VC. All SAECGs included were free from artefact. TFC clinical variables and genetic status were recorded for each patient. Where tests had been repeated the most recent values were used. Because of concerns about the use of a single abnormal SAECG parameter in making a clinical diagnosis we required ≥2 abnormal SAECG parameters, or a confirmed genetic mutation to make a diagnosis. A diagnosis of false positive SAECG was made with ≥2 abnormalities when the individual was known not to carry the familial pathogenic mutation.
Results
A study population of 160 patients (male 103 (64%), age 46yrs (range 18-85yrs); 41 pro-bands and 119 FM. 62(52%) FM had a clinical diagnosis of AVC, with ARVC the pre-dominant phenotype 51(82%). A pathogenic genetic variant was identified in 24(47%) of FM with ARVC. The SAECG data is presented graphically for each parameter. A clinical diagnosis of ARVC was made on the basis of an affected 1st degree FM and an abnormal SAECG in 24(47%) of FM. Of these, 16(67%) had three abnormal SAECG parameters, 6(25%) two and 2(8%) a single abnormal parameter. Both patients with only one abnormal SAECG parameter carry a pathogenic variant. In total 88% of FM with ARVC, and 32% of FM without AVC had an abnormal SAECG as per current TFC. False positive values were mainly in fQRS duration (17/18), but also LAS40 (5/18), and RMS40 (2/18). By redefining an abnormal fQRS duration to be ≥118ms, false positives are reduced from 17 to 4. In addition, if there is a requirement for a 2nd abnormality then the false positives are reduced to 2 (4%). By adjusting the diagnostic criteria to fQRS duration ≥118ms, with a 2nd abnormal parameter or known pathogenic gene carrier status none of the 24 FM with a clinical diagnosis on abnormal SAECG alone would change diagnostic classification.
Conclusion
The SAECG is useful in family screening as it is frequently the only test to show an abnormality. However, the current TFC reference values lack specificity. By redefining an abnormal fQRS as ≥118ms with the requirement of a 2nd abnormal parameter, specificity is increased to 96%, with no significant change in sensitivity. Abstract Figure. SAECG Parameters in Family Members
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Affiliation(s)
- M Obeidat
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Cooper
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - T Fairburn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - V Pettemerides
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Waktare
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Todd
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Lindegaard J, Petric P, Schmid M, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Huang F, Rai B, Cooper R, van der Steen-Banasik E, Van Limbergen E, Pieters B, Tan L, Nout R, de Leeuw A, Nesvacil N, Kirchheiner K, Jürgenliemk-Schultz I, Tanderup K, Kirisits C, Pötter R, Collaborative Group E. OC-0025 Tumor regression of cervical cancer during chemoradiation evaluated by the T-score in EMBRACE I. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Cooper R, Williams E, Seegobin S, Tye C, Kuntsi J, Asherson P. Pharmacological approaches of ADHD. Eur Psychiatry 2021. [PMCID: PMC9471268 DOI: 10.1192/j.eurpsy.2021.227] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract Body Adults with ADHD describe self-medicating with cannabis. A small number of psychiatrists in the US prescribe cannabis medication for ADHD, despite there being no evidence from trials. The EMA-C trial (Experimental Medicine in ADHD-Cannabinoids) was a pilot randomised placebo-controlled experimental study of a cannabinoid medication, Sativex Oromucosal Spray, in 30 adults with ADHD. The primary outcome was cognitive performance and activity level using the QbTest. Secondary outcomes included ADHD and emotional lability (EL) symptoms. From 17.07.14-18.06.15, 30 participants were randomly assigned to the active (n=15) or placebo (n=15) group. For the primary outcome, no significant difference was found in the intent-to-treat analysis although the overall pattern of scores was such that the active group usually had scores that were better than the placebo group (Est=-0.17,95%CI-0.40-0.07, p=0.16, n=15/11 active/placebo). For secondary outcomes Sativex was associated with a nominally significant improvement in hyperactivity/impulsivity (p=0.03) and a cognitive measure of inhibition (p=0.05), and a trend towards improvement for inattention (p=0.10) and EL (p=0.11). Per-protocol effects were higher. Results did not meet significance following adjustment for multiple testing. One serious (muscular seizures/spasms) and three mild adverse events occurred in the active group and one serious (cardiovascular problems) adverse event in the placebo group. Adults with ADHD may represent a subgroup of individuals who experience a reduction of symptoms and no cognitive impairments following cannabinoid use. While not definitive, this study provides preliminary evidence supporting the self-medication theory of cannabis use in ADHD and the need for further studies of the endocannabinoid system in ADHD. Disclosure During this work-RC was a Ph.D. student funded by a grant to PA from Vifor Pharma. PA received funds (consultancy/sponsored talks/research/education) from Shire, Lilly, Novartis, Janssen, PCMScientific, Vifor Pharma, QBTech. Sativex was free from GW Pharm
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Staines KA, Hardy R, Samvelyan HJ, Ward KA, Cooper R. Life course longitudinal growth and risk of knee osteoarthritis at age 53 years: evidence from the 1946 British birth cohort study. Osteoarthritis Cartilage 2021; 29:335-340. [PMID: 33383179 PMCID: PMC7955286 DOI: 10.1016/j.joca.2020.12.012] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the relationship between height gain across childhood and adolescence with knee osteoarthritis in the MRC National Survey of Health and Development (NSHD). MATERIALS AND METHODS Data are from 3035 male and female participants of the NSHD. Height was measured at ages 2, 4, 6, 7, 11 and 15 years, and self-reported at ages 20 years. Associations between (1) height at each age (2) height gain during specific life periods (3) Super-Imposition by Translation And Rotation (SITAR) growth curve variables of height size, tempo and velocity, and knee osteoarthritis at 53 years were tested. RESULTS In sex-adjusted models, estimated associations between taller height and decreased odds of knee osteoarthritis at age 53 years were small at all ages - the largest associations were an OR of knee osteoarthritis of 0.9 per 5 cm increase in height at age 4, (95% CI 0.7-1.1) and an OR of 0.9 per 5 cm increase in height, (95% CI 0.8-1.0) at age 6. No associations were found between height gain during specific life periods or the SITAR growth curve variables and odds of knee osteoarthritis. CONCLUSIONS There was limited evidence to suggest that taller height in childhood is associated with decreased odds of knee osteoarthritis at age 53 years in this cohort. This work enhances our understanding of osteoarthritis predisposition and the contribution of life course height to this.
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Affiliation(s)
- K A Staines
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh UK.
| | - R Hardy
- Cohort and Longitudinal Studies Enhancement Resources (CLOSER), UCL Institute of Education, London, UK.
| | - H J Samvelyan
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.
| | - K A Ward
- MRC Lifecourse Epidemiology, Human Development and Health, University of Southampton, Southampton, UK.
| | - R Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK.
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Cooper R, David A, Lange A, Tyler CR. Health Effects and Life Stage Sensitivities in Zebrafish Exposed to an Estrogenic Wastewater Treatment Works Effluent. Front Endocrinol (Lausanne) 2021; 12:666656. [PMID: 33995285 PMCID: PMC8120895 DOI: 10.3389/fendo.2021.666656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/24/2021] [Indexed: 11/27/2022] Open
Abstract
A wide range of health effects in fish have been reported for exposure to wastewater treatment work (WwTW) effluents including feminized responses in males. Most of these exposure studies, however, have assessed acute health effects and chronic exposure effects are less well established. Using an Estrogen Responsive Element-Green Fluorescent Protein (ERE-GFP)-Casper transgenic zebrafish, we investigated chronic health effects and life stage sensitivities for exposure to an estrogenic WwTW effluent and the synthetic estrogen 17α-ethinylestradiol (EE2). Exposure to the WwTW effluent (at full strength;100%) and to 10 ng/L (nominal) EE2 delayed testis maturation in male fish but accelerated ovary development in females. Exposure to 50% and 100% effluent, and to 10 ng/L EE2, also resulted in skewed sex ratios in favor of females. Differing patterns of green fluorescent protein (GFP) expression, in terms of target tissues and developmental life stages occurred in the ERE-GFP- zebrafish chronically exposed to 100% effluent and reflected the estrogenic content of the effluent. gfp and vitellogenin (vtg) mRNA induction were positively correlated with measured levels of steroidal estrogens in the effluent throughout the study. Our findings illustrate the importance of a fish's developmental stage for estrogen exposure effects and demonstrate the utility of the ERE-GFP zebrafish for integrative health analysis for exposure to estrogenic chemical mixtures.
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Affiliation(s)
- Ruth Cooper
- College of Life & Environmental Sciences, University of Exeter, Biosciences, Exeter, United Kingdom
| | - Arthur David
- School of Life Sciences, University of Sussex, Brighton, United Kingdom
| | - Anke Lange
- College of Life & Environmental Sciences, University of Exeter, Biosciences, Exeter, United Kingdom
| | - Charles R. Tyler
- College of Life & Environmental Sciences, University of Exeter, Biosciences, Exeter, United Kingdom
- *Correspondence: Charles R. Tyler,
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Schmid M, Kirisits C, Tanderup K, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Huang F, Rai B, Cooper R, Van der Steen-Banasik E, Van Limbergen E, Pieters B, Tan L, Nout R, De Leeuw A, Nesvacil N, Jürgenliemk-Schulz I, Lindegaard J, Pötter R. OC-1051: Local failure in cervical cancer patients after MR image-guided adaptive brachytherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pötter R, Tanderup K, Schmid M, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Huang F, Rai B, Cooper R, Van der Steen-Banasik E, Van Limbergen E, Pieters B, Tan L, Nout R, De Leeuw A, Nesvacil N, Kirchheiner K, Jürgenliemk-Schulz I, Kirisits C, Lindegaard J, Embrace C. OC-0437: MRI guided adaptive brachytherapy in locally advanced cervical cancer: overall results of EMBRACE I. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00459-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Smet S, Tanderup K, Nout R, Jürgenliemk-Schulz I, Spampinato S, Chargari C, Lindegaard J, Mahantshetty U, Strudza A, Schmid M, Hoskin P, Segedin B, Bruheim K, Rai B, Huang F, Van Der Steen-Basanik E, Cooper R, Van Limbergen E, Sundset M, Pötter R, Kirchheiner K. OC-0317: Risk factors for persistent late fatigue after radiochemotherapy in cervical cancer (EMBRACE study). Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jensen N, Pötter R, Fokdal L, Chargari C, Lindegaard J, Schmid M, Sturdza A, Mahantshetty U, Jürgenliemk-Schulz I, Hoskin P, Segedin B, Rai B, Bruheim K, Wiebe E, Van der Steen-Banasik E, Cooper R, Van Limbergen E, Sundset M, Pieters B, Nout R, Kirisits C, Kirchheiner K, Tanderup K. PH-0404: Risk factors for late diarrhoea after radio(chemo)therapy in cervical cancer: EMBRACE I results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Peters M, De Leeuw A, Pötter R, Nomden C, Tanderup K, Kirchheiner K, Schmid M, Fortin I, Haie-Meder C, Lindegaard J, Sturdza A, Mahantshetty U, Hoskin P, Segedin B, Bruheim K, Rai B, Huang F, Cooper R, Van der Steen-Banasik E, Van Limbergen E, Nout R, Jürgenliemk-Schulz I. OC-0566: Risk factors for nodal failure in the EMBRACE study cohort. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vittrup A, Kirchheiner K, Tanderup K, Jensen N, Spampinato S, Fokdal L, Kirisits C, Haie-Meder C, Lindegaard J, Schmid M, Sturdza A, Mahantshetty U, Jürgenliemk-Schulz I, Hoskin P, Segedin B, Bruheim K, Rai B, Wiebe E, Van der Steen-Banasik E, Cooper R, Van Limbergen E, Sundset M, Pieters B, Nout R, Pötter R. OC-0569: Incidence of severe gastrointestinal and urinary fistulas, bleeding and strictures: EMBRACE results. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bird D, Teo M, Casanova N, Cooper R, Gilbert A, Mccallum H, Sebag-Montefiore D, Henry A, Speight R, Al-Qaisieh B, Nix M. PH-0410: Multi-centre, deep learning, sCT generation for anorectal cancers with AI robustness assessment. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00432-1] [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: 10/22/2022]
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Knoth J, Pötter R, Jürgenliemk-Schulz IM, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Wiebe E, Rai B, Cooper R, van der Steen-Banasik E, van Limbergen E, Pieters BR, Sundset M, Tan LT, Nout RA, Tanderup K, Kirisits C, Nesvacil N, Lindegaard JC, Schmid MP. Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging - An analysis from the EMBRACE study. Gynecol Oncol 2020; 159:136-141. [PMID: 32798000 DOI: 10.1016/j.ygyno.2020.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/05/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate differences in local tumour staging between clinical examination and MRI and differences between FIGO 2009, FIGO 2018 and TNM in patients with primary cervical cancer undergoing definitive radio-chemotherapy. METHODS Patients from the prospective observational multi-centre study "EMBRACE" were considered for analysis. All patients had gynaecological examination and pelvic MRI before treatment. Nodal status was assessed by MRI, CT, PET-CT or lymphadenectomy. For this analysis, patients were restaged according to the FIGO 2009, FIGO 2018 and TNM staging system. The local tumour stage was evaluated for MRI and clinical examination separately. Descriptive statistics were used to compare local tumour stages and different staging systems. RESULTS Data was available from 1338 patients. For local tumour staging, differences between MRI and clinical examination were found in 364 patients (27.2%). Affected lymph nodes were detected in 52%. The two most frequent stages with FIGO 2009 are IIB (54%) and IIIB (16%), with FIGO 2018 IIIC1 (43%) and IIB (27%) and with TNM T2b N0 M0 (27%) and T2b N1 M0 (23%) in this cohort. CONCLUSIONS MRI and clinical examination resulted in a different local tumour staging in approximately one quarter of patients. Comprehensive knowledge of the differential value of clinical examination and MRI is necessary to define one final local stage, especially when a decision about treatment options is to be taken. The use of FIGO 2009, FIGO 2018 and TNM staging system leads to differences in stage distributions complicating comparability of treatment results. TNM provides the most differentiated stage allocation.
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Affiliation(s)
- J Knoth
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - R Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | | | - C Haie-Meder
- Department of Radiotherapy, Gustave-Roussy, France
| | - L Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
| | - A Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - U Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, India
| | - B Segedin
- Department of Oncology, Institute of Oncology Ljubljana, Slovenia
| | - K Bruheim
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Norway
| | - E Wiebe
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - B Rai
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Cooper
- Leeds Cancer Centre, St James's University Hospital, United Kingdom
| | | | - E van Limbergen
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - M Sundset
- Clinic of Oncology and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - L T Tan
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - R A Nout
- Department of Radiation Oncology, Erasmus MC, Erasmus University Rotterdam, The Netherlands
| | - K Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
| | - C Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - N Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria
| | - J C Lindegaard
- Department of Oncology, Aarhus University Hospital, Denmark
| | - M P Schmid
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, General Hospital of Vienna, Austria.
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Bozhilova N, Cooper R, Kuntsi J, Asherson P, Michelini G. Electrophysiological correlates of spontaneous mind wandering in attention-deficit/hyperactivity disorder. Behav Brain Res 2020; 391:112632. [PMID: 32361038 PMCID: PMC7303944 DOI: 10.1016/j.bbr.2020.112632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/16/2020] [Accepted: 03/28/2020] [Indexed: 11/18/2022]
Abstract
We recently hypothesised that increased spontaneous mind wandering (MW-S) reflects a core process underlying attention-deficit/hyperactivity disorder (ADHD). Previous studies show that individuals with ADHD and neurotypical individuals with increased MW-S display similar cognitive-performance and electrophysiological (EEG) impairments in attentional processes. However, the cognitive-EEG markers associated with increased MW-S in ADHD remain poorly understood. We therefore investigated such markers in a sample of 69 sex- and age-matched adults with ADHD and 29 controls during the Sustained Attention to Response Task. We compared task performance and EEG measures (P3, time-frequency brain-oscillations) of attentional processes between groups, and examined their association with a validated self-report questionnaire of MW-S. Finally, we tested the hypothesis that MW-S and ADHD diagnosis relate to the same cognitive-EEG impairments using a hierarchical regression model. Compared to controls, adults with ADHD showed attenuations in P3, event-related alpha and beta suppression during response inhibition (No-Go trials), and theta power activations during response execution (Go trials), as well as increased reaction time variability and more commission/omission errors. MW-S was also continuously associated with most cognitive-EEG measures related to ADHD. The hierarchical regressions on measures associated with both ADHD diagnosis and MW-S showed that MW-S did not explain additional variance in the cognitive-EEG markers (except for beta suppression) beyond ADHD diagnosis, and vice versa. These findings are consistent with our hypothesis that ADHD diagnosis and MW-S share common neural deficits, and that MW-S may reflect a core symptom of the disorder.
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Affiliation(s)
- Natali Bozhilova
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Ruth Cooper
- Newham Centre for Mental Health, Unit for Social and Community Psychiatry, Queen Mary University of London, London, United Kingdom
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Giorgia Michelini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom; Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 9002/4, United States.
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Merritt K, Catalan A, Cowley S, Demjaha A, Taylor M, McGuire P, Cooper R, Morrison P. Glyceryl trinitrate in first-episode psychosis unmedicated with antipsychotics: A randomised controlled pilot study. J Psychopharmacol 2020; 34:839-847. [PMID: 32436761 PMCID: PMC7376621 DOI: 10.1177/0269881120922967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a pressing need for new classes of treatment for psychosis. A key therapeutic target for novel compounds is the NMDA receptor, which may be modulated by nitric oxide donors such as sodium nitroprusside (SNP). Recent studies of SNP in patients with psychosis have mixed results, and the drug has to be administered intravenously. Glyceryl trinitrate (GTN) is a well-established cardiovascular medicine that is also a nitric oxide donor, and can be given orally. AIMS We explored the safety and potential effects of GTN in unmedicated patients with a first episode of psychosis. METHODS This was a single-centre, randomised, double-blind, placebo-controlled trial from December 2016 to April 2019 (ClinicalTrials.gov identifier: NCT02906553). Patients received 3 × sprays of GTN or placebo for three consecutive days, and were re-assessed on Days 1, 2, 3 and 7. The primary outcome was cognition (Jumping to Conclusions task), secondary outcomes were symptoms (Positive and Negative Syndrome Scale (PANSS)), verbal memory (Hopkins Verbal Learning task), and mood (Bond-Lader Visual Analogue Scales). RESULTS Nineteen patients were randomised, and 13 participants were included in the analyses. Compared with placebo, GTN was well tolerated, but was not associated with significant effects on cognition, symptoms, or mood. Bayesian statistics indicate that our results were 2× more likely under the null hypothesis than the alternative hypothesis, providing anecdotal evidence that GTN does not improve psychotic symptoms. CONCLUSIONS We found no indication of an effect of GTN on symptoms of psychosis or cognition.
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Affiliation(s)
- Kate Merritt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK,Division of Psychiatry, University College London, London, UK,Kate Merritt, Department of Psychosis Studies, Institute of Psychiatry, Psychology &
Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Ana Catalan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK,Osakidetza Basque Health Service, Department Psychiatry, Basurto University Hospital, Bilbao, Spain,Department of Neuroscience, University of the Basque Country, Leioa, Spain
| | - Samuel Cowley
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matthew Taylor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK,University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ruth Cooper
- Newham Centre for Mental Health, Unit for Social and Community Psychiatry, Queen Mary University of London, UK,East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
| | - Paul Morrison
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Cooper R, Wilkie G, Samuel K, McMillan L, Vickers M, Turner M, Campbell J, Fraser A. Therapeutic EBV-specific T cell cytotoxicity against allogeneic LCLs in vitro directly correlates to intracellular IFNγ/TNFα expression in response to EBV peptide stimulation. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fairfax B, Taylor C, Watson R, Nassiri I, Fang H, Mahe E, Cooper R, Danielli S, Woodcock V, Traill Z, Knight J, Payne M, Middleton M. Early peripheral T-cell responses predict oncological outcome to checkpoint immune blockade in metastatic melanoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.020] [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: 11/14/2022] Open
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Peeters G, Cooper R, Tooth L, van Schoor NM, Kenny RA. A comprehensive assessment of risk factors for falls in middle-aged adults: co-ordinated analyses of cohort studies in four countries. Osteoporos Int 2019; 30:2099-2117. [PMID: 31201482 DOI: 10.1007/s00198-019-05034-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/27/2019] [Indexed: 01/19/2023]
Abstract
UNLABELLED We identified demographic, health and lifestyle factors associated with falls in adults aged 50-64 years from Australia, The Netherlands, Great Britain and Ireland. Nearly all factors were associated with falls, but there were differences between countries and between men and women. Existing falls prevention programs may also benefit middle-aged adults. INTRODUCTION Between ages 40-44 and 60-64 years, the annual prevalence of falls triples suggesting that middle age may be a critical life stage for preventive interventions. We aimed to identify demographic, health and lifestyle factors associated with falls in adults aged 50-64 years. METHODS Harmonised data were used from four population-based cohort studies based in Australia (Australian Longitudinal Study on Women's Health, n = 10,641, 51-58 years in 2004), Ireland (The Irish Longitudinal Study on Ageing, n = 4663, 40-64 years in 2010), the Netherlands (Longitudinal Ageing Study Amsterdam, n = 862, 55-64 years in 2012-13) and Great Britain (MRC National Survey of Health and Development, n = 2987, 53 years in 1999). Cross-sectional and prospective associations of 42 potential risk factors with self-reported falls in the past year were examined separately by cohort and gender using logistic regression. In the absence of differences between cohorts, estimates were pooled using meta-analysis. RESULTS In cross-sectional models, nearly all risk factors were associated with fall risk in at least one cohort. Poor mobility (pooled OR = 1.71, CI = 1.34-2.07) and urinary incontinence (OR range = 1.53-2.09) were consistently associated with falls in all cohorts. Findings from prospective models were consistent. Statistically significant interactions with cohort and sex were found for some of the risk factors. CONCLUSION Risk factors known to be associated with falls in older adults were also associated with falls in middle age. Compared with findings from previous studies of older adults, there is a suggestion that specific risk factors, for example musculoskeletal conditions, may be more important in middle age. These findings suggest that available preventive interventions for falls in older adults may also benefit middle-aged adults, but tailoring by age, sex and country is required.
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Affiliation(s)
- G Peeters
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland.
- Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK.
| | - R Cooper
- Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - L Tooth
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - N M van Schoor
- Department of Epidemiology and Biostatistics Amsterdam UMC, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R A Kenny
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland
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Munjal I, Ng C, Imtiaz Z, Cooper R, Cope L. Adequacy of trauma c-spine X-rays: a case for ;straight to CT?’. Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vusirikala A, Ben-Shlomo Y, Kuh D, Stafford M, Cooper R, Morgan GS. Mid-life social participation and physical performance at age 60-64: evidence from the 1946 British Birth Cohort Study. Eur J Public Health 2019; 29:986-992. [PMID: 30726911 DOI: 10.1093/eurpub/ckz005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies linking social activity and disability have been limited by focussing on self-reported physical performance in older adults (>65). We examined whether social participation in mid-life is associated with objective and subjective measures of physical performance in older age. METHODS Participants of the Medical Research Council National Survey of Health and Development reported their involvement in social activities at ages 43 and 60-64 years; frequency of such involvement was classified into thirds. Physical performance was measured at age 60-64 using: grip strength; standing balance; chair rises; timed get-up-and-go; self-reported physical function from the Short Form-36. Multivariable regression was used to examine longitudinal associations between social participation and each physical performance measure. We also investigated whether change in social participation between 43 and 60-64 was associated with each outcome. RESULTS In fully adjusted models, higher frequency of social participation at 43 was associated with faster chair rise (1.42 repetitions/min, 95% CI 0.45-2.39) and timed get-up-and-go speed (2.47 cm/s, 95% CI 0.27-4.67) and lower likelihood of self-report limitations (OR of low physical function 0.67, 95% CI 0.50-0.91) at 60-64 compared with low frequency. Better performance in objectively measured outcomes was observed only if higher social participation persisted over time whereas lower odds of self-reported limitations were found in all groups when compared to those with persistently low participation (ORs 0.43-0.56, all P≤0.02). CONCLUSION Our findings suggest that associations between higher levels of social participation in mid-life and better physical performance exist only if this social participation persists through to older age.
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Affiliation(s)
- A Vusirikala
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Y Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - D Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at University College London (UCL), UK
| | - M Stafford
- Medical Research Council Unit for Lifelong Health and Ageing at University College London (UCL), UK
| | - R Cooper
- Medical Research Council Unit for Lifelong Health and Ageing at University College London (UCL), UK
| | - G S Morgan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Shakir R, Adams R, Cooper R, Downing A, Geh I, Gilbert D, Jacobs C, Jones C, Lorimer C, Namelo W, Sebag-Montefiore D, Shaw P, Muirhead R. Patterns and predictors of relapse following radical chemoradiotherapy delivered using intensity-modulated radiotherapy with a simultaneous integrated boost in anal squamous cell carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.158] [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: 11/14/2022] Open
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Hayes A, Burgoyne P, Cooper R, Pingen M, Graham G, Campbell J. Using chemokine sorting to imrpove NK cell function in an anti-tumour model. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.341] [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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Burgoyne P, Hayes A, Cooper R, Fraser A, Graham G, Campbell J. GMP-compliant sorting of dendritic cells for CCR7 expression improves therapeutic efficacy in cancer by enhancing lymph node migration and antigen-specific T cell activation. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fraser A, Cooper R, Barnett M, McGowan N, Campbell J. Development and implementation of a therapeutic GMP-compliant allogeneic peptide EBV-specific T cell bank using optimized culture and analysis processes. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.344] [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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Mowlem FD, Skirrow C, Reid P, Maltezos S, Nijjar SK, Merwood A, Barker E, Cooper R, Kuntsi J, Asherson P. Validation of the Mind Excessively Wandering Scale and the Relationship of Mind Wandering to Impairment in Adult ADHD. J Atten Disord 2019; 23:624-634. [PMID: 27255536 PMCID: PMC6429624 DOI: 10.1177/1087054716651927] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study investigates excessive mind wandering (MW) in adult ADHD using a new scale: the Mind Excessively Wandering Scale (MEWS). METHOD Data from two studies of adult ADHD was used in assessing the psychometric properties of the MEWS. Case-control differences in MW, the association with ADHD symptoms, and the contribution to functional impairment were investigated. RESULTS The MEWS functioned well as a brief measure of excessive MW in adult ADHD, showing good internal consistency (α > .9), and high sensitivity (.9) and specificity (.9) for the ADHD diagnosis, comparable with that of existing ADHD symptom rating scales. Elevated levels of MW were found in adults with ADHD, which contributed to impairment independently of core ADHD symptom dimensions. CONCLUSION Findings suggest excessive MW is a common co-occurring feature of adult ADHD that has specific implications for the functional impairments experienced. The MEWS has potential utility as a screening tool in clinical practice to assist diagnostic assessment.
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Affiliation(s)
- Florence D. Mowlem
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Caroline Skirrow
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Peter Reid
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Stefanos Maltezos
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Simrit K. Nijjar
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Andrew Merwood
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Department of Psychology, University of Bath, UK
| | - Edward Barker
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Ruth Cooper
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Jonna Kuntsi
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Philip Asherson, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK.
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Knoth J, Pötter R, Jürgenliemk-Schulz I, Haie-Meder C, Fokdal L, Sturdza A, Hoskin P, Mahantshetty U, Segedin B, Bruheim K, Wiebe E, Rai B, Cooper R, Van der Steen-Banasik E, Van Limbergen E, Pieters B, Sundset M, Tan L, Nout R, Tanderup K, Kirisits C, Nesvacil N, Lindegaard J, Schmid M. PO-0827 Comparison of clinical examination and MRI for local cervical cancer staging (FIGO and T(NM)). Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31247-2] [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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45
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Ajayi SO, Adeoye AM, Raji YR, Tayo B, Salako BL, Ogunniyi A, Ojo A, Cooper R. Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study. West Afr J Med 2019; 36:61-68. [PMID: 30924118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.
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Affiliation(s)
- S O Ajayi
- Department of Medicine, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Kok A, Stafford M, Cosco TD, Huisman M, Deeg DJH, Kuh D, Cooper R. FACTORS ASSOCIATED WITH REMAINING FREE FROM FUNCTIONAL LIMITATIONS DESPITE SOCIOECONOMIC ADVERSITY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Kok
- Free University of Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - M Stafford
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - T D Cosco
- Gerontology Research Centre, Simon Fraser University, Vancouver, Canada
| | - M Huisman
- Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - D J H Deeg
- Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
| | - R Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, United Kingdom
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Sherlaw W, Fernandez A, McColl K, Cooper R. Learning from transnational differences in how risk of harm is viewed in human research ethics. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Sherlaw
- Ecole des hautes études en santé publique (EHESP), LABERS – Laboratoire d'études et de recherches e, Rennes, France
| | - A Fernandez
- Andalusian School of Public Health, Granada, Spain
| | - K McColl
- EHESP Doctoral network, Rennes, France
| | - R Cooper
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
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Denham N, Pearman CM, Ding WY, Waktare J, Gupta D, Snowdon R, Hall M, Cooper R, Modi S, Todd D, Mahida S. 4287Systematic re-evaluation of ion channel mutations associated with Brugada syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Denham
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - C M Pearman
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - W Y Ding
- Aintree University Hospital, Liverpool, United Kingdom
| | - J Waktare
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - D Gupta
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - R Snowdon
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - M Hall
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - R Cooper
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - S Modi
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - D Todd
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - S Mahida
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Partridge DG, Winnard C, Townsend R, Cooper R, Stockley I. Joint aspiration, including culture of reaspirated saline after a 'dry tap', is sensitive and specific for the diagnosis of hip and knee prosthetic joint infection. Bone Joint J 2018; 100-B:749-754. [PMID: 29855250 DOI: 10.1302/0301-620x.100b6.bjj-2017-0970.r2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Aims The aim of this study was to establish the diagnostic accuracy of culture of joint aspirate with and without saline injection-reaspiration. Patients and Methods This is a retrospective analysis of 580 hip and knee aspirations in patients who were deemed to have a moderate to high risk of infection, and who subsequently proceeded to revision arthroplasty over a period of 12 years. It was carried out at a large quaternary referral centre where preoperative aspiration is routine. Results Fluid was aspirated primarily in 313 (54%) cases and after saline injection-reaspiration of a 'dry tap' in 267 (46%) cases. Overall sensitivity and specificity of the diagnostic aspirate were 84% (78% to 89%) and 85% (81% to 88%), respectively. Sensitivity and specificity of saline injection-reaspiration after 'dry tap' were 87% (79% to 92%) and 79% (72% to 84%) compared with 81% (71% to 88%) and 90% (85% to 93%) for direct aspiration. Conclusion Preoperative joint aspiration and culture is a sensitive and specific test for the confirmation of diagnosis in patients at a moderate to high risk of prosthetic joint infection. Culture of saline injection-reaspiration also provides accurate diagnostic information in the event of a 'dry tap'. Both methods allow susceptibility testing of relevant organisms and are therefore able to guide perioperative antibiotic therapy. Cite this article: Bone Joint J 2018;100-B:749-54.
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Affiliation(s)
- D G Partridge
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust and Florey Institute for Host-Pathogen Interactions, University of Sheffield, Sheffield, UK
| | - C Winnard
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Townsend
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Cooper
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - I Stockley
- Department of Orthopaedics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Dodds RM, Kuh D, Sayer AA, Cooper R. Can measures of physical performance in mid-life improve the clinical prediction of disability in early old age? Findings from a British birth cohort study. Exp Gerontol 2018; 110:118-124. [PMID: 29885357 DOI: 10.1016/j.exger.2018.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/14/2018] [Accepted: 06/01/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Poor performance in physical tests such as grip strength and walking speed is a risk factor for disability in old age, although whether such measures improve the discrimination of clinical prediction models when traditional clinical risk factors are already known is not clear. The prevalence of disability in mid-life is relatively low and hence screening in this age group may present an opportunity for early identification of those at increased future risk who may benefit most from preventative interventions. METHODS Data were drawn from two waves of the Medical Research Council National Survey of Health and Development. We examined whether several chronic conditions, poor health behaviours and lower scores on three measures of physical performance (grip strength, chair rise speed and standing balance time) at age 53 were associated with self-reported mobility and/or personal care disability at age 69. We used the area under the curve statistic (AUC) to assess model discrimination. RESULTS At age 69, 44% (826/1855) of participants reported mobility and/or personal care disability. Our final clinical prediction model included sex, knee osteoarthritis, taking 2+ medications, smoking, increased BMI and poor performance in all three physical tests, with an AUC of 0.740 compared with 0.708 for a model which did not include the performance measures. CONCLUSION Measures of physical performance in midlife improve discrimination in clinical prediction models for disability over 16 years. Importantly, these and similar measures are also potential targets of future diet, exercise and pharmacological intervention in mid-life.
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Affiliation(s)
- R M Dodds
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, United Kingdom; AGE Research Group, Institute of Neuroscience, Newcastle University, United Kingdom.
| | - D Kuh
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, United Kingdom
| | - A A Sayer
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, United Kingdom; AGE Research Group, Institute of Neuroscience, Newcastle University, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, United Kingdom; Newcastle University Institute for Ageing, United Kingdom
| | - R Cooper
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, United Kingdom
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