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Schön JL, Groß VE, Post WB, Daum A, Matúš D, Pilz J, Schnorr R, Horn S, Bäumers M, Weidtkamp-Peters S, Hughes S, Schöneberg T, Prömel S. The adhesion GPCR and PCP component flamingo (FMI-1) alters body size and regulates the composition of the extracellular matrix. Matrix Biol 2024; 128:1-10. [PMID: 38378098 DOI: 10.1016/j.matbio.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2024]
Abstract
The extracellular matrix (ECM) is a network of macromolecules that presents a vital scaffold for cells and enables multiple ways of cellular communication. Thus, it is essential for many physiological processes such as development, tissue morphogenesis, homeostasis, the shape and partially the size of the body and its organs. To ensure these, the composition of the ECM is tissue-specific and highly dynamic. ECM homeostasis is therefore tightly controlled by several mechanisms. Here, we show that FMI-1, the homolog of the Adhesion GPCR Flamingo/CELSR/ADGRC in the nematode Caenorhabditis elegans, modulates the composition of the ECM by controlling the production both of ECM molecules such as collagens and also of ECM modifying enzymes. Thereby, FMI-1 affects the morphology and functionality of the nematode´s cuticle, which is mainly composed of ECM, and also modulates the body size. Mechanistic analyses highlight the fact that FMI-1 exerts its function from neurons non-cell autonomously (trans) solely via its extracellular N terminus. Our data support a model, by which the activity of the receptor, which has a well-described role in the planar cell polarity (PCP) pathway, involves the PCP molecule VANG-1, but seems to be independent of the DBL-1/BMP pathway.
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Affiliation(s)
- Johanna Lena Schön
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, Leipzig, Germany; Department of Dermatology, Venereology and Allergology, Leipzig University Medical Center, Leipzig University, Leipzig, Germany
| | - Victoria Elisabeth Groß
- Institute of Cell Biology, Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Willem Berend Post
- Institute of Cell Biology, Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexandra Daum
- Institute of Cell Biology, Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Matúš
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, Leipzig, Germany; Department of Molecular and Cellular Physiology, Stanford University, Stanford, USA
| | - Johanna Pilz
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Rene Schnorr
- Institute of Cell Biology, Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Susanne Horn
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Miriam Bäumers
- Center for Advanced Imaging, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Samantha Hughes
- A-LIFE, Section Environmental Health and Toxicology, Free University Amsterdam, Amsterdam, the Netherlands
| | - Torsten Schöneberg
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, Leipzig, Germany; School of Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Simone Prömel
- Institute of Cell Biology, Department of Biology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Collins EMS, Hessel EVS, Hughes S. How neurobehavior and brain development in alternative whole-organism models can contribute to prediction of developmental neurotoxicity. Neurotoxicology 2024; 102:48-57. [PMID: 38552718 DOI: 10.1016/j.neuro.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
Developmental neurotoxicity (DNT) is not routinely evaluated in chemical risk assessment because current test paradigms for DNT require the use of mammalian models which are ethically controversial, expensive, and resource demanding. Consequently, efforts have focused on revolutionizing DNT testing through affordable novel alternative methods for risk assessment. The goal is to develop a DNT in vitro test battery amenable to high-throughput screening (HTS). Currently, the DNT in vitro test battery consists primarily of human cell-based assays because of their immediate relevance to human health. However, such cell-based assays alone are unable to capture the complexity of a developing nervous system. Whole organismal systems that qualify as 3 R (Replace, Reduce and Refine) models are urgently needed to complement cell-based DNT testing. These models can provide the necessary organismal context and be used to explore the impact of chemicals on brain function by linking molecular and/or cellular changes to behavioural readouts. The nematode Caenorhabditis elegans, the planarian Dugesia japonica, and embryos of the zebrafish Danio rerio are all suited to low-cost HTS and each has unique strengths for DNT testing. Here, we review the strengths and the complementarity of these organisms in a novel, integrative context and highlight how they can augment current cell-based assays for more comprehensive and robust DNT screening of chemicals. Considering the limitations of all in vitro test systems, we discuss how a smart combinatory use of these systems will contribute to a better human relevant risk assessment of chemicals that considers the complexity of the developing brain.
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Affiliation(s)
- Eva-Maria S Collins
- Swarthmore College, Biology, 500 College Avenue, Swarthmore, PA 19081, USA; Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center of Excellence in Environmental Toxicology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Ellen V S Hessel
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
| | - Samantha Hughes
- Department of Environmental Health and Toxicology, A-LIFE, Vrije Universiteit Amsterdam, de Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
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Bennett KH, Khor BY, Hughes S, Patel AJ. A multi-lesional analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: a single-centre analysis. Clin Radiol 2024:S0009-9260(24)00091-6. [PMID: 38378386 DOI: 10.1016/j.crad.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/10/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM To conduct a multi-lesional computed tomography (CT) analysis of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) patients to determine volumetric changes in lesions over 5 years. MATERIALS AND METHODS A retrospective case-note review was undertaken to identify 16 patients with histological and radiological features of DIPNECH between 2012-2021. Area and volume were calculated for 17 sets of lesions identified on high-resolution CT. Clinical data were extracted from electronic patient records, which included demographic data, outpatient clinic letters, histology reports, and imaging reports. RESULTS One hundred and twenty-eight lesions were identified in 16 patients (one male, 15 female) and followed-up annually over a median 1,985 days (range 1,450-2,290). At year 1 follow-up, lesion area ranged from 1-48 mm2, and lesion volume ranged from 8-18,380 mm3; lesion area ranged from 1-45mm2 and lesion volume ranged from 11-17,800 mm3 and year 5. Half (8/16) of the patients had concomitant typical carcinoid tumours and one patient had an atypical carcinoid tumour. No statistically significant correlation (p<0.05) was found between lesion cross-sectional area or volume and duration of follow-up (years and days). No metastatic spread was observed at the time of analysis. CONCLUSIONS No significant increase was observed in the size of over 100 lesions in patients with DIPNECH over a 5-year period and no metastasis occurred during the study period affirming the relatively indolent course of the disease.
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Affiliation(s)
- K H Bennett
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - B Y Khor
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - S Hughes
- Department of Nuclear Medicine and Radiology, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK
| | - A J Patel
- Department of Thoracic Surgery, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2WB, UK; Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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4
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Spelman T, Herring WL, Acosta C, Hyde R, Jokubaitis VG, Pucci E, Lugaresi A, Laureys G, Havrdova EK, Horakova D, Izquierdo G, Eichau S, Ozakbas S, Alroughani R, Kalincik T, Duquette P, Girard M, Petersen T, Patti F, Csepany T, Granella F, Grand'Maison F, Ferraro D, Karabudak R, Jose Sa M, Trojano M, van Pesch V, Van Wijmeersch B, Cartechini E, McCombe P, Gerlach O, Spitaleri D, Rozsa C, Hodgkinson S, Bergamaschi R, Gouider R, Soysal A, Castillo-Triviño, Prevost J, Garber J, de Gans K, Ampapa R, Simo M, Sanchez-Menoyo JL, Iuliano G, Sas A, van der Walt A, John N, Gray O, Hughes S, De Luca G, Onofrj M, Buzzard K, Skibina O, Terzi M, Slee M, Solaro C, Oreja-Guevara, Ramo-Tello C, Fragoso Y, Shaygannejad V, Moore F, Rajda C, Aguera Morales E, Butzkueven H. Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom. J Med Econ 2024; 27:109-125. [PMID: 38085684 DOI: 10.1080/13696998.2023.2293379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
AIM To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.
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Affiliation(s)
- T Spelman
- MSBase Foundation, Melbourne, VIC, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - W L Herring
- Health Economics, RTI Health Solutions, NC, USA
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - C Acosta
- Value and Access, Biogen, Baar, Switzerland
| | - R Hyde
- Medical, Biogen, Baar, Switzerland
| | - V G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - E Pucci
- Neurology Unit, AST-Fermo, Fermo, Italy
| | - A Lugaresi
- Dipartamento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - G Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - T Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Duquette
- CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | - T Petersen
- Aarhus University Hospital, Arhus C, Denmark
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico "G Rodloico-San Marco", University of Catania, Italy
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - M Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - M Trojano
- School of Medicine, University of Bari, Bari, Italy
| | - V van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Belgium
| | - B Van Wijmeersch
- University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium
| | | | - P McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - O Gerlach
- Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - C Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - S Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - R Gouider
- Department of Neurology, LR18SP03 and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital -, Mannouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Castillo-Triviño
- Hospital Universitario Donostia and IIS Biodonostia, San Sebastián, Spain
| | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | - J Garber
- Westmead Hospital, Sydney, Australia
| | - K de Gans
- Groene Hart Ziekenhuis, Gouda, Netherlands
| | - R Ampapa
- Nemocnice Jihlava, Jihlava, Czech Republic
| | - M Simo
- Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
| | - J L Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain
- Biocruces-Bizkaia Health Research Institute, Spain
| | - G Iuliano
- Ospedali Riuniti di Salerno, Salerno, Italy
| | - A Sas
- Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary
| | - A van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - N John
- Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - O Gray
- South Eastern HSC Trust, Belfast, United Kingdom
| | - S Hughes
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G De Luca
- MS Centre, Neurology Unit, "SS. Annunziata" University Hospital, University "G. d'Annunzio", Chieti, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - K Buzzard
- Department of Neurosciences, Box Hill Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - O Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - M Slee
- Flinders University, Adelaide, Australia
| | - C Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitation, ML Novarese Hospital Moncrivello
| | - Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
| | - C Ramo-Tello
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Y Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - F Moore
- Department of Neurology, McGill University, Montreal, Canada
| | - C Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - E Aguera Morales
- Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Shan L, Heusinkveld HJ, Paul KC, Hughes S, Darweesh SKL, Bloem BR, Homberg JR. Towards improved screening of toxins for Parkinson's risk. NPJ Parkinsons Dis 2023; 9:169. [PMID: 38114496 PMCID: PMC10730534 DOI: 10.1038/s41531-023-00615-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive and disabling neurodegenerative disorder. The prevalence of PD has risen considerably over the past decades. A growing body of evidence suggest that exposure to environmental toxins, including pesticides, solvents and heavy metals (collectively called toxins), is at least in part responsible for this rapid growth. It is worrying that the current screening procedures being applied internationally to test for possible neurotoxicity of specific compounds offer inadequate insights into the risk of developing PD in humans. Improved screening procedures are therefore urgently needed. Our review first substantiates current evidence on the relation between exposure to environmental toxins and the risk of developing PD. We subsequently propose to replace the current standard toxin screening by a well-controlled multi-tier toxin screening involving the following steps: in silico studies (tier 1) followed by in vitro tests (tier 2), aiming to prioritize agents with human relevant routes of exposure. More in depth studies can be undertaken in tier 3, with whole-organism (in)vertebrate models. Tier 4 has a dedicated focus on cell loss in the substantia nigra and on the presumed mechanisms of neurotoxicity in rodent models, which are required to confirm or refute the possible neurotoxicity of any individual compound. This improved screening procedure should not only evaluate new pesticides that seek access to the market, but also critically assess all pesticides that are being used today, acknowledging that none of these has ever been proven to be safe from a perspective of PD. Importantly, the improved screening procedures should not just assess the neurotoxic risk of isolated compounds, but should also specifically look at the cumulative risk conveyed by exposure to commonly used combinations of pesticides (cocktails). The worldwide implementation of such an improved screening procedure, would be an essential step for policy makers and governments to recognize PD-related environmental risk factors.
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Affiliation(s)
- Ling Shan
- Department Neuropsychiatric Disorders, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
| | - Harm J Heusinkveld
- Centre for Health Protection, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Kimberly C Paul
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Samantha Hughes
- A-LIFE Amsterdam Institute for Life and Environment, Section Environmental Health and Toxicology, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Judith R Homberg
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Harris M, Crone D, Hughes S. Factors That Help and Hinder the Implementation of Community-Wide Behavior Change Programs. Health Promot Pract 2023:15248399231172760. [PMID: 37165856 DOI: 10.1177/15248399231172760] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Novel community-wide approaches that gamify physical activity through challenges and competition have become increasingly popular in recent years. However, little is known about the factors that help or hinder their implementation. This qualitative study aimed to address this gap in the literature by systematically investigating the facilitators (organizational and experiential) and barriers to successful implementation of a community-wide intervention delivered in Gloucester, the United Kingdom. A two-phased process evaluation was conducted. Phase 1 involved the thematical analysis of open question feedback from n = 289 adults. Phase 2 included three focus groups conducted with n = 12 participants. This research showed that promoting the initiative through primary education settings was fundamental to enhancing awareness and participation. Social elements of the intervention were identified as a motivating factor for, and a consequential outcome of, participation. A lack of promotion to wider-reaching proportions of the community was perceived to be a significant barrier to implementation, potentially limiting inclusivity and participation in the activity. Game dynamics, timing, and fears regarding sustainability represented further difficulties to implementation.
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Affiliation(s)
- Marc Harris
- Cardiff Metropolitan University, Cardiff, UK
| | - Diane Crone
- Cardiff Metropolitan University, Cardiff, UK
| | - Samantha Hughes
- University of Gloucestershire, Cheltenham, Gloucestershire, UK
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7
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Dijkman HB, Slaats I, Hughes S. Exposure to silicone breast implant-infused media is detrimental to Caenorhabditis elegans. MicroPubl Biol 2023; 2023:10.17912/micropub.biology.000732. [PMID: 36855740 PMCID: PMC9968400 DOI: 10.17912/micropub.biology.000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/20/2023] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
Women are raising concerns about breast implant illness (BII), a collective term for a range of symptoms attributed to gel bleed. To study this, Caenorhabditis elegans was exposed to increasing duration of gel bleed from silicone breast implants (SBI) and the impact on health parameters observed. SBI exposure results in a slight reduction in total brood size with the progeny having impaired mobility. Nematodes displayed stress characteristics and silicones were detected inside the animals, suggesting silicone uptake after exposure to SBI. Our data highlights the need for more investigations into the mechanisms and pathways impacted by SBI.
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Affiliation(s)
| | - Inca Slaats
- HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Samantha Hughes
- Amsterdam Institute for Life and Environment, Environmental Health and Toxicology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
,
Correspondence to: Samantha Hughes (
)
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8
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Solovyeva O, Dimairo M, Weir C, de Bono J, Bedding A, Chan AW, Espinasse A, Evans T, Hee S, Hopewell S, Hughes S, Jaki T, Kightley A, Lee S, Mander A, Patel D, Rantell K, Rekowski J, Ursino M, Yap C. 79MO Developing international consensus-driven SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: The DEFINE (DosE FIndiNg Extensions) study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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McKeeby JW, Siwy CM, Southers J, Newcomer DA, Hughes S, Sano JM, Patel JJ, Kanthan F, Farinre M, Brose MM, Anderson RV, Chan J, Bailin H, Bell MR, McLamb JS, Novak S, House DJ, Sparks MJ, Nansel M, Carlson SD, Liu Y, Stephens C, Tsui E, Coffey PS, McCormick-Ell J. Establishing a Health Information Technology for the Vaccination of National Institutes of Health Staff. Appl Biosaf 2022; 27:231-236. [PMID: 37020568 PMCID: PMC10068668 DOI: 10.1089/apb.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction Healthcare organizations faced unique operational challenges during the COVID-19 pandemic. Assuring the safety of both patients and healthcare workers in hospitals has been the primary focus during the COVID-19 pandemic. Methods The NIH Vaccine Program (VP) with the Vaccine Management System (VMS) was created based on the commitment of NIH leadership, program leadership, the development team, and the program team; defining Key Performance Indicators (KPIs) of the VP and the VMS; and the NIH Clinical Center's (NIH CC) interdisciplinary approach to deploying the VMS. Results This article discusses the NIH business requirements of the VP and VMS, the target KPIs of the VP and the VMS, and the NIH CC interdisciplinary approach to deploying an organizational VMS for vaccinating the NIH workforce. The use of the DCRI Spiral-Agile Software Development Life Cycle enabled the development of a system with stakeholder involvement that could quickly adapt to changing requirements meeting the defined KPIs for the program and system. The assessment of the defined KPIs through a survey and comments from the survey support that the VP and VMS were successful. Conclusion A comprehensive program to maintain a healthy workforce includes asymptomatic COVID testing, symptomatic COVID testing, contact tracing, vaccinations, and policy-driven education. The need to develop systems during the pandemic resulted in changes to build software quickly with the input of many more users and stakeholders then typical in a decreased amount of time.
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Affiliation(s)
- Jon Walter McKeeby
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Christopher M. Siwy
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Jordan Southers
- NIH Office of Research Services (ORS), Division of Emergency Management (DEM), NIH, Bethesda, Maryland, USA
| | - Derek A. Newcomer
- NIH Office of Research Services (ORS), Division of Occupational Health and Safety (DOHS), NIH, Bethesda, Maryland, USA
| | - Samantha Hughes
- NIH Office of Research Services (ORS), Division of Emergency Management (DEM), NIH, Bethesda, Maryland, USA
| | - Jeffery M. Sano
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Jharana J. Patel
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Falguni Kanthan
- NIH CC Department of Pharmacy, NIH CC, Bethesda, Maryland, USA
| | - Marilyn Farinre
- NIH CC Department of Pharmacy, NIH CC, Bethesda, Maryland, USA
| | - Megan Morgan Brose
- NIH National Institute of Allergy and Infectious Diseases Rocky Mountain Labs (NIAID-RML), NIH, Hamilton, Montana, USA
| | - Rebecca V. Anderson
- NIH National Institute of Allergy and Infectious Diseases Rocky Mountain Labs (NIAID-RML), NIH, Hamilton, Montana, USA
| | - Judy Chan
- NIH Office of Research Services (ORS), Division of Occupational Health and Safety (DOHS), NIH, Bethesda, Maryland, USA
| | - Heike Bailin
- NIH Office of Research Services (ORS), Division of Occupational Health and Safety (DOHS), NIH, Bethesda, Maryland, USA
| | - Michael R. Bell
- NIH Office of Research Services (ORS), Division of Occupational Health and Safety (DOHS), NIH, Bethesda, Maryland, USA
| | - John S. McLamb
- NIH National Institute of Environmental Health Sciences, NIH, Raleigh, North Carolina, USA
| | - Stephen Novak
- NIH National Institute of Environmental Health Sciences, NIH, Raleigh, North Carolina, USA
| | - Dennis J. House
- NIH Office of Research Services (ORS), Division of Occupational Health and Safety (DOHS), NIH, Bethesda, Maryland, USA
| | - Mary J. Sparks
- NIH CC Office of Patient Safety and Clinical Quality, NIH CC, Bethesda, Maryland, USA
| | - Michael Nansel
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Seth D. Carlson
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Yenshei Liu
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Cory Stephens
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Erin Tsui
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Patricia S. Coffey
- NIH CC Department of Clinical Research Informatics (DCRI), NIH CC, Bethesda, Maryland, USA
| | - Jessica McCormick-Ell
- NIH Office of Research Services (ORS), Division of Occupational Health and Safety (DOHS), NIH, Bethesda, Maryland, USA
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Kinsella EL, Muldoon OT, Lemon S, Stonebridge N, Hughes S, Sumner RC. In it together?: Exploring solidarity with frontline workers in the United Kingdom and Ireland during COVID-19. Br J Soc Psychol 2022; 62:241-263. [PMID: 36097335 PMCID: PMC9538398 DOI: 10.1111/bjso.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The phrase 'in it together' has been used liberally since the outbreak of COVID-19, but the extent that frontline workers felt 'in it together' is not well understood. Here, we consider the factors that built (or eroded) solidarity while working through the pandemic, and how frontline workers navigated their lives through periods of disconnection. Semi-structured interviews with 21 frontline workers, across all sectors, were conducted in the United Kingdom and Ireland. The qualitative data were analysed systematically using reflexive thematic analysis. The three themes identified in the data were: (1) Solidarity as central to frontline experiences; (2) Leadership as absent, shallow and divisive: highlighting 'us-them' distinctions and (3) The rise of 'us' and 'we' among colleagues. Our research offers insights into how frontline workers make sense of their experiences of solidarity and discordance during the first year of the COVID-19 pandemic, with relevance for government and organizational policy-makers shaping future conditions for frontline workers.
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Affiliation(s)
- Elaine L. Kinsella
- Department of Psychology, Centre for Social Issues ResearchUniversity of LimerickLimerickIreland
| | - Orla T. Muldoon
- Department of Psychology, Centre for Social Issues ResearchUniversity of LimerickLimerickIreland
| | - Sarah Lemon
- Department of Psychological SciencesUniversity of GloucestershireCheltenhamUK
| | - Natasha Stonebridge
- Department of Psychological SciencesUniversity of GloucestershireCheltenhamUK
| | - Samantha Hughes
- Department of Psychological SciencesUniversity of GloucestershireCheltenhamUK
| | - Rachel C. Sumner
- Health and Human Performance Global AcademyCardiff Metropolitan UniversityCardiffUK
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11
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van Boxel J, Darraz O, van Duursen M, Lamoree M, Hughes S. P06-06 Toxicological effects of polystyrene nanoparticles on the nematode Caenorhabditis elegans: A predictive model for human toxicity of microplastics. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.324] [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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12
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Counter C, Owen R, Sinha S, Muthusamy A, Drage M, Callaghan C, Elker D, Harper S, Sutherland A, Van Dellen D, Johnson P, Manas D, Shaw J, Forsythe J, Wilson C, Hughes S, Casey J, White S. O007 Pancreas and islet transplantation in the United Kingdom during the COVID-19 era. Br J Surg 2022; 109:znac242.007. [PMCID: PMC9384530 DOI: 10.1093/bjs/znac242.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction Methods Results Conclusion Take-home message
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Affiliation(s)
| | - R Owen
- NHSBT Pancreas Advisory Group
| | - S Sinha
- NHSBT Pancreas Advisory Group
| | | | - M Drage
- NHSBT Pancreas Advisory Group
| | | | - D Elker
- NHSBT Pancreas Advisory Group
| | | | | | | | | | - D Manas
- NHSBT Pancreas Advisory Group
| | - J Shaw
- NHSBT Pancreas Advisory Group
| | | | | | | | - J Casey
- NHSBT Pancreas Advisory Group
| | - S White
- NHSBT Pancreas Advisory Group
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13
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Ratcliffe H, Tiley KS, Andrews N, Amirthalingam G, Vichos I, Morey E, Douglas NL, Marinou S, Plested E, Aley P, Galiza EP, Faust SN, Hughes S, Murray CS, Roderick M, Shackley F, Oddie SJ, Lees T, Turner DPJ, Raman M, Owens S, Turner P, Cockerill H, Lopez Bernal J, Linley E, Borrow R, Brown K, Ramsay ME, Voysey M, Snape MD. Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021. Arch Dis Child 2022; 108:archdischild-2022-324375. [PMID: 35858775 PMCID: PMC9887370 DOI: 10.1136/archdischild-2022-324375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER NCT04061382.
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Affiliation(s)
| | - K S Tiley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Health Protection Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - I Vichos
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - E Morey
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - N L Douglas
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - S Marinou
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma Plested
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder Aley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eva P Galiza
- St George's Vaccine Institute, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Saul N Faust
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Hughes
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Clare S Murray
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Respiratory Group, University of Manchester, Manchester, UK
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Fiona Shackley
- Immunology, Allergy and Infectious Diseases, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sam J Oddie
- Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - Tim Lees
- Paediatric Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D P J Turner
- School of Life Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Raman
- Department of Paediatrics, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Turner
- Section of Paediatrics, Imperial College London, London, UK
| | - H Cockerill
- Department of Paediatrics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK
| | - J Lopez Bernal
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - E Linley
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Kevin Brown
- Virus Reference Department, Public Health England, Colindale, UK
| | - Mary Elizabeth Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - M Voysey
- Department of Paediatrics, University of Oxford, Oxford, UK
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Smith E, Hegde G, Czyz M, Hughes S, Haleem S, Grainger M, James SL, Botchu R. A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know? Indian J Radiol Imaging 2022; 32:205-212. [PMID: 35924121 PMCID: PMC9340175 DOI: 10.1055/s-0042-1744162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
AbstractEn bloc resection in the spine is performed for both primary and metastatic bone lesions and has been proven to lengthen disease-free survival and decrease the likelihood of local recurrence. It is a complex procedure, which requires a thorough multi-disciplinary approach. This article will discuss the role of the radiologist in characterizing the underlying tumor pathology, staging the tumor and helping to predict possible intraoperative challenges for en bloc resection of primary bone lesions. The postoperative appearances and complications following en bloc resection in the spine will be considered in subsequent articles.
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Affiliation(s)
- E. Smith
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - G. Hegde
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M. Czyz
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. Hughes
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. Haleem
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M. Grainger
- Department of Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S. L. James
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - R. Botchu
- Department of Musculoskeletal Imaging, Royal Orthopaedic Hospital, Birmingham, United Kingdom
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15
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McKee JD, Spence RW, Hughes S, Gray O, Campbell J, Droogan A, McDonnell GV. 094 Measuring neutralising antibodies (NAbs) to interferon-beta (IFNB) for multiple sclerosis (MS): a neglected practice? J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.419] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveTo determine frequency of testing for NAbs to IFNB in our MS population and adherence to international (EFNS) guidelines.BackgroundIFNB was the first approved MS disease modifying therapy (DMT). NAbs diminish efficacy regarding relapse rate, lesion load and disease progression.MethodsIn August 2019, the Northern Ireland (NI) DMT database was interrogated for patients currently or previously receiving IFNB. The NI Electronic Care Record and regional laboratory database were reviewed to verify if NAb testing ever undertaken, results, outcomes of positive results and reasons for treatment cessation.Results488 patients were currently on IFNB, 21.6% of the DMT population (IFNB1a intramuscularly - 210, pegylated IFNB1a - 71, IFNB1a subcutaneously - 175, IFNB1b subcutaneously - 32). Overall, 20.1% had NAbs checked (11.2% positive). Additionally, 288 patients had ceased treatment in the past 13 years, 273 having available records, 32 (11.7%) with NAb testing including 7 (21.9%) testing positive. 62/273 patients had discontinued due to relapse or disease progression - only 9 (14.5%) of these had ever had NAbs checked.ConclusionsThese data suggest that guidelines are poorly observed in this population. Improved testing could identify potential treatment failures earlier, avoiding adverse outcomes and facilitating more effective DMT decision making.jonmckee@doctors.org.uk72
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16
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Englezou C, Hayton T, Chelvarajah R, Hughes S, Sawlani V, Shirley C, McCorry D. 154 Crossed cerebellar diaschisis in refractory epilepsy. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.183] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCrossed cerebellar diaschisis is the unilateral depression in functional activity of the cerebel- lar hemisphere, caused by a controlateral supratentorial lesion. The phenomenon arises from disruption of neuronal connections between the cerebrum and the cerebellum.Case reportWe present the case of a 42 year old woman with refractory epilepsy since early childhood. Her epilepsy is characterised by focal seizures with no impairment of awareness, and bilateral tonic- clonic seizures. She is currently on triple therapy with topiramate, gabapentin, and lacosamide. Seizure frequency varies with events occurring at least twice a week. MRI brain showed left mesial sclerosis, and PET CT demonstrated marked reduction in glucose uptake in the left temporal lobe, as well as reduction in uptake in the right cerebellar hemisphere. Scalp videotelemetry captured her events and demonstrated onset from the left fronto-temporal region.DiscussionThe epileptogenic focus was localised to the left fronto-temporal region. The PET CT demon- strated the phenomenon of crossed cerebellar diaschisis. It has been said that the phenomenon shows reversibility, but it is a poor prognostic factor, and it could result in cerebellar atrophy.englezou.chr@gmail.com
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17
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Hughes S, van de Klashorst D, Veltri CA, Grundmann O. Acute, Sublethal, and Developmental Toxicity of Kratom ( Mitragyna speciosa Korth.) Leaf Preparations on Caenorhabditis elegans as an Invertebrate Model for Human Exposure. Int J Environ Res Public Health 2022; 19:6294. [PMID: 35627831 PMCID: PMC9140534 DOI: 10.3390/ijerph19106294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022]
Abstract
Kratom (Mitragyna speciosa Korth.) is a tree native to Southeast Asia with stimulant and opioid-like effects which has seen increased use in Europe and North America in recent years. Its safety and pharmacological effects remain under investigation, especially in regard to developmental and generational toxicity. In the current study, we investigated commercial kratom preparations using the nematode Caenorhabditis elegans as a translational model for toxicity and pharmacological effects. The pure alkaloids mitragynine and 7-hydroxymitragynine as well as aqueous, ethanolic, and methanolic extracts of three commercial kratom products were evaluated using a battery of developmental, genotoxic, and opioid-related experiments. As determined previously, the mitragynine and 7-hydroxymitragynine content in kratom samples was higher in the alcoholic extracts than the aqueous extracts. Above the human consumption range equivalent of 15-70 µg/mL, kratom dose-dependently reduced brood size and health of parent worms and their progeny. 7-hydroxymitragynine, but not mitragynine, presented with toxic and developmental effects at very high concentrations, while the positive control, morphine, displayed toxic effects at 0.5 mM. Kratom and its alkaloids did not affect pumping rate or interpump interval in the same way as morphine, suggesting that kratom is unlikely to act primarily via the opioid-signalling pathway. Only at very high doses did kratom cause developmental and genotoxic effects in nematodes, indicating its relative safety.
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Affiliation(s)
- Samantha Hughes
- A-LIFE Amsterdam Institute for Life and Environment, Section Environmental Health and Toxicology, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | | | - Charles A. Veltri
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, AZ 85308, USA;
| | - Oliver Grundmann
- Department of Pharmaceutical Sciences, College of Pharmacy, Midwestern University, Glendale, AZ 85308, USA;
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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Khanra D, Calvert P, Wright P, Hughes S, Mahida S, Hall M, Todd D, Gupta D, Luther V. Differentiating border-zone tissue from post-infarct scar using ripple mapping during VT ablation. Europace 2022. [DOI: 10.1093/europace/euac053.352] [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.
Background
Areas of post-infarct ventricular scar and border-zone slow conduction are often highlighted on a bipolar voltage map with generalized values 0.5mV–1.5mV. The true voltage that differentiates regions of conducting from non-conducting tissue is unknown. Ripple Mapping (RM)displays allows conducting tissue to be seen as areas supporting Ripple activation, and non-conducting tissue as areas devoid of Ripple activation.
Purpose
We describe application of Ripple Maps to differentiate areas of scar from conducting tissue during ischemic VT ablation.
Methods
Dense bipolar voltage maps were created (Pentaray catheter, pacing 80-100bpm) and presented as a single value (e.g. 0.5mV-0.5mV) to binarize the color display (red and purple). RMs were superimposed on the voltage map and played above a pre-set noise threshold (>0.05mV). The voltage map mV limit was sequentially reduced ("border-zone threshold") until only those areas devoid of Ripple bars appeared red. The surrounding border-zone supporting ripple activation thus appeared purple. We performed off-line analysis of border-zone voltage thresholds from a series of RM guided VT ablations.
Results
10 consecutive patients (LVEF 32.3±7.5%) with remote myocardial infarction underwent VT ablation (median 19days (IQR 8-33) since last VT). Bipolar voltage mapping (5873±2841 points, median shell area 224cm2), revealed voltages<0.5mV covered a median 11% (IQR 7-17%) of the shell. The border-zone voltage threshold was median 0.2mV (range 0.12mV - 0.3mV). Non-conducting tissue below this value covered only median 5% (IQR 3-7%) of the entire shell. VT was mappable in 4 patients, and the isthmus was bordered by tissue below the same border-zone threshold as found in normal rhythm. The border-zone was homogenized with ablation(40-50W, median 29 mins (IQR 22-33), and clinical VT was non-inducible in all, and 9 pts (91%) remain sustained VT-free at median 90-day follow-up (IQR 23-139), 2-weeks blanking period).
Picture 1 presents an infero-lateral LV infarct collected in an RV paced rhythm (7340points) and displayed at conventional bipolar voltage settings 0.5-1.5mV. Tissue with voltages<0.5mV appear red and cover 30% of the total area. In this case, this border-zone voltage threshold was defined as 0.25mV. Non-conducting tissue, seen as areas devoid of ripple bars below this value, now appeared as red, and covered only 11% of the total area. Picture 2 demonstrates the morphologies of 4 poorly tolerated induced VTs during this case. Each had near perfect pacemaps to the exit sites of border-zone tissue defined using this approach, and were targets for ablation resulting in complete non-inducibility and no VT recurrence in early follow-up.
Conclusion
The bipolar voltage that differentiates putative scar from bordering conducting tissue is unique to each patient, and far lower than 0.5mV-1.5mV. RM presents a practical approach to visualize the border-zone activation to guide ablation.
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Affiliation(s)
- D Khanra
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - P Calvert
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - P Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Mahida
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Hall
- 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
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - V Luther
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Elumalai T, Portner R, Mariam N, Young T, Hughes S, Wickramasinghe K, Bhana R, Jayaprakash K, Sabar M, Hudson A, Hoskin P, Mistry H, Choudhury A. MO-0555 Radiotherapy for node-positive prostate cancer correlates with improved survival. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hughes S, van Dop M, Kolsters N, van de Klashorst D, Pogosova A, Rijs AM. Using a Caenorhabditis elegans Parkinson's Disease Model to Assess Disease Progression and Therapy Efficiency. Pharmaceuticals (Basel) 2022; 15:512. [PMID: 35631338 PMCID: PMC9143865 DOI: 10.3390/ph15050512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/12/2022] Open
Abstract
Despite Parkinson's Disease (PD) being the second most common neurodegenerative disease, treatment options are limited. Consequently, there is an urgent need to identify and screen new therapeutic compounds that slow or reverse the pathology of PD. Unfortunately, few new therapeutics are being produced, partly due to the low throughput and/or poor predictability of the currently used model organisms and in vivo screening methods. Our objective was to develop a simple and affordable platform for drug screening utilizing the nematode Caenorhabditis elegans. The effect of Levodopa, the "Gold standard" of PD treatment, was explored in nematodes expressing the disease-causing α-synuclein protein. We focused on two key hallmarks of PD: plaque formation and mobility. Exposure to Levodopa ameliorated the mobility defect in C. elegans, similar to people living with PD who take the drug. Further, long-term Levodopa exposure was not detrimental to lifespan. This C. elegans-based method was used to screen a selection of small-molecule drugs for an impact on α-synuclein aggregation and mobility, identifying several promising compounds worthy of further investigation, most notably Ambroxol. The simple methodology means it can be adopted in many labs to pre-screen candidate compounds for a positive impact on disease progression.
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Affiliation(s)
- Samantha Hughes
- HAN BioCentre, HAN University of Applied Sciences, Laan van Scheut 2, 6525 EM Nijmegen, The Netherlands; (M.v.D.); (N.K.); (D.v.d.K.); (A.P.)
- A-LIFE Amsterdam Institute for Life and Environment, Section Environmental Health and Toxicology, Vrije Univeristeit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Maritza van Dop
- HAN BioCentre, HAN University of Applied Sciences, Laan van Scheut 2, 6525 EM Nijmegen, The Netherlands; (M.v.D.); (N.K.); (D.v.d.K.); (A.P.)
| | - Nikki Kolsters
- HAN BioCentre, HAN University of Applied Sciences, Laan van Scheut 2, 6525 EM Nijmegen, The Netherlands; (M.v.D.); (N.K.); (D.v.d.K.); (A.P.)
| | - David van de Klashorst
- HAN BioCentre, HAN University of Applied Sciences, Laan van Scheut 2, 6525 EM Nijmegen, The Netherlands; (M.v.D.); (N.K.); (D.v.d.K.); (A.P.)
| | - Anastasia Pogosova
- HAN BioCentre, HAN University of Applied Sciences, Laan van Scheut 2, 6525 EM Nijmegen, The Netherlands; (M.v.D.); (N.K.); (D.v.d.K.); (A.P.)
| | - Anouk M. Rijs
- Division of BioAnalytical Chemistry, AIMMS Amsterdam Institute of Molecular and Life Sciences, Vrije Univeristeit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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21
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Harris M, Crone D, Hughes S, Bird W. Creating a social movement to engage communities in physical activity: A mixed methods study of motivations to engagement. PLoS One 2022; 17:e0263414. [PMID: 35143546 PMCID: PMC8830723 DOI: 10.1371/journal.pone.0263414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Throughout the world social isolation and loneliness are common and both have several adverse impacts on health and wellbeing. We are designed to live in close-knit communities and we thrive in close co-operation, however, modern life isolates us from others. To reduce the burden of loneliness and social isolation we need to find strategies to reconnect people to each other, their place and provide a common purpose. Social movements aim to create healthier communities by connecting people to each other and giving people a common purpose. Interventions which create a social movement appear to be effective at engaging substantial portions of a community, however, it remains unclear why individuals are attracted to these initiatives, and if such reasons differ by sociodemographic characteristics. This study combined qualitative and quantitative methods to understand what motivated (different) people to take part in a social movement based intervention. This study suggests that it is not one but a combination of reasons people engage in interventions of this nature. This diversity needs to be acknowledged when promoting and communicating these interventions to potential participants to maximise engagement. Promoting an end reward or health/fitness may not be the most effective way to promote interventions to a large proportion of people. Instead, communications should be centred around what people value (i.e., being with their friends, doing what they enjoy and are good at).
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Affiliation(s)
- Marc Harris
- Cardiff Metropolitan University, Cardiff, England
- Intelligent Health, Waltham Cross, England
- * E-mail:
| | - Diane Crone
- Cardiff Metropolitan University, Cardiff, England
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22
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Howells RL, Lamont SG, McGuire TM, Hughes S, Borrows R, Fairley G, Feron LJL, Greenwood RDR, Lenz E, Grant E, Simpson I. Synthesis of Novel Pyrazine-Substituted 1H-Pyrrole-2-carboxamides and Related Tethered Heterocycles. SYNTHESIS-STUTTGART 2022. [DOI: 10.1055/s-0040-1719873] [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: 10/19/2022]
Abstract
AbstractAs part of a drug discovery program, 4-pyrazin-2-yl-1H-pyrrole-2-carboxamides were accessed along with a number of bicyclic analogues. Routes to these compounds were largely absent from the scientific literature. The synthesis of a 4-(pyrazin-2-yl)-1H-pyrrole-2-carboxamide and several fused bicyclic analogues all using standard procedures (SNAr, borylation, C–C cross couplings, hydrolysis, amide bond formation, cyclisation, halogenation, and alkylation) from readily available starting materials is reported. The synthetic sequences range from 4–12 steps per final compound, with yields of isolated intermediates ranging from 20 to ∼100%.
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23
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Hughes S, Kolsters N, van de Klashorst D, Kreuter E, Berger Büter K. An extract of Rosaceae, Solanaceae and Zingiberaceae increases health span and mobility in Caenorhabditis elegans. BMC Nutr 2022; 8:5. [PMID: 35027085 PMCID: PMC8756710 DOI: 10.1186/s40795-022-00498-8] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022] Open
Abstract
Background Members of the Rosaceae, Solanaceae and Zingiberaceae families which include fruits such as cherries, tomatoes and ginger are known to have health promoting effects. There is growing interest in consuming these “functional foods” as a means to increase health and healthy ageing. However, many studies explore the effect of these foods in isolation, not as a blend of multiple functional foods. Methods In this study, an extract containing the dried berries, fruits, and roots of members of these families was prepared, which we called Bioact®180. The nematode Caenorhabditis elegans was used to evaluate the effects of Bioact®180 on lifespan and health endpoints, including muscle and mitochondria structure and locomotion. Results Exposure to the 1000 µg/mL of Bioact®180 extract, containing 4% total phenols, were healthier, as observed by an increase in mean lifespan with and small but significant increase in maximal lifespan. Nematodes exposed to Bioact®180 displayed better mobility in mid-life stages as well as enhanced mitochondrial morphology, which was more comparable to younger animals, suggesting that these worms are protected to some degree from sarcopenia. Conclusions Together, our findings reveal that Bioact®180, a blend of fruits and roots from Rosaceae, Solanaceae and Zingiberaceae family members has anti-aging effects. Bioact®180 promotes health and lifespan extension in C. elegans, corresponding to functional improvements in mobility.
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Affiliation(s)
- Samantha Hughes
- BioCentre, HAN University of Applied Sciences, 6525EM, Nijmegen, Netherlands.,Department of Environment and Health, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, Netherlands
| | - Nikki Kolsters
- BioCentre, HAN University of Applied Sciences, 6525EM, Nijmegen, Netherlands
| | | | - Emanuel Kreuter
- Bioactive Botanicals Swiss AG, Emeligarten 6, 8592, Uttwil, Switzerland
| | - Karin Berger Büter
- Bioactive Botanicals Swiss AG, Emeligarten 6, 8592, Uttwil, Switzerland.
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24
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Cheon IS, Li C, Son YM, Goplen NP, Wu Y, Cassmann T, Wang Z, Wei X, Tang J, Li Y, Marlow H, Hughes S, Hammel L, Cox TM, Goddery E, Ayasoufi K, Weiskopf D, Boonyaratanakornkit J, Dong H, Li H, Chakraborty R, Johnson AJ, Edell E, Taylor JJ, Kaplan MH, Sette A, Bartholmai BJ, Kern R, Vassallo R, Sun J. Immune signatures underlying post-acute COVID-19 lung sequelae. Sci Immunol 2021; 6:eabk1741. [PMID: 34591653 DOI: 10.1126/sciimmunol.abk1741] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- I S Cheon
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - C Li
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y M Son
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - N P Goplen
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y Wu
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - T Cassmann
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Z Wang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - X Wei
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - J Tang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - H Marlow
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - S Hughes
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - L Hammel
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - T M Cox
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - E Goddery
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - K Ayasoufi
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - D Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - J Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - H Dong
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - H Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
| | - R Chakraborty
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - A J Johnson
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - E Edell
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - J J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - M H Kaplan
- Department of Microbiology and Immunology, Indiana University of School of Medicine, Indianapolis, IN 46202, USA
| | - A Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA.,Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - B J Bartholmai
- Department of Radiology, Mayo Clinic, Rochester, MN 5590, USA
| | - R Kern
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R Vassallo
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - J Sun
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.,Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA.,Carter Immunology Center, University of Virginia, Charlottesville, VA 22908, USA.,Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
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25
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Hughes S, Andracchio L, Fredkin K. 62: Patients’ greatest needs: A qualitative survey analysis of care team perspectives on greatest needs of patients. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Dowd C, Lomas P, Harris E, Hughes S, Riley M. 65: Care center local collaborations: A survey analysis of care center perspectives on current relationships. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01490-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Amarnani R, Hughes S, Morris-Jones R, Kanwar AJ, Bunker CB. Persistent facial discoid dermatosis successfully treated with topical calcipotriol. Clin Exp Dermatol 2021; 47:229-231. [PMID: 34648653 DOI: 10.1111/ced.14945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- R Amarnani
- Department of, Dermatology, University College London Hospital NHS Foundation Trust, London, UK
| | - S Hughes
- Department of, Histopathology, University College London Hospital NHS Foundation Trust, London, UK
| | - R Morris-Jones
- Department of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - C B Bunker
- Department of, Dermatology, University College London Hospital NHS Foundation Trust, London, UK
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28
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Choudri MJ, Tahir M, Haleem S, Hughes S. 1091 Assessment of Cauda Equina Syndrome Referrals to The Tertiary Spinal Service for Compliance with National Standards. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.122] [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]
Abstract
Abstract
Introduction
Urgent assessment/investigation and appropriate referral of Cauda Equina Syndrome (CES) is important in preventing morbidity and avoiding litigation. A recent GIRFT review outlined a series of guidelines on the management of patients with suspected CES. This audit aimed to assess whether CES referrals to a tertiary spinal service are compliant with GIRFT recommendations and SBNS/BASS guidelines.
Method
Retrospective review of an electronic referral system at a tertiary spinal centre over 4 months, examining CES referrals from surrounding peripheral hospitals. General Practice referrals were excluded. Data collected included patient demographics, symptoms/examination findings, timing of MRI and outcomes of the referral.
Results
A total of 48 referrals were included for analysis, mean age was 46.7 and 64% were female. 27% had no ‘red' or ‘yellow' flag signs/symptoms and were inappropriately referred. Majority did not perform pre/post void bladder scans prior to referring. 58% of all referrals were made without an MRI. 22% of those referred within ‘working hours’ were referred without MRI scan. There were significant variations in time taken to perform MRI at the referring hospital; median delay 11.1 hours (3-21hrs).
Conclusions
SBNS/BASS standards are currently not being met, which may adversely impact patient outcomes. Cost implications of patients being transferred to tertiary spinal centres who are found to have no abnormality, must be balanced against the cost of missed CES. This audit highlights the need for improvement in the quality of referrals through education and training at the referring centres.
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Affiliation(s)
- M J Choudri
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - M Tahir
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S Haleem
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - S Hughes
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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29
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Lithgow K, Venkataraman H, Hughes S, Shah H, Kemp-Blake J, Vickrage S, Smith S, Humphries S, Elshafie M, Taniere P, Diaz-Cano S, Dasari BVM, Almond M, Ford S, Ayuk J, Shetty S, Shah T, Geh I. Well-differentiated gastroenteropancreatic G3 NET: findings from a large single centre cohort. Sci Rep 2021; 11:17947. [PMID: 34504148 PMCID: PMC8429701 DOI: 10.1038/s41598-021-97247-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
Neuroendocrine neoplasms are known to have heterogeneous biological behavior. G3 neuroendocrine tumours (NET G3) are characterized by well-differentiated morphology and Ki67 > 20%. The prognosis of this disease is understood to be intermediate between NET G2 and neuroendocrine carcinoma (NEC). Clinical management of NET G3 is challenging due to limited data to inform treatment strategies. We describe clinical characteristics, treatment, and outcomes in a large single centre cohort of patients with gastroenteropancreatic NET G3. Data was reviewed from 26 cases managed at Queen Elizabeth Hospital, Birmingham, UK, from 2012 to 2019. Most commonly the site of the primary tumour was unknown and majority of cases with identifiable primaries originated in the GI tract. Majority of cases demonstrated somatostatin receptor avidity. Median Ki67 was 30%, and most cases had stage IV disease at diagnosis. Treatment options included surgery, somatostatin analogs (SSA), and chemotherapy with either platinum-based or temozolomide-based regimens. Estimated progression free survival was 4 months following initiation of SSA and 3 months following initiation of chemotherapy. Disease control was observed following treatment in 5/11 patients treated with chemotherapy. Estimated median survival was 19 months; estimated 1 year survival was 60% and estimated 2 year survival was 13%. NET G3 is a heterogeneous group of tumours and patients which commonly have advanced disease at presentation. Prognosis is typically poor, though select cases may respond to treatment with SSA and/or chemotherapy. Further study is needed to compare efficacy of different treatment strategies for this disease.
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Affiliation(s)
- K Lithgow
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada.
| | - H Venkataraman
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Hughes
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Shah
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Kemp-Blake
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Vickrage
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Smith
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Humphries
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Elshafie
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Taniere
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Diaz-Cano
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - B V M Dasari
- Department of Liver Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Almond
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Ford
- Department of General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Ayuk
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Shetty
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Shah
- Department of Liver Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - I Geh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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30
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Mcgaffin S, Taggart M, Smyth D, O"doherty D, Brown J, Teague S, Slevin C, Montgomery L, Coll M, Lindsay C, Crumley B, Gibson L, Elliott H, Hughes S, Connolly S. Transitioning a cardiovascular health and rehabilitation programme to a virtual platform during covid 19. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.073] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Our Hearts Our Minds
Purpose
Can a virtual cardiovascular prevention and rehabilitation programme be as effective as face-to-face programme.
Background
The Our Hearts Our Minds (OHOM) prevention and rehabilitation programme rapidly transitioned to a virtual platform in the covid era. Here we compare if a virtual programme potentially could offer the same standard of the nursing intervention (education, smoking cessation, medical risk factor management and psychosocial health) as the previous face to face programme
Methods
Both the initial assessment (IA) and end of programme (EOP) assessments were conducted via telephone/video as per patient preference. The following measures were recorded at both time points (home blood pressure (BP) monitors were provided)
Smoking (self report) BP/Heart rate, Lipids/HbA1c (facilitated by phlebotomy hub), cardio protective drugs (doses, adherence), Hospital Anxiety and Depression score, EuroQoL
Nursing Intervention Smoking cessation counselling and pharmacotherapy where appropriate
Weekly meeting with cardiologist to optimise BP and lipid management and up titration cardio protective drugs
Bimonthly virtual coaching consultation for monitoring/goal resetting
Bimonthly group video education sessions
Results
From April to November 2020, of the 432 referrals received 400 were eligible with 377 accepting the offer of an IA (94% response rate). 262 have had an IA with the remaining 115 awaiting an assessment date. Of the completed IA’s 257 were willing to attend the programme (98% uptake). 120 had been offered an end of programme assessment with 114 attending (96% of those offered). The results for the virtual programme were then compared to the same period one year previously when the programme was fully face to face and are outlined in the table below.
The comparison of results delivered via remote delivery are remarkably similar to those achieved in the previous year delivered via face to face.
Conclusion
Initial data has shown that virtual delivery of the nursing component of the OHOM prevention/rehabilitation programme was highly acceptable to patients and was as effective as that of the traditional face to face service.
Table 1 below exhibits the clinical and patient-reported outcomes.
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Affiliation(s)
- S Mcgaffin
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - M Taggart
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D Smyth
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - D O"doherty
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - J Brown
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Teague
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - C Slevin
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - L Montgomery
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - M Coll
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - C Lindsay
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - B Crumley
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - L Gibson
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - H Elliott
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Altnagelvin Area Hospital, Our Hearts Our Minds, Londonderry, United Kingdom of Great Britain & Northern Ireland
| | - S Connolly
- South West Acute Hospital, Our Hearts Our Minds, Enniskillen, United Kingdom of Great Britain & Northern Ireland
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31
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Kinsella EL, Hughes S, Lemon S, Stonebridge N, Sumner RC. "We shouldn't waste a good crisis": the lived experience of working on the frontline through the first surge (and beyond) of COVID-19 in the UK and Ireland. Psychol Health 2021; 37:151-177. [PMID: 34187244 DOI: 10.1080/08870446.2021.1928668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Frontline workers have shown extraordinary resilience and sustained efforts since the outbreak of COVID-19. The present study used semi-structured interviews with 38 frontline workers in the UK and Ireland to explore the psychological impact of working through COVID-19. DESIGN The qualitative data were analysed systematically using thematic analysis. RESULTS Four themes were interpreted: 1)) "I've stopped turning the telly on. I've had to because the news was making me ill": An ecosystem of influence; 2) "Dead, dead, dead": The emotional and psychological toll: 3) "It's shone a light on what we're failing on as well": Injustices, hierarchies and heroes: and 4) "I definitely think COVID happened for a reason to stop us in our tracks and to slow us down": Unexpected positives. CONCLUSION This research offers insights into how frontline workers make sense of their experiences during periods of enormous societal and occupational stress. The learnings generated have relevance for government and organisational policy-makers who have opportunities to shape future conditions for frontline workers.
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Affiliation(s)
- Elaine L Kinsella
- Department of Psychology, Centre for Social Issues Research, RISE (Research on Influence, Social networks & Ethics) lab, and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Samantha Hughes
- Department of Psychological Sciences, HERA Lab, University of Gloucestershire, Cheltenham, United Kingdom
| | - Sarah Lemon
- Department of Psychological Sciences, HERA Lab, University of Gloucestershire, Cheltenham, United Kingdom
| | - Natasha Stonebridge
- Department of Psychological Sciences, HERA Lab, University of Gloucestershire, Cheltenham, United Kingdom
| | - Rachel C Sumner
- Department of Psychological Sciences, HERA Lab, University of Gloucestershire, Cheltenham, United Kingdom
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Sumner RC, Crone DM, Baker C, Hughes S, Loughren EA, James DVB. Factors associated with attendance, engagement and wellbeing change in an arts on prescription intervention. J Public Health (Oxf) 2021; 42:e88-e95. [PMID: 30957172 DOI: 10.1093/pubmed/fdz032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 02/01/2019] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Arts on prescription interventions have grown in number in recent years with a corresponding evidence base in support. Despite the growth and presence of these interventions, there have been no evaluations to date as to what factors predict patient success within these referral schemes. METHODS Using the largest cohort of patient data to date in the field (N = 1297), we set out to understand those factors that are associated with attendance, programme engagement and wellbeing change of patients. Factors associated with these outcomes were assessed using three binary logistic regression models. RESULTS Baseline wellbeing was associated with each outcome, with higher baseline wellbeing being associated with attendance and engagement, and lower baseline wellbeing associated with positive wellbeing change. Additionally, deprivation was associated with attendance, with those from the median deprivation quintile being more likely to attend. CONCLUSIONS The role of baseline wellbeing in each outcome of these analyses is the most critical associative factor. Whilst those that are lower in wellbeing have more to gain from these interventions, they are also less likely to attend or engage, meaning they may need additional support in commencing these types of social prescribing interventions.
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Affiliation(s)
- Rachel C Sumner
- School of Natural & Social Sciences, University of Gloucestershire, Gloucestershire, UK
| | - Diane M Crone
- School of Health and Social Care, University of Gloucestershire, Gloucestershire, UK
| | - Colin Baker
- School of Sport and Exercise Science, University of Gloucestershire, Gloucestershire, UK
| | - Samantha Hughes
- School of Health and Social Care, University of Gloucestershire, Gloucestershire, UK
| | - Elizabeth A Loughren
- School of Health and Social Care, University of Gloucestershire, Gloucestershire, UK
| | - David V B James
- School of Sport and Exercise Science, University of Gloucestershire, Gloucestershire, UK
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Jinadu T, Dowd R, Bradley L, Painter E, Hughes S, Ahmad S, Khan N, Khanra D, Arya A, Selvakumar V, Spencer C, Petkar S. Observations during the COVID-19 pandemic in chronic heart failure patients with complex devices in a tertiary care cardiac centre using the HeartLogic software. Europace 2021. [PMCID: PMC8194883 DOI: 10.1093/europace/euab116.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Decompensation of heart failure leading (HF) to hospitalisation is the single most important drain on healthcare resources when managing patients with left ventricular systolic dysfunction. Cardiac resynchronisation therapy with/without defibrillators (CRT-P/D) decreases hospitalisation due to HF and improves survival while implantable cardiac defibrillators (ICD"s) have a favourable effect on the former. Proprietary software algorithms embedded in these complex devices give an early warning to clinicians when decompensation of HF is imminent allowing preventative action to be undertaken. HeartLogic (HL) is one such new algorithm in Boston Scientific CRT-D/ICD devices using multiple sensors to track 5 physiological parameters, combining them into one composite Index, with an Alert being triggered if the Index is >16. The COVID-19 pandemic, due to multiple reasons, resulted in a significant decrease in availability of routine HF services in the United Kingdom, especially during the initial lockdown period from 23rd March to 1st July 2020. Aim To assess the impact of the COVID-19 pandemic, using HL, in patients with HF and complex devices. Materials and Methods Retrospective analysis of patients in a tertiary care cardiac centre in whom the HL software had been activated in March/April 2019 (n = 49) and comparison of those with (Group A n = 21) and without (Group B n = 28) an Alert (HLA) during the COVID-19 pandemic. Results (Table): Whole cohort n = 49. Age: 72 ± 12 years, Median: 75, Range: 36-95. 36/49 (73.5%) males. Type of device implanted: Resonate X4 CRT-D: 28/49 (57.1%); Momentum CRT-D: 8/49 (16.3%); Resonate ICD: 13/49 (26.5%). Ischaemic aetiology of HF: 35/49 (71.4%), Total duration of HL monitoring: 632 ± 7 days (median: 632; range: 626-672). There was no difference in the age, gender, and type of device implanted between Group A and Group B. Over nearly ∼1 year of monitoring in each of the groups, Group A had more unstable HF with 10/21 (47.6%) having their first HLA during the pandemic. Multiple HLA"s, longer period in HLA and those with ischaemic aetiology of HF were higher in Group A. 17/40 (42.5%) HLA"s in Group A were within the first lockdown period (March - July). 24/28 (85.7%) patients in Group B had no HLA"s either before or during the pandemic. There was no difference in the HLA score between Groups A and B. Conclusion In this limited group of patients with a medium term follow-up, using the HeartLogic software, patients with ischaemic aetiology of HF and those with more HLA"s prior to the pandemic did worse than those who no HLA"s. First HLA"s, multiple alerts and longer duration of alerts in this group of patients suggests a lack of access to adequate HF services during the pandemic. It has implications with regard to how HF services are configured in future whenever resources are constrained.
Abstract Figure. ![]()
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Affiliation(s)
- T Jinadu
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - R Dowd
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - L Bradley
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - E Painter
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - S Ahmad
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - N Khan
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - D Khanra
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - A Arya
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - V Selvakumar
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - C Spencer
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
| | - S Petkar
- New Cross Hospital, Wolverhampton, United Kingdom of Great Britain & Northern Ireland
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Garner D, Leung WY, Llewellyn J, Goode R, Lunt L, Hughes S, Kahn M, Wright DJ, Rao A. CIED guided HF management : a prospective cohort study. Europace 2021. [DOI: 10.1093/europace/euab116.473] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Liverpool Clinical Commissioning Group
Background
Heart failure (HF) is associated with significant morbidity and mortality. (1) Cardiac Implantable Electronic Devices (CIED) generated Heart Failure Risk Score (HFRS) alerts may guide management in this complex cohort and help direct resources to appropriate patients. (2)
Aim
To develop and evaluate an integrated, multidisciplinary approach to HF management for patients with CIED by sharing HFRS alerts directly with the HF teams.
Methods
We undertook a prospective, single centre cohort study of patients who generated high risk HFRS alerts. These alerts were shared with community HF teams responsible for routine care of patient, prompting patient contact and appropriate intervention by the team. Impact of the pathway was evaluated by review of outcomes including hospitalisation and clinical intervention within 4- 6 weeks of the alert and mortality during the follow up period. Ongoing education was provided to help teams deal with alerts. A validated user questionnaire was completed by the stake holders to obtain user feedback.
Results
365 "High risk" alerts were noted in 188 patients in a 2 year period (November 2018 - November 2020). The mean number of alerts per patients was 1.9 and 44 (23%) of patients had >3 "high risk" alerts in the follow up period. Having three or more alerts significantly increased the risk of hospitalisation for heart failure (HR 2.5, CI 1.1–5.6 p = 0.03) but not mortality (HR 2.1 CI 0.6-7.2 p = 0.23). Overall 75 (39%) of patients were hospitalised in the 4-6 week period of the alert – 53 (28%) of these were unplanned of which 24(13%) were for decompensated HF. A further 24(13%) had planned admissions for care to improve therapy (AV node ablation, device and lead replacement) and reduce morbidity (LA appendage occlude, IV Iron therapy). 33(18%) of patients died in the follow up period. 15(8%) received therapy from the device. 18(10%) of patient underwent deactivation of ICD therapy.
Contact was established in 176 (94%) of patients, and alerts actioned appropriately. 55 patients reported being asymptomatic, and in 45 the trends were improving so no further clinical action was taken. 76 patients had an onward referral made for further management including; 32 to a Cardiologist, 20 to primary care, 13 referrals to community HF teams and 11 referrals to palliative care. 23 patients had medications changes instituted. The feedback on the pathway was positive.
Conclusions
An integrated approach to HF for patients with CIEDs in situ can facilitate timely risk stratification and intervention in this cohort of patients and potentially reduce unplanned health care utilisation. Intervention in these patients is not limited to HF alone and provides the opportunity for holistic management of this complex cohort Abstract Figure.
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Affiliation(s)
- D Garner
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - WY Leung
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Llewellyn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Goode
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - L Lunt
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DJ Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Marlin D, Martin H, Hughes S, Williams J. Stirrup forces during approach, take-off and landing in horses jumping 70 cm. Comparative Exercise Physiology 2021. [DOI: 10.3920/cep200056] [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: 11/19/2022]
Abstract
Stirrups aid the rider to stabilise their lower leg allowing it to be used effectively for communication and in maintaining their position in the saddle. Relatively few studies have investigated stirrup forces and to the best our knowledge no studies have reported stirrup forces in jumping. The aim of the present study was to measure stirrup forces in five showjumping horses ridden by the same professional rider. All horses were in regular training and competition jumping at least 30 cm higher than the fence used for the study. The fence chosen was a 70 cm upright with a pole at the top and a groundline. Right and left stirrup forces were measured using wireless load cells placed between the stirrup leathers and the stirrup. The signals were transmitted and digitised at 100 Hz and synchronised with video from a webcam using an inertial measurement unit. After warming-up, including over jumps, each horse attempted the jump three times from each rein in canter (3 horses left then right rein; 2 horses right then left rein). Mean peak total (sum of left and right) stirrup force for the approach (n=5 strides per horse per jump), take-off and landing phase of the jump was 1,034±110, 1,042±284 and 1,447±256 N (range 905 to 1,815 N), respectively (mean ± standard deviation). There was no significant difference between right or left mean peak stirrup force during approach or take-off, but mean peak force was consistently higher on the right stirrup during the early phase of landing on either the right or left rein (right: 827±320 N; left: 615±336 N; P<0.05). In conclusion, the mean total peak stirrup forces measured in the present study in the same rider jumping five different horses over a 70 cm single upright fence are similar to previous reports of peak stirrup forces in gallop and consistent with observations of asymmetric loading of the saddle and horses’ backs by riders.
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Affiliation(s)
- D.J. Marlin
- AnimalWeb Ltd, Cambridge, CB4 0WZ, United Kingdom
| | - H.P. Martin
- Higher Durston, Taunton, TA3 5AG, United Kingdom
| | - S. Hughes
- Wilby, Wellingborough, Northants, NN8 2UQ, United Kingdom
| | - J.M. Williams
- Department of Animal Science, Hartpury University, Hartpury, Gloucestershire, Gl19 3BE, United Kingdom
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Ellwood RA, Hewitt JE, Torregrossa R, Philp AM, Hardee JP, Hughes S, van de Klashorst D, Gharahdaghi N, Anupom T, Slade L, Deane CS, Cooke M, Etheridge T, Piasecki M, Antebi A, Lynch GS, Philp A, Vanapalli SA, Whiteman M, Szewczyk NJ. Mitochondrial hydrogen sulfide supplementation improves health in the C. elegans Duchenne muscular dystrophy model. Proc Natl Acad Sci U S A 2021; 118:e2018342118. [PMID: 33627403 PMCID: PMC7936346 DOI: 10.1073/pnas.2018342118] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder characterized by progressive muscle degeneration and weakness due to mutations in the dystrophin gene. The symptoms of DMD share similarities with those of accelerated aging. Recently, hydrogen sulfide (H2S) supplementation has been suggested to modulate the effects of age-related decline in muscle function, and metabolic H2S deficiencies have been implicated in affecting muscle mass in conditions such as phenylketonuria. We therefore evaluated the use of sodium GYY4137 (NaGYY), a H2S-releasing molecule, as a possible approach for DMD treatment. Using the dys-1(eg33) Caenorhabditis elegans DMD model, we found that NaGYY treatment (100 µM) improved movement, strength, gait, and muscle mitochondrial structure, similar to the gold-standard therapeutic treatment, prednisone (370 µM). The health improvements of either treatment required the action of the kinase JNK-1, the transcription factor SKN-1, and the NAD-dependent deacetylase SIR-2.1. The transcription factor DAF-16 was required for the health benefits of NaGYY treatment, but not prednisone treatment. AP39 (100 pM), a mitochondria-targeted H2S compound, also improved movement and strength in the dys-1(eg33) model, further implying that these improvements are mitochondria-based. Additionally, we found a decline in total sulfide and H2S-producing enzymes in dystrophin/utrophin knockout mice. Overall, our results suggest that H2S deficit may contribute to DMD pathology, and rectifying/overcoming the deficit with H2S delivery compounds has potential as a therapeutic approach to DMD treatment.
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MESH Headings
- Animals
- Caenorhabditis elegans/genetics
- Caenorhabditis elegans/metabolism
- Caenorhabditis elegans Proteins/genetics
- Caenorhabditis elegans Proteins/metabolism
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Dystrophin/deficiency
- Dystrophin/genetics
- Forkhead Transcription Factors/genetics
- Forkhead Transcription Factors/metabolism
- Gene Expression Regulation
- Humans
- Hydrogen Sulfide/metabolism
- Hydrogen Sulfide/pharmacology
- Locomotion/drug effects
- Locomotion/genetics
- Male
- Mice
- Mice, Inbred mdx
- Mitochondria, Muscle/drug effects
- Mitochondria, Muscle/metabolism
- Mitochondria, Muscle/pathology
- Mitogen-Activated Protein Kinases/genetics
- Mitogen-Activated Protein Kinases/metabolism
- Morpholines/metabolism
- Morpholines/pharmacology
- Muscle, Skeletal/drug effects
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Muscular Dystrophy, Animal/drug therapy
- Muscular Dystrophy, Animal/genetics
- Muscular Dystrophy, Animal/metabolism
- Muscular Dystrophy, Animal/pathology
- Muscular Dystrophy, Duchenne/drug therapy
- Muscular Dystrophy, Duchenne/genetics
- Muscular Dystrophy, Duchenne/metabolism
- Muscular Dystrophy, Duchenne/pathology
- Organophosphorus Compounds/metabolism
- Organophosphorus Compounds/pharmacology
- Organothiophosphorus Compounds/metabolism
- Organothiophosphorus Compounds/pharmacology
- Prednisone/pharmacology
- Sirtuins/genetics
- Sirtuins/metabolism
- Thiones/metabolism
- Thiones/pharmacology
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Utrophin/deficiency
- Utrophin/genetics
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Affiliation(s)
- Rebecca A Ellwood
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital, University of Nottingham, Derby DE22 3DT, United Kingdom
- Musculoskeletal Conditions, National Institute for Health Research Nottingham Biomedical Research Centre, Derby DE22 3DT, United Kingdom
| | - Jennifer E Hewitt
- Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409
- Molecular Genetics of Ageing, Max Planck Institute for Biology of Ageing, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Roberta Torregrossa
- University of Exeter Medical School, University of Exeter, EX1 2LU Exeter, United Kingdom
| | - Ashleigh M Philp
- Mitochondrial Metabolism and Ageing, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
- St. Vincent's Clinical School, University of New South Wales (UNSW) Medicine, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Justin P Hardee
- Centre for Muscle Research, Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Samantha Hughes
- HAN BioCentre, HAN University of Applied Sciences, Nijmegen 6525EM, The Netherlands
| | | | - Nima Gharahdaghi
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital, University of Nottingham, Derby DE22 3DT, United Kingdom
- Musculoskeletal Conditions, National Institute for Health Research Nottingham Biomedical Research Centre, Derby DE22 3DT, United Kingdom
| | - Taslim Anupom
- Department of Electrical and Computer Engineering, Texas Tech University, Lubbock, TX 79409
| | - Luke Slade
- University of Exeter Medical School, University of Exeter, EX1 2LU Exeter, United Kingdom
- Sport and Health Sciences, University of Exeter, EX1 2LU Exeter, United Kingdom
| | - Colleen S Deane
- Sport and Health Sciences, University of Exeter, EX1 2LU Exeter, United Kingdom
- Living System Institute, University of Exeter, EX4 4QD Exeter, United Kingdom
| | - Michael Cooke
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital, University of Nottingham, Derby DE22 3DT, United Kingdom
- Musculoskeletal Conditions, National Institute for Health Research Nottingham Biomedical Research Centre, Derby DE22 3DT, United Kingdom
- Sport and Health Sciences, University of Exeter, EX1 2LU Exeter, United Kingdom
| | - Timothy Etheridge
- Sport and Health Sciences, University of Exeter, EX1 2LU Exeter, United Kingdom
| | - Mathew Piasecki
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital, University of Nottingham, Derby DE22 3DT, United Kingdom
- Musculoskeletal Conditions, National Institute for Health Research Nottingham Biomedical Research Centre, Derby DE22 3DT, United Kingdom
| | - Adam Antebi
- Molecular Genetics of Ageing, Max Planck Institute for Biology of Ageing, 50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Gordon S Lynch
- Centre for Muscle Research, Department of Anatomy and Physiology, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Andrew Philp
- Mitochondrial Metabolism and Ageing, Garvan Institute of Medical Research, Sydney, NSW 2010, Australia
- St. Vincent's Clinical School, University of New South Wales (UNSW) Medicine, University of New South Wales Sydney, Sydney, NSW 2052, Australia
| | - Siva A Vanapalli
- Department of Chemical Engineering, Texas Tech University, Lubbock, TX 79409
| | - Matthew Whiteman
- University of Exeter Medical School, University of Exeter, EX1 2LU Exeter, United Kingdom;
| | - Nathaniel J Szewczyk
- Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research, Royal Derby Hospital, University of Nottingham, Derby DE22 3DT, United Kingdom;
- Musculoskeletal Conditions, National Institute for Health Research Nottingham Biomedical Research Centre, Derby DE22 3DT, United Kingdom
- Ohio Musculoskeletal and Neurologic Institute, Ohio University, Athens, OH 45701
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701
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Sumner RC, Crone DM, Hughes S, James DVB. Arts on prescription: observed changes in anxiety, depression, and well-being across referral cycles. Public Health 2021; 192:49-55. [PMID: 33631514 DOI: 10.1016/j.puhe.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/07/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Arts on prescription (AoP) interventions are part of mainstream social prescribing provision in primary health care. Whilst the body of evidence for AoP interventions has been developing, this has primarily focused on well-being. STUDY DESIGN The present work is an observational longitudinal study on a community-based AoP social prescribing intervention in the South West UK. METHOD The present study assessed changes in anxiety, depression, and well-being in a cohort of patients participating in up to two eight-week cycles of AoP. The sample consisted of 245 individuals referred into the programme from 2017 to 2019, with a sub-sample of participants (N = 110) with identifiable multimorbidity. Outcomes were measured pre- and post-intervention at both initial and re-referral. RESULTS Anxiety, depression, and well-being were all significantly improved after initial referral, re-referral, and overall from initial to post re-referral for this intervention in the whole sample and multimorbid sub-sample. Multivariate analyses revealed that no participant variables appeared to account for the variance in outcome change scores. CONCLUSION The research provides further support for AoP interventions, finding associations with reduced anxiety and depression and increased well-being. Additionally, these outcomes are evidenced in those with multimorbidity, as well as across initial- and re-referral cycles.
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Affiliation(s)
- R C Sumner
- HERA Lab, School of Natural and Social Sciences, University of Gloucesterhire, Cheltenham, UK.
| | - D M Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - S Hughes
- HERA Lab, School of Natural and Social Sciences, University of Gloucesterhire, Cheltenham, UK
| | - D V B James
- School of Sport and Exercise Science, University of Gloucestershire, Gloucester, UK
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Quarterman C, Shaw M, Hughes S, Wallace V, Agarwal S. Anaemia in cardiac surgery - a retrospective review of a centre's experience with a pre-operative intravenous iron clinic. Anaesthesia 2020; 76:629-638. [PMID: 33150612 DOI: 10.1111/anae.15271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
Pre-operative anaemia is associated with higher rates of transfusion and worse outcomes, including prolonged hospital stay, morbidity and mortality. Iron deficiency is associated with significantly lower haemoglobin levels throughout the peri-operative period and more frequent blood transfusion. Correction of iron stores before surgery forms part of the first pillar of patient blood management. We established a pre-operative anaemia clinic to aid identification and treatment of patients with iron deficiency anaemia scheduled for elective cardiac surgery. We present a retrospective observational review of our experience from January 2017 to December 2019. One-hundred and ninety patients received treatment with intravenous iron, a median of 21 days before cardiac surgery. Of these, 179 had a formal laboratory haemoglobin level measured before surgery, demonstrating a median rise in haemoglobin of 8.0 g.l-1 . Patients treated with i.v. iron demonstrated a significantly higher incidence of transfusion (60%) compared with the non-anaemic cohort (22%) during the same time period, p < 0.001. Significantly higher rates of new requirement for renal replacement therapy (6.7% vs. 0.6%, p < 0.001) and of stroke (3.7% vs. 1.2%, p = 0.010) were also seen in this group compared with those without anaemia, although there was no significant difference in in-hospital mortality (1.6% vs. 0.8%, p = 0.230). In patients where the presenting haemoglobin was less than 130 g.l-1 , but there was no intervention or treatment, there was no difference in rates of transfusion or of complications compared with the anaemic group treated with iron. In patients with proven iron deficiency anaemia, supplementation with intravenous iron showed only a modest effect on haemoglobin and this group still had a significantly higher transfusion requirement than the non-anaemic cohort. Supplementation with intravenous iron did not improve outcomes compared with patients with anaemia who did not receive intravenous iron and did not reduce peri-operative risk to non-anaemic levels. Questions remain regarding identification of patients who will receive most benefit, the use of concomitant treatment with other agents, and the optimum time frames for treatment in order to produce benefit in the real-world setting.
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Affiliation(s)
- C Quarterman
- Department of Anaesthesia, Liverpool Heart and Chest Hospital, UK
| | - M Shaw
- Liverpool Heart and Chest Hospital, UK
| | - S Hughes
- Liverpool Heart and Chest Hospital, UK
| | - V Wallace
- Liverpool Heart and Chest Hospital, UK
| | - S Agarwal
- Department of Anaesthesia, Manchester University NHS Foundation Trust, UK
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Scott JS, Moss TA, Balazs A, Barlaam B, Breed J, Carbajo RJ, Chiarparin E, Davey PRJ, Delpuech O, Fawell S, Fisher DI, Gagrica S, Gangl ET, Grebe T, Greenwood RD, Hande S, Hatoum-Mokdad H, Herlihy K, Hughes S, Hunt TA, Huynh H, Janbon SLM, Johnson T, Kavanagh S, Klinowska T, Lawson M, Lister AS, Marden S, McGinnity DF, Morrow CJ, Nissink JWM, O'Donovan DH, Peng B, Polanski R, Stead DS, Stokes S, Thakur K, Throner SR, Tucker MJ, Varnes J, Wang H, Wilson DM, Wu D, Wu Y, Yang B, Yang W. Discovery of AZD9833, a Potent and Orally Bioavailable Selective Estrogen Receptor Degrader and Antagonist. J Med Chem 2020; 63:14530-14559. [PMID: 32910656 DOI: 10.1021/acs.jmedchem.0c01163] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Herein we report the optimization of a series of tricyclic indazoles as selective estrogen receptor degraders (SERD) and antagonists for the treatment of ER+ breast cancer. Structure based design together with systematic investigation of each region of the molecular architecture led to the identification of N-[1-(3-fluoropropyl)azetidin-3-yl]-6-[(6S,8R)-8-methyl-7-(2,2,2-trifluoroethyl)-6,7,8,9-tetrahydro-3H-pyrazolo[4,3-f]isoquinolin-6-yl]pyridin-3-amine (28). This compound was demonstrated to be a highly potent SERD that showed a pharmacological profile comparable to fulvestrant in its ability to degrade ERα in both MCF-7 and CAMA-1 cell lines. A stringent control of lipophilicity ensured that 28 had favorable physicochemical and preclinical pharmacokinetic properties for oral administration. This, combined with demonstration of potent in vivo activity in mouse xenograft models, resulted in progression of this compound, also known as AZD9833, into clinical trials.
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Affiliation(s)
- James S Scott
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Thomas A Moss
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Amber Balazs
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Bernard Barlaam
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Jason Breed
- Discovery Sciences R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | | | | | - Paul R J Davey
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Oona Delpuech
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Stephen Fawell
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - David I Fisher
- Discovery Sciences R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | | | - Eric T Gangl
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Tyler Grebe
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | | | - Sudhir Hande
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Holia Hatoum-Mokdad
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Kara Herlihy
- Discovery Sciences R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Samantha Hughes
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Thomas A Hunt
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Hoan Huynh
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Sophie L M Janbon
- Early Chemical Development, Pharmaceutical Sciences, R&D, Macclesfield, United Kingdom
| | - Tony Johnson
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Stefan Kavanagh
- Oncology Safety, Clinical Pharmacology and Safety Sciences, R&D, AstraZeneca, Cambridge, United Kingdom
| | | | - Mandy Lawson
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Andrew S Lister
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Stacey Marden
- Advanced Drug Delivery, Pharmaceutical Sciences, R&D, Boston, Massachusetts, United States
| | | | | | | | | | - Bo Peng
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Radoslaw Polanski
- Discovery Sciences R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Darren S Stead
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Stephen Stokes
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Kumar Thakur
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Scott R Throner
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | | | - Jeffrey Varnes
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Haixia Wang
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - David M Wilson
- Oncology R&D, AstraZeneca, Cambridge CB4 0WG, United Kingdom
| | - Dedong Wu
- Advanced Drug Delivery, Pharmaceutical Sciences, R&D, Boston, Massachusetts, United States
| | - Ye Wu
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Bin Yang
- Oncology R&D, AstraZeneca, R&D Boston, 35 Gatehouse Drive, Waltham, Massachusetts 02451, United States
| | - Wenzhan Yang
- Advanced Drug Delivery, Pharmaceutical Sciences, R&D, Boston, Massachusetts, United States
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Ortega Franco A, Tay R, Raja H, Ackermann C, Carter M, Lindsay C, Hughes S, Cove-Smith L, Taylor P, Summers Y, Blackhall F, Califano R. 108P Pembrolizumab in pre-treated advanced non-small cell lung cancer (NSCLC) patients (pts): Impact of blood-based biomarkers on survival outcomes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Niazi T, Williams S, Davis I, Stockler M, Martin A, Bracken K, Roncolato F, McJannett M, Horvath L, Sengupta S, Hughes S, McDermott R, Catto J, Kelly P, Vapiwala N, Parulekar W, Morgan S, Rendon R, Sweeney C. 694TiP DASL-HiCaP: Darolutamide augments standard therapy for localised very high-risk cancer of the prostate (ANZUP1801). A randomised phase III double-blind, placebo-controlled trial of adding darolutamide to androgen deprivation therapy and definitive or salvage radiation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gentry MT, Lapid MI, Syrjanen J, Calvert K, Hughes S, Brushaber D, Kremers W, Bove J, Brannelly P, Coppola G, Dheel C, Dickerson B, Dickinson S, Faber K, Fields J, Fong J, Foroud T, Forsberg L, Gavrilova R, Gearhart D, Ghoshal N, Goldman J, Graff-Radford J, Graff-Radford N, Grossman M, Haley D, Heuer H, Hsiung GY, Huey E, Irwin D, Jones D, Jones L, Kantarci K, Karydas A, Knopman D, Kornak J, Kramer J, Kukull W, Lucente D, Lungu C, Mackenzie I, Manoochehri M, McGinnis S, Miller B, Pearlman R, Petrucelli L, Potter M, Rademakers R, Ramos EM, Rankin K, Rascovsky K, Sengdy P, Shaw L, Tatton N, Taylor J, Toga A, Trojanowski J, Weintraub S, Wong B, Wszolek Z, Boeve BF, Boxer A, Rosen H. Quality of life and caregiver burden in familial frontotemporal lobar degeneration: Analyses of symptomatic and asymptomatic individuals within the LEFFTDS cohort. Alzheimers Dement 2020; 16:1115-1124. [PMID: 32656921 PMCID: PMC7534513 DOI: 10.1002/alz.12095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects evaluates familial frontotemporal lobar degeneration (FTLD) kindreds with MAPT, GRN, or C9orf72 mutations. Objectives were to examine whether health-related quality of life (HRQoL) correlates with clinical symptoms and caregiver burden, and whether self-rated and informant-rated HRQoL would correlate with each other. METHODS Individuals were classified using the Clinical Dementia Rating (CDR® ) Scale plus National Alzheimer's Coordinating Center (NACC) FTLD. HRQoL was measured with DEMQOL and DEMQOL-proxy; caregiver burden with the Zarit Burden Interview (ZBI). For analysis, Pearson correlations and weighted kappa statistics were calculated. RESULTS The cohort of 312 individuals included symptomatic and asymptomatic individuals. CDR® plus NACC FTLD was negatively correlated with DEMQOL (r = -0.20, P = .001), as were ZBI and DEMQOL (r = -0.22, P = .0009). There was fair agreement between subject and informant DEMQOL (κ = 0.36, P <.0001). CONCLUSION Lower HRQoL was associated with higher cognitive/behavior impairment and higher caregiver burden. These findings demonstrate the negative impact of FTLD on individuals and caregivers.
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Affiliation(s)
| | | | | | | | | | | | | | - Jessica Bove
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick Brannelly
- Tau Consortium, Rainwater Charitable Foundation, Fort Worth, Texas, USA
| | | | | | | | - Susan Dickinson
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | - Kelley Faber
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | - Tatiana Foroud
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | | | | | | | | | | | | | - Ging-Yuek Hsiung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Edward Huey
- Columbia University, New York, New York, USA
| | - David Irwin
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Lynne Jones
- Washington University, St. Louis, Missouri, USA
| | | | | | | | | | | | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC), University of Washington, Seattle, Washington, USA
| | | | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, USA
| | - Ian Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Madeline Potter
- National Cell Repository for Alzheimer's Disease (NCRAD), Indiana University, Indianapolis, Indiana, USA
| | | | | | | | | | - Pheth Sengdy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nadine Tatton
- Association for Frontotemporal Degeneration, Radnor, Pennsylvania, USA
| | | | - Arthur Toga
- Laboratory of Neuroimaging (LONI), USC, Los Angeles, California, USA
| | | | | | - Bonnie Wong
- Harvard University/MGH, Boston, Massachusetts, USA
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Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect 2020; 26:1395-1399. [PMID: 32603803 PMCID: PMC7320692 DOI: 10.1016/j.cmi.2020.06.025] [Citation(s) in RCA: 399] [Impact Index Per Article: 99.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
Objectives To investigate the incidence of bacterial and fungal coinfection of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study across two London hospitals during the first UK wave of coronavirus disease 2019 (COVID-19). Methods A retrospective case series of hospitalized patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (20 February–20 April 2020; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza-positive patients admitted during the 2019–2020 flu season. Patient demographics, microbiology and clinical outcomes were analysed. Results A total of 836 patients with confirmed SARS-CoV-2 were included; 27 (3.2%) of 836 had early confirmed bacterial isolates identified (0–5 days after admission), rising to 51 (6.1%) of 836 throughout admission. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens and respiratory viral PCR panels were obtained from 643 (77%), 110 (13%), 249 (30%), 246 (29%) and 250 (30%) COVID-19 patients, respectively. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteraemia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteraemia was identified in six patients (three Candida, two Enterococcus spp. and one Pseudomonas aeruginosa). All other community-acquired bacteraemias (n = 16) were attributed to nonrespiratory infection. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Comparable rates of positive coinfection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141; 1.4%), respiratory cultures (10/38; 26.3%) and pneumococcal-positive antigens (1/19; 5.3%) were low. Conclusions We found a low frequency of bacterial coinfection in early COVID-19 hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.
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Affiliation(s)
- S Hughes
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK.
| | - O Troise
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK
| | - H Donaldson
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - N Mughal
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - L S P Moore
- Chelsea and Westminster NHS Foundation Trust, Hammersmith Campus, London, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Hammersmith Campus, London, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
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Finnegan T, Murray CF, Hughes S, Maski K. 1165 Online CME-Certified Case Challenges Improve Competence for the Diagnosis and Management of Pediatric Narcolepsy Among Pediatricians. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1159] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Narcolepsy is a chronic neurologic sleep disorder that typically starts in childhood. Symptoms of narcolepsy in pediatric patients can differ from adult onset narcolepsy and few treatment options are approved for pediatric narcolepsy. Given the challenges of recognizing the condition in children and selecting an appropriate therapeutic intervention, we investigated whether a case-based educational activity was able to improve the competence of pediatricians to accurately diagnose and manage narcolepsy.
Methods
An online, text-based educational intervention comprised of 2 patient case scenarios was developed. Using a “test and teach” approach, clinicians were presented with multiple-choice questions to evaluate their application of evidence-based recommendations. Each response was followed by detailed, referenced, feedback to teach. Educational effect was evaluated with a repeated-pairs pre- to post-assessment study design in which each individual learner acts as his/her own control. A chi-square test was utilized to identify whether proportions of correct answers at pre and post were significantly different. Cramer’s V was used to calculate the effect size of the intervention. Data were collected between April 20, 2019 and September 17, 2019.
Results
The education resulted in an extensive educational effect for pediatricians (n=125; V =.424). Significant improvements were observed in several topics (P <.05 for all comparisons) including: the use of hypocretin cerebrospinal fluid testing as a diagnostic tool for patients with symptoms suggestive of type 1 narcolepsy; appropriate guidance to transition patients with type 1 narcolepsy from one therapeutic regimen to another; and therapeutic selection for a patient with type 2 narcolepsy. Overall, participation in the education resulted in 34% of pediatricians reporting increased confidence in diagnosing and managing sleep disorders in children.
Conclusion
This study demonstrated the success of a targeted, online, interactive, case-based educational intervention on improving awareness among pediatricians regarding the diagnosis and management of narcolepsy. The results indicated that pediatricians would benefit from continued education on the care of patients with narcolepsy.
Support
Support for this program came from an unrestricted educational grant from Jazz Pharmaceuticals, Inc.
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Affiliation(s)
| | | | - S Hughes
- Medscape Education, New York, NY
| | - K Maski
- Boston Children’s Hospital, Boston, MA
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Rajput J, Moore LSP, Mughal N, Hughes S. Evaluating the risk of hyperkalaemia and acute kidney injury with cotrimoxazole: a retrospective observational study. Clin Microbiol Infect 2020; 26:1651-1657. [PMID: 32220637 DOI: 10.1016/j.cmi.2020.02.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/12/2020] [Accepted: 02/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Increasing antimicrobial resistance has renewed interest in older, less used antimicrobials. Cotrimoxazole shows promise; however, hyperkalaemia and acute kidney injury (AKI) are potential complications. Identifying risk factors for and quantification of these events is required for safe use. This study aimed to evaluate predictors of cotrimoxazole-associated AKI and hyperkalaemia in a clinical setting. METHODS Patients prescribed cotrimoxazole were identified using electronic healthcare records over 3 years (1 April 2016 to 31 March 2019). Individual risk factors were recognized. Serum creatinine and potassium trends were analysed over the subsequent 21 days. AKI and patients with hyperkalaemia were classified using Kidney Disease Improving Global Outcomes (KDIGO) and laboratory criteria. Univariate and multiple logistic regression analyses were performed. RESULTS Among 214 patients prescribed cotrimoxazole, 42 (19.6%, 95% confidence interval (CI) 14.6-25.7) met AKI criteria and 33 (15.4%, 95% CI 11.0-21.1) developed hyperkalaemia. Low baseline estimated glomerular filtration rate (<60 mL/min/1.73 m2, odds ratio (OR) 7.78, 95% CI 3.57-16.13, p < 0.0001) and cardiac disorders (OR 2.40, 95% CI 1.17-4.82, p 0.011) predicted AKI, while low baseline estimated glomerular filtration rate (<60 mL/min/1.73 m2, OR 6.80, 95% CI 3.09-15.06, p < 0.0001) and higher baseline serum potassium (p 0.001) predicted hyperkalaemia. Low-dose cotrimoxazole (<1920 mg/d) was associated with lower AKI and hyperkalaemia risk (p 0.007 and 0.019 respectively). Early (within the first 2-4 days of therapy) serum creatinine changes predicted AKI (OR 3.65, 95% CI 1.73-7.41, p 0.001), and early serum potassium changes predicted hyperkalaemia (>0.6 mmol/L, OR 2.47, 95% CI 1.14-5.27, p 0.0236). CONCLUSIONS Cotrimoxazole-associated AKI and hyperkalaemia is frequent and dose dependent. Renal function, serum potassium and preexisting cardiac disorders should be evaluated before prescribing cotrimoxazole. Serum creatinine and potassium monitoring within first 2 to 4 days of treatment to identify susceptible patients is recommended, and the lowest effective dose ought to be prescribed.
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Affiliation(s)
- J Rajput
- Imperial College London, South Kensington Campus, London, England, UK
| | - L S P Moore
- Imperial College London, South Kensington Campus, London, England, UK; Chelsea and Westminster NHS Foundation Trust, London, England, UK; North West London Pathology, Imperial College Healthcare NHS Trust, London, England, UK
| | - N Mughal
- Imperial College London, South Kensington Campus, London, England, UK; Chelsea and Westminster NHS Foundation Trust, London, England, UK; North West London Pathology, Imperial College Healthcare NHS Trust, London, England, UK
| | - S Hughes
- Chelsea and Westminster NHS Foundation Trust, London, England, UK.
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Moss C, Haire A, Cahill F, Enting D, Hughes S, Smith D, Sawyer E, Davies A, Zylstra J, Haire K, Rigg A, Van Hemelrijck M. Guy's cancer cohort - real world evidence for cancer pathways. BMC Cancer 2020; 20:187. [PMID: 32178645 PMCID: PMC7077127 DOI: 10.1186/s12885-020-6667-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background The burden of disease due to cancer remains substantial. Since the value of real-world evidence has also been recognised by regulatory agencies, we established a Research Ethics Committee (REC) approved research database for cancer patients (Reference: 18/NW/0297). Construction and content Guy’s Cancer Cohort introduces the concept of opt-out consent processes for research in a subset of oncology patients diagnosed and treated at a large NHS Trust in the UK. From April 2016 until March 2017, 1388 eligible patients visited Guy’s and St Thomas’ NHS Foundation Trust (GSTT) for breast cancer management. For urological cancers this number was 1757 and for lung cancer 677. The Cohort consists of a large repository of routinely collected clinical data recorded both retrospectively and prospectively. The database contains detailed clinical information collected at various timepoints across the treatment pathway inclusive of diagnostic data, and data on disease progression, recurrence and survival. Conclusions Guy’s Cancer Cohort provides a valuable infrastructure to answer a wide variety of research questions of a clinical, mechanistic, and supportive care nature. Clinical research using this database will result in improved patient safety and experience. Guy’s Cancer Cohort promotes collaborative research and will accept applications for the release of anonymised datasets for research purposes.
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Affiliation(s)
- C Moss
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.
| | - A Haire
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - F Cahill
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
| | - D Enting
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.,Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Hughes
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK.,Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - D Smith
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Sawyer
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Davies
- Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Zylstra
- Department of Upper Gastrointestinal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Haire
- South East London (SEL) Accountable Cancer Network, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Rigg
- Comprehensive Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), Guy's Hospital, 3rd Floor Bermondsey Wing, London, SE1 9RT, UK
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Abstract
BACKGROUND Breast cancer is the most common cancer in women globally. Its negative effects on a woman's quality of life are related to the individual and socio-cultural factors. This review aimed to identify and synthesise the reported experiences and quality of life of women with breast cancer in Arab countries. METHODS PubMed, Embase, Web of Science, SCOPUS, PsychInfo, CINAHL, Allied and Complementary Medicine Database, and Index Medicus for the Eastern Mediterranean Region were searched for articles published from start to March 2019 using PRISMA guidelines. These searches were complimented by citation tracking and hand searching of relevant journals. A thematic synthesis was carried out on the 'findings/results' sections from the identified papers. RESULTS Of 5228 records identified, 19 were included in the review which represented 401 women from 11 Arab countries. All used qualitative methods of data collection to produce rich descriptions of experiences. Thematic synthesis of the extracted data identified three major themes, Perceptions and reactions, Coping or enduring and Changing roles. CONCLUSIONS This review provides a rich description of the reported quality of life and experiences of women with breast cancer in Arab countries. These are influenced by the women's and society's views of cancer, the women's role in society and family, religious faith and the healthcare context and access to treatment choices and information.
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Affiliation(s)
- D Fearon
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
- Cairdeas International Palliative Care Trust, Nouakchott, Mauritania.
| | - S Hughes
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - S G Brearley
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Beech A, Faivre-Finn C, Bayman N, Blackhall F, Califano R, Chan C, Cobben D, Coote J, Cove-Smith L, Harris M, Hughes S, Martimarti F, Pemberton L, Salem A, Summers Y, Taylor P, Wang X, Woolf D, Sheikh H. Pneumocystis jirovecii pneumonia (PJP) prophylaxis in lung cancer patients receiving radical radiotherapy (RT) ± chemotherapy (CTRT): audit of the first UK departmental guideline. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30113-6] [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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Finnegan T, Murray C, Hughes S, Roth T. Online medical education improves knowledge of physiologic mechanisms of sleep among neurologists and primary care clinicians. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barlaam B, Breed J, Carbajo RJ, Gangl E, Hughes S, Morrow CJ, Moss TA, Polanski R, Nissink WM, O'Donovan D, Varnes J, Yang B, Scott JS. Abstract A107: Small Molecule Degraders of the Estrogen Receptor (SERDs): Optimization of the tricyclic indole scaffold beyond AZD9496. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-a107] [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: 11/16/2022]
Abstract
Abstract
The estrogen receptor alpha (ERα) is expressed in >70% of breast cancers and is a clinically validated target in oncology.1 Anti-hormonal therapies that directly block ER function (e.g., tamoxifen) or therapies that block the production of estrogen itself (e.g., aromatase inhibitors) have proven to be effective treatments of the disease. Further advances have been made with the development of SERDs (Selective Estrogen Receptor Degraders) such as fulvestrant which both antagonise ERα-driven tumor cell growth and cause degradation of the ERα receptor.2 We previously disclosed the identification of a tricyclic indole scaffold that led to the orally active clinical candidate AZD9496.3 Additional work to identify novel chemotypes including phenol 14 and indazole 25 was also disclosed together. The work previously disclosed relied on the presence of the acrylic acid for efficient degradation of the estrogen receptor. In this poster we will discuss the replacement of the acrylic acid on the tricyclic indole scaffold with amines (e.g. compound 3). Compound 3 is a degrader of the estrogen receptor in the MCF-7 cell line (pIC50 8.4). Further optimisation of lead structure 3 led to more potent selective degraders of the estrogen receptor in multiple cell lines (e.g. pIC50 >10 in MCF-7) with suitable properties for oral absorption (e.g. oral AUC 44 μM.h in mice at 20 mg/kg). We will discuss some of the medicinal chemistry challenges that were faced along the way and the optimisation strategy (use of NMR derived solution phase conformations, understanding of the binding mode in the estrogen receptor by X-ray crystallography). ol>
Citation Format: Bernard Barlaam, Jason Breed, Rodrigo J Carbajo, Eric Gangl, Samantha Hughes, Christopher J Morrow, Thomas A Moss, Radoslaw Polanski, Willem M Nissink, Daniel O'Donovan, Jeffrey Varnes, Bin Yang, James S Scott. Small Molecule Degraders of the Estrogen Receptor (SERDs): Optimization of the tricyclic indole scaffold beyond AZD9496 [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A107. doi:10.1158/1535-7163.TARG-19-A107
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