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Farmer N, Tuason R, Middleton KR, Ude A, Tataw-Ayuketah G, Flynn S, Kazmi N, Baginski A, Mitchell V, Powell-Wiley TM, Wallen GR. Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention. Nutrients 2024; 16:463. [PMID: 38337747 PMCID: PMC10857272 DOI: 10.3390/nu16030463] [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: 12/28/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions. METHODS A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization. RESULTS Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas. CONCLUSIONS Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Ralph Tuason
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Assumpta Ude
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Gladys Tataw-Ayuketah
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Sharon Flynn
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Alyssa Baginski
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
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Hayden NK, Flynn S, Blumenfeld F, Hastings RP, Gray KM, Cullen S, Cullen MA, Langdon PE. Reducing the risk of criminal exploitation using multi-systemic therapy (the RESET Study): study protocol for a feasibility study and process evaluation. Pilot Feasibility Stud 2023; 9:193. [PMID: 38012747 PMCID: PMC10680250 DOI: 10.1186/s40814-023-01409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Child criminal exploitation is a form of child abuse that poses a serious risk to the welfare, safety, and wellbeing of young people. Multisystemic therapy (MST) is an intensive family and community-based intervention for young people with anti-social behavioral problems, many of whom will be at risk of criminal exploitation. This protocol describes a pilot feasibility study and process evaluation, designed to examine MST for children at risk of criminal exploitation. METHODS This pilot feasibility study and process evaluation involves two phases with associated subphases: phase 1.1 involved the collaborative refinement of the logic model adapting MST for children at risk of criminal exploitation; phase 1.2 involved pre-pilot interviews with MST therapists, families, and young people; phase 2.1 is a pilot modeling study of MST for children at risk of criminal exploitation, and; Phase 2.2 is a process evaluation that will involve interviewing stakeholders, MST therapists and employees, families, and young people. The dataset for the process evaluation will include questionnaires completed by parents and young people at baseline, mid-treatment, end of treatment, and 6 months after treatment. We will supplement these data with participant-level data linkage from MST sites and services. RESULTS Accrual to the pilot stage of this project opened on 6th August 2021 and is due to close on 31st May 2022. We aim to publish the results of this feasibility study and process evaluation in 2023. CONCLUSIONS The results of this feasibility study and process evaluation will inform the decision as to whether it is advisable to progress to a pilot clinical trial of MST for children at risk of criminal exploitation. TRIAL REGISTRATION Trial registration: ISRCTN registry, ISRCTN16164816 on 25th January 2021- https://doi.org/10.1186/ISRCTN16164816 .
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Affiliation(s)
- N K Hayden
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - S Flynn
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - F Blumenfeld
- School of Health and Social Care, University of Essex, Colchester, UK
| | - R P Hastings
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - K M Gray
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - S Cullen
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - M A Cullen
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK
| | - P E Langdon
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, UK.
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK.
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Sutherland D, Flynn S, Kurzeja O, Griffin J, Hastings R. Family-systems interventions for families of people with an intellectual disability or who are autistic: a systematic review. J Intellect Disabil Res 2023; 67:1003-1028. [PMID: 37532456 DOI: 10.1111/jir.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Family-systems interventions have been proposed as one way of supporting families of people with an intellectual disability (ID) or who are autistic. This systematic review aimed to summarise what family-systems interventions have been studied with this population, what evidence there is for their effectiveness and families' experiences of the interventions. METHODS The review was preregistered on PROSPERO (CRD42022297516). We searched five electronic databases, identified 6908 records and screened 72 full texts. Study quality was evaluated using the Mixed Methods Appraisal Tool, and a narrative synthesis was used. RESULTS We identified 13 eligible articles with 292 participating families. Most studies reported positive effects of the interventions on wellbeing and family relationships, and families reported positive experiences. However, research quality was poor and there are no any sufficiently powered randomised controlled trials demonstrating family-systems interventions' effectiveness for this population. CONCLUSIONS There is a need for higher-quality research to establish whether family-systems interventions are beneficial for families of people who have an ID or who are autistic.
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Affiliation(s)
- D Sutherland
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - O Kurzeja
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - J Griffin
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - R Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, Australia
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Son EH, Wallen GR, Flynn S, Yang L, Lee LJ. Patterns of health-promoting behaviors and associated factors in family caregivers of people receiving cancer treatment: A latent class profile analysis. Psychooncology 2023; 32:1038-1047. [PMID: 37157152 PMCID: PMC10590684 DOI: 10.1002/pon.6145] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Family caregivers tend to neglect their health while prioritizing the needs of their care recipients. Identifying subgroups of caregivers based on the patterns of health-promoting behaviors (HPBs) may help develop tailored interventions for them, yet little is known. The purpose of this study was: (1) to identify latent classes with distinct patterns of HPBs in family caregivers of people with cancer; and (2) to investigate factors associated with the latent class membership. METHODS We performed a cross-sectional data analysis using the baseline dataset from a longitudinal survey study that assessed HPBs of family caregivers of individuals who received cancer treatment at a national research hospital (N = 124). Latent class profile analysis was conducted to identify latent classes based on the subdomains of the Health-Promoting Lifestyle Profile II, followed by multinomial logistic regression analysis to investigate factors associated with the latent class membership. RESULTS Three latent classes were identified: a high level of HPB (Class 1, 25.8%); a moderate level of HPB (Class 2, 53.2%); and a low level of HPB (Class 3, 21.0%) of HPBs. Controlling for caregiver age and sex, caregiver burden due to lack of family support, perceived stress, self-efficacy and body mass index were factors associated with the latent class membership. CONCLUSIONS HPBs of our caregiver sample appeared in relatively stable patterns at different levels. Higher caregiver burden and perceived stress and lower self-efficacy were associated with the lower practice of HPBs overall. Our findings may serve as a reference for screening caregivers who need support and developing person-centered interventions.
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Affiliation(s)
- Elisa H. Son
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Sharon Flynn
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Li Yang
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lena J. Lee
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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Lee LJ, Son H, Wallen GR, Flynn S, Cox R, Yang L, Ross A. Symptom Clusters in Family Caregivers of Hematopoietic Stem Cell Transplantation Recipients: Loneliness as a Risk Factor. Transplant Cell Ther 2023; 29:50.e1-50.e8. [PMID: 36202335 PMCID: PMC9825650 DOI: 10.1016/j.jtct.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Family caregivers of allogeneic hematopoietic stem cell transplantation (HSCT) recipients experience multiple concurrent symptoms, but the majority of symptom research in this population has focused on assessing and managing individual symptoms. The purpose of this analysis was to determine (1) whether clusters of 5 highly prevalent symptoms (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) in allogeneic HSCT caregivers could be identified and (2) which caregiver and patient characteristics influence membership in the identified symptom cluster groups. Baseline cross-sectional data were collected from allogeneic HSCT caregivers participating in a randomized controlled trial at the National Institutes of Health Clinical Center. Measures included the Caregiver Reaction Assessment (CRA), Health-Promoting Lifestyle Profile II (HPLP-II), Fatigue Symptom Inventory (MFSI), Pittsburgh Sleep Quality Index (PSQI), and Patient-Reported Outcomes Measurement Information System (PROMIS). Cluster analysis was used to identify symptom clusters, and univariate analyses and multiple logistic regression were performed to identify factors that contribute to symptom clusters. The average age of caregivers (n = 44) was 45.20 ± 15.05 years; primarily white (52.3%) and female (88.6%) and often the spouse/partner of the patient (50.0%). Two symptom cluster groups were identified: low symptom burden (n = 24; 54.5%) and high symptom burden (n = 20; 45.5%). Caregivers with higher levels of loneliness (odds ratio, 1.12; 95% confidence interval, 1.04 to 1.22; P = .004) were more likely to be in the high symptom burden group. This study provides evidence that 5 symptoms commonly found in family caregivers-fatigue, sleep disturbance, depression, anxiety, and cognitive impairment-tend to occur in clusters. Therefore, clinicians should be aware that caregivers with 1 or more of these symptoms may be at higher risk for developing the others, and caregivers reporting high levels of loneliness may be at particular risk. Future research is needed to identify novel interventions that target multiple, co-occurring symptoms. Such interventions also might include components that decrease loneliness. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Lena J Lee
- National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Hyojin Son
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sharon Flynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Robert Cox
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Li Yang
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Alyson Ross
- National Institutes of Health Clinical Center, Bethesda, Maryland
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Farmer N, Tuason RT, Kazmi N, Flynn S, Mitchell V, Middleton K, Cox R, Franklin K, Gordon T, Baginski A, Wallen GR. Going virtual during the COVID-19 pandemic: adaptation of a mixed-methods dietary behavior study within a community-based participatory research study of African-American adults at risk for cardiovascular disease. BMC Med Res Methodol 2022; 22:330. [PMID: 36550396 PMCID: PMC9773576 DOI: 10.1186/s12874-022-01806-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic. METHOD The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who previously participated in the DC CHOC community-based studies were contacted to participate in Phase 1. The quantitative part of the mixed-methods included survey data collection. RESULTS Due to the pandemic, the mode of data collection for surveys changed from self-administered face-to-face to internet-based. All virtual study procedures were conducted between March and April, 2021. Anticipated benefits of the virtual setting included participant safety during the pandemic, ease of logistics for participants. Anticipated challenges included administration of electronic devices to participants, research team training, and potential threats to established trust related to the privacy and confidentiality of participants. CONCLUSION The transition to a virtual setting for study procedures in a mixed-methods study was conducted successfully in terms of recruitment, retention of participants, and training of research team members. The virtual transition required established and ongoing engagement through the community advisory board and CBPR practices, institutional support through virtual research policies, collaborations with information technology-based teams, and equipment administration for the study. TRIALS REGISTRATION NCT04305431 . Registered on March 12, 2020.
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Affiliation(s)
- Nicole Farmer
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Ralph Thadeus Tuason
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Narjis Kazmi
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Sharon Flynn
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Valerie Mitchell
- grid.279885.90000 0001 2293 4638Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, Bethesda, MD USA
| | - Kimberly Middleton
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Robert Cox
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Kristina Franklin
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Talya Gordon
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Alyssa Baginski
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Gwenyth R. Wallen
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
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Douralis A, Bass G, Dumbill A, Flynn S, Lee N, Manning J, Subiel A. ESTABLISHMENT OF A FLASH RADIOTHERAPY FACILITY AT NPL AND DOSIMETRY STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01627-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Edge L, Cunningham C, Murphy N, Dillon A, Flynn S, O'Shaughnessy Í, Davis A, O'Rourke B, Brossier L, Doran C, Hennessy A, Kennedy U, McMahon G, McNamara R, Shields D, Staunton P, Horgan F. 142 FRAILTY IDENTIFICATION AND INTERDISCIPLINARY ASSESSMENT OF OLDER PEOPLE IN THE EMERGENCY DEPARTMENT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.142] [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: 02/25/2023] Open
Abstract
Abstract
Background
Older People are attending Emergency Departments (EDs) in increasing numbers but the optimal assessment measures to use have yet to be established. This study examined the clinical utility of different assessments of strength, functional mobility, sarcopenia, cognition and frailty used by the physiotherapist in an interdisciplinary team (IDT) in the ED and determined any associations with clinical outcomes.
Methods
This observational cross-sectional study recruited adults ≥70 years who were assessed by an IDT on weekdays during working hours. Demographic variables such as age, gender, social situation, baseline mobility, falls and clinical measures such as Clinical Frailty Scale (CFS), 4AT, hand-held dynamometry, calf circumference and functional mobility in ED were recorded. Clinical outcomes were admission to hospital, discharge from ED with onward referral (ambulatory care or community) and discharge from ED with no referral. Ethical approval was obtained and SPSS was used for statistical analysis.
Results
Two hundred and fifty four participants were recruited, 58.3% female, mean age 80.23 (SD 6.56). Median CFS was 4 (IRQ 2.0), range 1–7 with 32.7% (n = 83) considered frail. Sarcopenia prevalence was 89.3% using grip strength and 7.1% using calf circumference. Grip strength predicted frailty even after adjusting for age (p < 0.0001), gender (p < 0.0001) and falls (p = 0.043). Admission to hospital was predicted by major diagnostic category (p = 0.016) and inability to sit to stand independently in ED (p < 0.0001). Seventy percent (n = 179) of participants were discharged from ED, with 27.6% referred to ambulatory care or community services. Onward referral was predicted by frailty (p = 0.016) and falls in the last six months (p = 0.028).
Conclusion
Grip strength in addition to a validated tool such as CFS may assist an experienced IDT in identifying frailty, which can in turn inform decision-making regarding ED disposition and pathways of care for older people. Functional assessment in the ED is also important to determine the need for hospital admission.
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Affiliation(s)
- L Edge
- St James's Hospital , Dublin, Ireland
| | | | - N Murphy
- St James's Hospital , Dublin, Ireland
| | - A Dillon
- St James's Hospital , Dublin, Ireland
| | - S Flynn
- St James's Hospital , Dublin, Ireland
| | | | - A Davis
- St James's Hospital , Dublin, Ireland
| | - B O'Rourke
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - L Brossier
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | - C Doran
- Royal College of Surgeons in Ireland , Dublin, Ireland
| | | | - U Kennedy
- St James's Hospital , Dublin, Ireland
| | - G McMahon
- St James's Hospital , Dublin, Ireland
| | | | - D Shields
- St James's Hospital , Dublin, Ireland
| | | | - F Horgan
- Royal College of Surgeons in Ireland , Dublin, Ireland
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Hatton C, Bailey T, Bradshaw J, Caton S, Flynn S, Gillooly A, Jahoda A, Maguire R, Marriott A, Mulhall P, Oloidi E, Taggart L, Todd S, Abbott D, Beyer S, Gore N, Heslop P, Scior K, Hastings RP. The willingness of UK adults with intellectual disabilities to take COVID-19 vaccines. J Intellect Disabil Res 2021; 65:949-961. [PMID: 34529314 PMCID: PMC8657332 DOI: 10.1111/jir.12884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/29/2021] [Accepted: 08/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Given the much greater COVID-19 mortality risk experienced by people with intellectual disabilities (ID), understanding the willingness of people with ID to take a COVID-19 vaccine is a major public health issue. METHOD In December 2020 to February 2021, across the United Kingdom, 621 adults with ID were interviewed remotely and 348 family carers or support workers of adults with ID with greater needs completed an online survey, including a question on willingness to take a COVID-19 vaccine if offered. RESULTS Eighty-seven per cent of interviewees with ID were willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having already had a flu vaccine, gaining information about COVID-19 from television but not from social media, and knowing COVID-19 social restrictions rules. A percentage of 81.7% of surveyed carers of adults with ID with greater needs reported that the person would be willing to take a COVID-19 vaccine, with willingness associated with white ethnicity, having a health condition of concern in the context of COVID-19, having had a flu vaccine, being close to someone who had died due to COVID-19, and having shielded at some point during the pandemic. CONCLUSIONS Reported willingness to take the COVID-19 vaccine is high among adults with ID in the United Kingdom, with factors associated with willingness having clear implications for public health policy and practice.
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Affiliation(s)
- C. Hatton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
| | - T. Bailey
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | | | - S. Caton
- Department of Social Care and Social WorkManchester Metropolitan UniversityManchesterUK
| | - S. Flynn
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
| | - A. Gillooly
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - A. Jahoda
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - R. Maguire
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - A. Marriott
- National Development Team for InclusionBathUK
| | - P. Mulhall
- Institute of Nursing and Health ResearchUniversity of UlsterJordanstownUK
| | - E. Oloidi
- Unit for Development in Intellectual and Developmental DisabilitiesUniversity of South WalesPontypriddUK
| | - L. Taggart
- Institute of Nursing and Health ResearchUniversity of UlsterJordanstownUK
| | - S. Todd
- Unit for Development in Intellectual and Developmental DisabilitiesUniversity of South WalesPontypriddUK
| | - D. Abbott
- School for Policy StudiesUniversity of BristolBristolUK
| | - S. Beyer
- School of MedicineUniversity of CardiffCardiffUK
| | - N. Gore
- Tizard CentreUniversity of KentCanterburyUK
| | - P. Heslop
- School for Policy StudiesUniversity of BristolBristolUK
| | - K. Scior
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - R. P. Hastings
- Centre for Educational Development, Appraisal and ResearchUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and PsychologyMonash UniversityMelbourneVICAustralia
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Ross A, Geiger-Brown J, Yang L, Flynn S, Cox R, Wehrlen L, Lee LJ. Acute and chronic fatigue in nurses providing direct patient care and in non-direct care roles: A cross-sectional analysis. Nurs Health Sci 2021; 23:628-638. [PMID: 34145719 DOI: 10.1111/nhs.12862] [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: 01/28/2021] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
Nurses are at risk for work-related fatigue, which can impact their health, well-being, and job readiness. The purpose of this study was to examine the levels, types, and factors associated with fatigue in registered nurses (RNs) in direct patient care (DCRNs) and in non-direct patient care (non-DCRNs) roles. A cross-sectional survey was administered to 313 RNs. Measures included: Multidimensional Fatigue Symptom Inventory, Occupational Fatigue Exhaustion Recovery, Brief COPE, PROMIS® Global Sleep Disturbance, and Job Content Questionnaire. Acute fatigue levels in RNs were similar to those in diseased populations, and nearly 50% reported moderate/high levels of chronic fatigue. DCRNs reported higher levels of acute and chronic fatigue than non-DCRNs, but the differences were small and disappeared when accounting for other factors associated with fatigue including sleep disturbance, job strain, workplace support, maladaptive coping, and especially intershift recovery, which accounted for 20%-41% of fatigue variability. This study suggests that it may not be only nurses providing direct patient care who are at risk for acute and chronic fatigue. Intershift recovery may be particularly important in alleviating acute and chronic fatigue in nurses.
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Affiliation(s)
- Alyson Ross
- Nursing Department, Research and Translational Science, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Jeanne Geiger-Brown
- George Washington University School of Nursing, Washington, District of Columbia, USA
| | - Li Yang
- Nursing Department, Research and Translational Science, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Sharon Flynn
- Nursing Department, Research and Translational Science, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Robert Cox
- Nursing Department, Research and Translational Science, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Leslie Wehrlen
- Office of Research Support & Compliance (ORSC), NIH Clinical Center, Bethesda, Maryland, USA
| | - Lena J Lee
- Nursing Department, Research and Translational Science, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
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11
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Jess M, Flynn S, Bailey T, Hastings RP, Totsika V. Failure to replicate a robust Down syndrome advantage for maternal well-being. J Intellect Disabil Res 2021; 65:262-271. [PMID: 33404135 PMCID: PMC8049030 DOI: 10.1111/jir.12808] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Family members caring for children with intellectual disability (ID) routinely report heightened levels of psychological distress. However, families of children with Down syndrome typically report better outcomes (known as the Down syndrome advantage). We examined whether the Down syndrome advantage would be present for maternal psychological distress, impact of caregiving, life satisfaction and perceived positive impact of the child with ID when controlling for external variables. METHODS Mothers of children with Down syndrome (n = 111) and mothers of children with ID of mixed aetiologies (n = 196) completed measures about their own mental health, perceived impact of caregiving, life satisfaction and perceived positive impact of their child on themselves and the family unit. RESULTS A series of group comparisons revealed small to moderate differences supporting the presence of a putative Down syndrome advantage in relation to personal maternal well-being outcomes. However, when child-related characteristics and external variables were controlled, the Down syndrome advantage was no longer present, with reduced, small effect sizes observed for all maternal outcomes. CONCLUSIONS Initial group differences in psychological distress and life satisfaction were largely associated with family poverty, indicating that the Down syndrome advantage may be less robust than previously thought. Future research should seek to move beyond examining the existence of the putative Down syndrome advantage and focus on how families of children with Down syndrome experience family life, including longitudinal research exploring responses to life cycle and transition challenges.
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Affiliation(s)
- M. Jess
- CEDARUniversity of WarwickCoventryUK
| | - S. Flynn
- CEDARUniversity of WarwickCoventryUK
| | - T. Bailey
- CEDARUniversity of WarwickCoventryUK
| | - R. P. Hastings
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - V. Totsika
- CEDARUniversity of WarwickCoventryUK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
- Division of Psychiatry, Faculty of Brain SciencesUniversity College LondonLondonUK
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12
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Farmer N, Powell-Wiley TM, Middleton KR, Roberson B, Flynn S, Brooks AT, Kazmi N, Mitchell V, Collins B, Hingst R, Swan L, Yang S, Kakar S, Harlan T, Wallen GR. A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart. Pilot Feasibility Stud 2020; 6:158. [PMID: 33088581 PMCID: PMC7574184 DOI: 10.1186/s40814-020-00697-9] [Citation(s) in RCA: 4] [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: 04/23/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cooking interventions have increased in popularity in recent years. Evaluation by meta-analyses and systematic reviews show consistent changes in dietary quality reports and cooking confidence, but not of cardiovascular (CVD) biomarkers. Interventions evaluating or reporting behavioral mechanisms as an explanatory factor for these outcomes has been sparse. Moreover, evaluations of cooking interventions among communities with health disparities or food access limitations have received little attention in the literature. Methods This study will occur over two phases. Phase 1 will assess acceptability among the target population of African-American adults living within an urban food desert. Phase 2 will consist of a 6-week cooking intervention delivered at a community kitchen setting. Pre and post intervention visits for clinical examinations and biomarker collection will be conducted, as well as dietary and cooking skill assessments. Primary outcomes include cooking behavior and feasibility measures. Secondary outcomes are related to dietary quality, psychosocial factors, CVD biomarkers, and food environment measures. Discussion This study seeks to demonstrate feasibility of a community-based cooking intervention and to provide necessary information to plan future interventions that identify cooking behavior as an outcome of participation in cooking interventions among African-American adults, especially in relation to dietary and biomarker outcomes. Trial registration This study was registered at ClinicalTrials.gov (NCT04305431) on March 12, 2020.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD USA
| | | | - Brenda Roberson
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Sharon Flynn
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Alyssa T Brooks
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Narjis Kazmi
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Billy Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Rachel Hingst
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Lucy Swan
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Shanna Yang
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Seema Kakar
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Timothy Harlan
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD USA
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13
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Abstract
Short sleep duration is a known risk factor for suicidality in the general population, yet it is unclear how short sleep interacts with autism traits in predicting suicidality. In this cross-sectional online study, a general population sample (N = 650) completed measures assessing autism traits, suicidal ideation, and sleep duration. Moderated hierarchical regressions demonstrated that higher autism traits and shorter sleep were independent predictors of increased suicide ideation. However, sleep duration did not significantly moderate the autism trait to suicide ideation relationship. Future work should explore this relationship longitudinally using objective measures before considering intervention work to increase sleep duration in those with elevated autism traits.
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Affiliation(s)
- K D Hochard
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK.
| | - R Pendrous
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - T Mari
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, CV4 7AL, UK
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14
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Bonney A, Mullan J, Hammond A, Burns P, Yeo G, Thomson B, Flynn S, Carrigan T. A case-study of the experiences of junior medical officers in the emergency departments of a metropolitan hospital and rural hospital. Aust J Rural Health 2019; 27:476-481. [PMID: 31691410 DOI: 10.1111/ajr.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/09/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Increased exposure to post-graduate rural medical training is associated with increased likelihood of future rural practice. Training rotations in rural emergency departments provide a possible avenue for such exposure, but have been under-investigated. This study aimed to compare junior medical officers' emergency department experiences in a metropolitan and a rural hospital to inform rural health workforce initiatives. DESIGN Mixed-method case-study design. SETTING Two 10-week periods in the respective emergency departments. PARTICIPANTS Four junior medical officers at the rural site and 22 junior medical officers at the metropolitan hospital. MAIN OUTCOME MEASURES Caseloads extracted from electronic medical records and training experience. RESULTS Data were collected over 142 days. The average number of patients seen per day, per junior medical officer, was significantly higher at the rural hospital emergency department (7.2 patients per day) in comparison with the metropolitan hospital (4.3 patients per day). Junior medical officers at the rural hospital saw relatively more lower acuity patients. The seven junior medical officers who were interviewed provided consistently positive responses regarding their training experiences in both locations. This was particularly evident in the rural hospital and was attributed to one-on-one supervision. CONCLUSIONS Most junior medical officers agreed that their expectations for support and learning opportunities were met and/or exceeded. However, junior medical officers reported feeling more supported at the rural hospital due to direct contact and communication with senior medical officers. Placement in a smaller hospital emergency department did not disadvantage the junior medical officers' training in this case-study and provided a positive rural training experience. These findings support workforce policies which encourage rural hospital emergency department training.
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Affiliation(s)
- Andrew Bonney
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Athena Hammond
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pippa Burns
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgia Yeo
- Milton Medical Centre, Milton, New South Wales, Australia
| | - Brett Thomson
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Milton Medical Centre, Milton, New South Wales, Australia
| | - Sharon Flynn
- Coast City Country General Practice Training, Wagga Wagga, New South Wales, Australia
| | - Tom Carrigan
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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15
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Friedland N, Negi S, Vinogradova-Shah T, Wu G, Ma L, Flynn S, Kumssa T, Lee CH, Sayre RT. Fine-tuning the photosynthetic light harvesting apparatus for improved photosynthetic efficiency and biomass yield. Sci Rep 2019; 9:13028. [PMID: 31506512 PMCID: PMC6736957 DOI: 10.1038/s41598-019-49545-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/22/2019] [Indexed: 12/21/2022] Open
Abstract
Photosynthetic electron transport rates in higher plants and green algae are light-saturated at approximately one quarter of full sunlight intensity. This is due to the large optical cross section of plant light harvesting antenna complexes which capture photons at a rate nearly 10-fold faster than the rate-limiting step in electron transport. As a result, 75% of the light captured at full sunlight intensities is reradiated as heat or fluorescence. Previously, it has been demonstrated that reductions in the optical cross-section of the light-harvesting antenna can lead to substantial improvements in algal photosynthetic rates and biomass yield. By surveying a range of light harvesting antenna sizes achieved by reduction in chlorophyll b levels, we have determined that there is an optimal light-harvesting antenna size that results in the greatest whole plant photosynthetic performance. We also uncover a sharp transition point where further reductions or increases in antenna size reduce photosynthetic efficiency, tolerance to light stress, and impact thylakoid membrane architecture. Plants with optimized antenna sizes are shown to perform well not only in controlled greenhouse conditions, but also in the field achieving a 40% increase in biomass yield.
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Affiliation(s)
- N Friedland
- New Mexico Consortium, Los Alamos, NM, 87544, USA
| | - S Negi
- New Mexico Consortium, Los Alamos, NM, 87544, USA
| | - T Vinogradova-Shah
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Pebble Labs, 100 Entrada Drive, Los Alamos, NM, 87544, USA
| | - G Wu
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Department of Molecular Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - L Ma
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Department of Molecular Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - S Flynn
- New Mexico Consortium, Los Alamos, NM, 87544, USA
| | - T Kumssa
- University of Nebraska, Lincoln, NE, United States
| | - C-H Lee
- New Mexico Consortium, Los Alamos, NM, 87544, USA.,Department of Molecular Biology, Pusan National University, Busan, 46241, Republic of Korea
| | - R T Sayre
- New Mexico Consortium, Los Alamos, NM, 87544, USA. .,Pebble Labs, 100 Entrada Drive, Los Alamos, NM, 87544, USA.
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16
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Flynn S, Raphael J, Graney J, Nyathi T, Williams A, Kapur N, Appleby L, Shaw J. The personality disorder patient pathway: Service user and clinical perspectives. Personal Ment Health 2019; 13:134-143. [PMID: 31106989 DOI: 10.1002/pmh.1444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/30/2022]
Abstract
AIMS There have been recent policy developments and research into care provision for service users with personality disorder. However, few studies have focused on service user and staff perspectives on how services could be improved. METHODS A qualitative study was undertaken in the UK between 2016 and 2017. We conducted six focus groups with clinicians in mental health services with experience of working with people with personality disorder. Using an online survey, we asked current and past service users with personality disorder to describe their experiences of mental health services and make recommendations for improvements. A thematic analysis was conducted. RESULTS Forty-five clinicians participated in the focus group and 131 service users contributed to the online survey. The main areas of concern identified by both staff and patients were the diagnosis of personality disorder, the absence of a coherent care pathway, access to psychological treatment and staff training. CONCLUSIONS The care pathway for individuals with personality disorder is unclear to clinicians and service users, and elements of the pathway are disjointed and not working as effectively as they could. Guidelines recommended by National Institute for Health and Care Excellence are not being followed. Specialist psychological interventions should be available to ensure consistent and stable care provision. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- S Flynn
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - J Raphael
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - J Graney
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - T Nyathi
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - A Williams
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - N Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - L Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - J Shaw
- National Confidential Inquiry into Suicide and Safety in Mental Health, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
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17
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Fehlings M, Nardin A, Jhunjhunwala S, Kowanetz M, O'Gorman B, Hegde P, Li J, Sumatoh H, Lee B, Kim L, Flynn S, Ballinger M, Newell E, Yadav M. Late-differentiated effector neoantigen-specific CD8+ T cells are enriched in non-small cell lung carcinoma patients responding to atezolizumab treatment. Eur J Cancer 2019. [DOI: 10.1016/j.ejca.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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20
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Hastings RP, Gillespie D, Flynn S, McNamara R, Taylor Z, Knight R, Randell E, Richards L, Moody G, Mitchell A, Przybylak P, Williams B, Hunt PH. Who's challenging who training for staff empathy towards adults with challenging behaviour: cluster randomised controlled trial. J Intellect Disabil Res 2018; 62:798-813. [PMID: 30033655 DOI: 10.1111/jir.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One in five adults with intellectual disabilities (ID) known to services display challenging behaviours (CBs), and these individuals are at risk for restrictive practices and poor care. Staff attitudes may contribute to the development and/or maintenance of CBs. We investigated the effectiveness of co-produced Who's Challenging Who? training delivered by people with ID to staff. METHOD This study involved a cluster randomised controlled trial (RCT) of Who's Challenging Who? training with follow-up at six and 20 weeks post-randomisation. PARTICIPANTS two staff from each of 118 residential care settings for adults with ID at least one of whom displayed aggressive CB. PRIMARY OUTCOME Self-reported Staff Empathy for people with Challenging Behaviour Questionnaire. ANALYSIS intention to treat of all randomised settings. ISCRTN registration: ISRCTN53763600. RESULTS 118 residential settings (including 236 staff) were randomised to either receive training (59 settings) or to receive training after a delay (59 settings). The primary analysis included data from 121 staff in 76 settings (51% of staff, 64% of settings). The adjusted mean difference on the transformed (cubed) Staff Empathy for people with Challenging Behaviour Questionnaire score at the primary end point was 1073.2 (95% CI: -938.1 to 3084.5, P = 0.296) in favour of the intervention group (effect size Cohen's d = .19). CONCLUSIONS This is the first large-scale RCT of a co-produced training course delivered by people with ID. Findings indicated a small positive (but statistically non-significant) effect on increased staff empathy at 20 weeks, and small to moderate effects for staff reported secondary outcomes in favour of the intervention group.
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Affiliation(s)
- R P Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - D Gillespie
- Centre for Trials Research, Cardiff University, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - R McNamara
- Centre for Trials Research, Cardiff University, UK
| | - Z Taylor
- Royal Mencap Society, London, UK
| | - R Knight
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - E Randell
- Centre for Trials Research, Cardiff University, UK
| | - L Richards
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - G Moody
- Centre for Trials Research, Cardiff University, UK
| | - A Mitchell
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - P Przybylak
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
| | - B Williams
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK
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Abstract
BACKGROUND Observations in psychiatric in-patient settings are used to reduce suicide, self-harm, violence and absconding risk. The study aims were to describe the characteristics of in-patients who died by suicide under observation and examine their service-related antecedents. METHOD A national consecutive case series in England and Wales (2006-2012) was examined. RESULTS There were 113 suicides by in-patients under observation, an average of 16 per year. Most were under intermittent observation. Five deaths occurred while patients were under constant observation. Patient deaths were linked with the use of less experienced staff or staff unfamiliar with the patient, deviation from procedures and absconding. CONCLUSIONS We identified key elements of observation that could improve safety, including only using experienced and skilled staff for the intervention and using observation levels determined by clinical need not resources.
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Affiliation(s)
- S Flynn
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - T Nyathi
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - S-G Tham
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - A Williams
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - K Windfuhr
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - N Kapur
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - L Appleby
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
| | - J Shaw
- The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness,Centre for Mental Health and Safety, University of Manchester,Jean McFarlane Building,Oxford Road,Manchester,UK
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Walker B, Flynn S, Johnson R. RELIABILITY AND VALIDITY OF HEALTH IN MOTION© FALLS SCREENING TOOL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Walker
- University of Indianapolis, Indianapolis, Indiana
| | - S. Flynn
- Blue Marble Game Company, Los Angeles, California,
| | - R. Johnson
- Blue Marble Game Company, Los Angeles, California,
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Bourke M, Fitzgerald T, Donlon N, Flynn S, Creedon S, Sparrow P, Brady A, McEneaney P, O'Brien G, McGreal G. Complications Arising Following Endovascular Repair of Aorto-iliac Aneurysms that Require Open Management: Ten Years’ Experience at a Single Centre. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.08.042] [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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Kowanetz M, Zou W, Shames D, Cummings C, Rizvi N, Spira A, Frampton G, Leveque V, Flynn S, Mocci S, Shankar G, Funke R, Ballinger M, Waterkamp D, Sandler A, Hampton G, Amler L, Hegde P, Hellmann M. Tumor mutation load assessed by FoundationOne (FM1) is associated with improved efficacy of atezolizumab (atezo) in patients with advanced NSCLC. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.25] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Kelly C, Smith M, Flynn S, Reyes A, Higgins M, McCaffrey J, Kelly C. Accrual to Cancer Clinical Trial. Ir Med J 2016; 109:436. [PMID: 27834087] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Accrual to cancer clinical trials (CCT) is imperative to safeguard continued improvement in cancer outcomes. A retrospective chart review was performed of patients (n=140) starting a new anti-cancer agent in a north Dublin cancer centre. This review was performed over a four-month period, beginning in November 2015. Only 29% (n=41) had a CCT option. The overall accrual rate to CCT was 5% (n=7), which is comparable to internationally reported figures. The main reasons for failure to recruit to CCT included the lack of a CCT option for cancer type (n=30, 23%), stage (n=25, 19%), and line of treatment (n=23, 17%). Over the last decade, the rate of accrual to CCTs has in fact doubled and the number of trials open to recruitment has tripled. Ongoing governmental and philanthropic support is necessary to continue this trend to further expand CCT patient options with a target accrual rate of 10%.
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Affiliation(s)
- C Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M Smith
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - S Flynn
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - A Reyes
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - J McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - C Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
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Flynn S, Ellery S, Mason L. LIVING WITH CHRONIC HEART FAILURE. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.20] [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: 11/03/2022]
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Lange B, Flynn S, Rizzo A. Initial usability assessment of off-the-shelf video game consoles for clinical game-based motor rehabilitation. Physical Therapy Reviews 2013. [DOI: 10.1179/108331909x12488667117258] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chalwin RP, Moran JL, Peake SI, Flynn S, Pieterse J, Williams P. Assessing the performance of a continuous infusion for potassium supplementation in the critically ill. Anaesth Intensive Care 2012; 40:433-41. [PMID: 22577908 DOI: 10.1177/0310057x1204000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Abstract
Hypokalaemia is a common problem in critically ill patients, which if untreated, can result in dysrhythmia or another adverse outcome. We assessed the safety and efficacy of a continuous infusion of potassium chloride versus an existing intermittent infusion regimen. In this open-label randomised parallel-arm active-controlled pilot study, critically ill adults with plasma potassium concentration between 2.5 and 3.8 mmol/l were randomised to receive either a continuous infusion or intermittent infusions of potassium chloride for establishment and maintenance of normokalaemia. The primary outcome was the mean difference in plasma potassium concentration over time between the two study arms as assessed by a linear mixed-effects model. Although a statistically significant difference was observed (0.22 mmol/l; 95% confidence interval 0.17, 0.27; P <0.0001), this did not reach the pre-determined level indicative of a treatment effect (0.5 mmol/l). The continuous group demonstrated less variance in (mean) plasma potassium as reflected in narrower confidence intervals in a prediction-by-time model. The incidence rate ratio of dysrhythmia, assessed by a mixed-effects Poisson model, was similar in each group (0.62; 95% confidence interval 0.32, 1.21; P=0.16). We recorded no adverse events directly attributable to infusion of potassium chloride in either study arm. Although titrated continuous infusion did not demonstrate a clinically important difference by comparison with intermittent infusions for the maintenance of normokalaemia, there was more consistent control of plasma potassium with no observed complications or adverse events. Therefore, this trial showed an acceptable efficacy and safety profile for the continuous infusion regimen, suggesting scope for further study.
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Affiliation(s)
- R P Chalwin
- The Department of Intensive Care, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Flynn S, Parker G, Gamble R. A survey of the pre-entry occupational health assessment process for undergraduate medical, nursing and midwifery students in England, Scotland and Wales. Occup Environ Med 2011. [DOI: 10.1136/oemed-2011-100382.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ragupathy S, Flynn S, Duncan K. 16. Axillary ultrasound accuracy in assessing nodal metastases in a breast screening service. Cancer Imaging 2011. [DOI: 10.1102/1470-7330.2011.9079] [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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Ragupathy SKA, Gagliardi T, Redpath TW, Flynn S, Jagpal B, Begley JKP, Gilbert FJ. Comparison of 1.5T and 3T in assessment of suspicious breast lesions. Breast Cancer Res 2010. [PMCID: PMC2978835 DOI: 10.1186/bcr2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Balshaw R, Khorasheh S, Barbeau M, Kelly S, Flynn S, Heisel O, McBurney CR. Longitudinal Outcomes of GastroIntestinal symptoms in Canada (LOGIC): key factors for an effective patient retention in observational studies. Can J Clin Pharmacol 2009; 16:e140-e150. [PMID: 19182307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Longitudinal Outcomes of GastroIntestinal symptoms in Canada (LOGIC) is an ongoing study on irritable bowel syndrome (IBS) treatment patterns and health outcomes in routine Canadian clinical practice. Advancements in understanding IBS, a chronic multifaceted GI disorder, may be possible through methodical observational studies. The objective of this paper is to describe site recruitment techniques and extensive subject follow-up methodology used to facilitate a high return rate of questionnaires from this population-based study of subjects with IBS. METHODS Invitation letters along with protocol synopses and preliminary site assessment questionnaires were faxed to potential sites across Canada. There were 1,556 subjects enrolled in this study from general practitioner sites (GP) and specialist sites (SP) in Canada. Subjects were compensated for the return of questionnaires reporting symptoms, quality of life, productivity, healthcare and resource utilization at baseline, Month 1, 3, 6, 9, and 12. Upon the return of questionnaires, subjects received thank you cards which included a reminder of the next questionnaire's due date. If subject questionnaires were not received within 2 weeks after the due date, the subjects received a reminder letter in the mail. RESULTS The methodology in the LOGIC study allowed for a high patient questionnaire return rate (89%) through extensive subject reminders and follow-up. Subject participation throughout the study was not found to be linked to study site size or type (GP or SP). CONCLUSION Questionnaire based observational studies may benefit from focusing resources on increasing questionnaire return rates to effectively maintain data reliability and also reduce non-response bias.
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Affiliation(s)
- R Balshaw
- Syreon Corporation, Vancouver, Canada
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Smith GN, Boydell J, Murray RM, Flynn S, McKay K, Sherwood M, Honer WG. The incidence of schizophrenia in European immigrants to Canada. Schizophr Res 2006; 87:205-11. [PMID: 16905294 DOI: 10.1016/j.schres.2006.06.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 06/08/2006] [Accepted: 06/14/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The risk for schizophrenia in immigrants to Europe is approximately three times that of native-born populations. Discrimination and marginalization may influence the risk for schizophrenia within migrant populations. The primary objective of the present study was to determine whether the risk associated with migration was also evident 100 years ago. A second objective was to determine whether changing social stresses are associated with changes to the incidence of schizophrenia. METHOD During the first two decades of the twentieth century, the Provincial Mental Hospital was the sole provider of psychiatric services in British Columbia, Canada. Detailed clinical records have been preserved for 99.5% of 2477 patients who had a psychiatric admission between 1902 and 1913. Diagnoses were made after a detailed file review and 807 patients met DSM-IV criteria for first-episode schizophrenia, schizophreniform disorder, schizoaffective disorder, or psychosis not otherwise specified. Diagnoses had high inter-rater reliability. The incidence of schizophrenia in migrants from Britain or Continental Europe was compared with that in the Canadian-born population using indirect standardization and Poisson models. RESULTS Migration from Britain or Continental Europe to Canada in the early twentieth century was associated with an increased rate of schizophrenia; IRR=1.54, (95% CI=1.33-1.78). Incidence increased over time in immigrants but not in the native-born population and this increase occurred during a period of economic recession. CONCLUSIONS Migration was a risk factor for schizophrenia a century ago as it is today. This risk occurred in white migrants from Europe and increased during a period of increased social stress.
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Affiliation(s)
- G N Smith
- Department of Psychiatry, University of British Columbia, 828 West 10th Ave, Vancouver, BC, Canada V5Z 1L8.
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Ehmann TS, Khanbhai I, Macewan GW, Smith GN, Honer WG, Flynn S, Altman S. Neuropsychological correlates of the PANSS Cognitive Factor. Psychopathology 2004; 37:253-8. [PMID: 15452413 DOI: 10.1159/000081022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2002] [Accepted: 06/21/2004] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Factor analytic studies of the Positive and Negative Syndrome Scale (PANSS) have consistently isolated a factor that is frequently labeled as 'cognitive'. The present study sought to further explore the factor by examining the relationships between 4 versions of the cognitive factor and a set of neuropsychological tests. METHOD Thirty-seven inpatients diagnosed with schizophrenia or schizoaffective disorder were assessed with the PANSS and neuropsychological measures. RESULTS Verbal intelligence and verbal memory were found to be most closely associated with cognitive factor scores. A global rating of illness severity showed greater relationships to cognitive variables than any cognitive factor. CONCLUSIONS The PANSS cognitive factor may reflect verbal ability and memory, but is not sufficiently comprehensive to be considered as a replacement for direct assessment of cognitive functioning.
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Affiliation(s)
- T S Ehmann
- Department of Psychiatry, St. Paul's Hospital, Vancouver, Canada
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Tierney J, Gowing H, Van Sinderen D, Flynn S, Stanley L, McHardy N, Hallahan S, Mulcahy G. In vitro inhibition of Eimeria tenella invasion by indigenous chicken Lactobacillus species. Vet Parasitol 2004; 122:171-82. [PMID: 15219358 DOI: 10.1016/j.vetpar.2004.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Revised: 03/22/2004] [Accepted: 05/04/2004] [Indexed: 11/21/2022]
Abstract
The aim of this study was to determine the effects of indigenous chicken Lactobacillus species isolates from different parts of the gastrointestinal tract on Eimeria tenella invasion in vitro and to characterise the nature of inhibition, if any. The effects of competitive exclusion, steric interference and bacterial extracellular factors on E. tenella invasion were examined in an MDBK cell model. Several Lactobacillus species were initially isolated from chickens and identified by biochemical characteristics and 16S-rRNA. All Lactobacillus species isolates tested, significantly inhibited E. tenella invasion. Steric interference did not affect parasite invasion. Extracellular metabolic factors secreted by Lactobacillus species isolates into the surrounding media were shown to inhibit parasite invasion and these factors appeared to be heat stable. These results show that the natural microflora of poultry can provide a source of E. tenella-inhibiting Lactobacillus species in vitro, and thus may contribute to the control of Eimeria infection.
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Affiliation(s)
- J Tierney
- Department of Veterinary Microbiology and Parasitology, Faculty of Veterinary Medicine, University College Dublin, Belfield, 4, Ireland.
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Chang L, Kjer-Nielsen L, Flynn S, Brooks AG, Mannering SI, Honeyman MC, Harrison LC, McCluskey J, Purcell AW. Novel strategy for identification of candidate cytotoxic T-cell epitopes from human preproinsulin. ACTA ACUST UNITED AC 2004; 62:408-17. [PMID: 14617048 DOI: 10.1034/j.1399-0039.2003.00122.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe a strategy for identifying ligands of human leukocyte antigen (HLA) class I molecules based on a peptide library-mediated in vitro assembly of recombinant class I molecules. We established a microscale class I assembly assay and used a capture ELISA to quantify the assembled HLA-peptide complexes. The identity of the bound ligands was then deduced by mass spectrometry. In this method, HLA complexes assembled in vitro in the presence of components of a mixture of peptides were immunoprecipitated and the bound peptide(s) identified by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. This process of epitope extraction is robust and can be used with complex mixtures containing in excess of 300 candidate ligands. A library of overlapping peptides representing all potential octamers, nonamers and decamers from human preproinsulin was synthesized using unique library chemistry. Peptides from the library were used to initiate assembly of recombinant HLA-B8, HLA-B15 and HLA-A2, facilitating the identification of candidate T-cell epitopes from preproinsulin.
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Affiliation(s)
- L Chang
- Department of Microbiology and Immunology and ImmunoID, University of Melbourne, Vic., Australia
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MacDonald IM, Hébert M, Yau RJ, Flynn S, Jumpsen J, Suh M, Clandinin MT. Effect of docosahexaenoic acid supplementation on retinal function in a patient with autosomal dominant Stargardt-like retinal dystrophy. Br J Ophthalmol 2004; 88:305-6. [PMID: 14736799 PMCID: PMC1772019 DOI: 10.1136/bjo.2003.024299] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morton LM, Holford TR, Leaderer B, Boyle P, Zahm SH, Zhang Y, Flynn S, Tallini G, Zhang B, Owens PH, Zheng T. Cigarette smoking and risk of non-Hodgkin lymphoma subtypes among women. Br J Cancer 2004; 89:2087-92. [PMID: 14647142 PMCID: PMC2376853 DOI: 10.1038/sj.bjc.6601388] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [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] [Indexed: 11/23/2022] Open
Abstract
Previous studies of the relationship between cigarette smoking and non-Hodgkin lymphoma (NHL) have yielded conflicting results, perhaps because most studies have evaluated the risk for all NHL subtypes combined. Data from a population-based case–control study conducted among women in Connecticut were used to evaluate the impact of cigarette smoking on the risk of NHL by histologic type, tumour grade, and immunologic type. A total of 601 histologically confirmed, incident cases of NHL and 718 population-based controls provided in-person interviews. A standardised, structured questionnaire was used to collect information on each subject's current smoking status, age at initiation, duration and intensity of smoking, and cumulative lifetime exposure to smoking. Our data suggest that cigarette smoking does not alter the risk of all NHL subtypes combined. However, increased risk of follicular lymphoma appears to be associated with increased intensity and duration of smoking, and cumulative lifetime exposure to smoking. Compared with nonsmokers, women with a cumulative lifetime exposure of 16–33 pack-years and 34 pack-years or greater experience 50% increased risk (OR=1.5, 95% CI 0.9–2.5) and 80% increased risk (OR=1.8, 95% CI 1.1–3.2), respectively, of follicular lymphoma (P for linear trend=0.05). Our study findings are consistent with several previous epidemiologic studies suggesting that cigarette smoking increases the risk of follicular lymphoma. This research highlights the importance of distinguishing between NHL subtypes in future research on the aetiology of NHL.
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Affiliation(s)
- L M Morton
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA
| | - T R Holford
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA
| | - B Leaderer
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA
| | - P Boyle
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan 20141, Italy
| | - S H Zahm
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, USA
| | - Y Zhang
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA
| | - S Flynn
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - G Tallini
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - B Zhang
- Department of Epidemiology and Biostatistics, McGill University, Montreal 3, Canada H3A1A2
| | - P H Owens
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA
| | - T Zheng
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA
- Department of Epidemiology and Public Health, Yale University School of Medicine, 129 Church Street, Suite 700, New Haven, CT 06510, USA. E-mail:
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Flynn S. Inoculation injuries at work. West J Med 2003. [DOI: 10.1136/bmj.326.7380.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marin DB, Flynn S, Mare M, Lantz M, Hsu MA, Laurans M, Paredes M, Shreve T, Zaklad GR, Mohs RC. Reliability and validity of a chronic care facility adaptation of the Clinical Dementia Rating scale. Int J Geriatr Psychiatry 2001; 16:745-50. [PMID: 11536340 DOI: 10.1002/gps.385] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study investigated the reliability and validity of a chronic care facility adaptation of the Clinical Dementia Rating scale (CDR-CC). METHOD Sixty-two residents in a chronic care facility participated in an inter-rater and 1 month test-retest reliability study. The instrument was validated against the Mini-Mental State Examination (MMSE). RESULTS Inter-rater and 1 month test-retest reliability for the global CDR-CC score were excellent (intraclass correlation coefficients 0.99 and 0.92, respectively). The CDR-CC domain and global scores were negatively correlated with the MMSE. CONCLUSIONS The CDR-CC is a global assessment tool that reliably and validly measures cognitive and functional impairment in a chronic care setting.
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Affiliation(s)
- D B Marin
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Dunne C, O'Mahony L, Murphy L, Thornton G, Morrissey D, O'Halloran S, Feeney M, Flynn S, Fitzgerald G, Daly C, Kiely B, O'Sullivan GC, Shanahan F, Collins JK. In vitro selection criteria for probiotic bacteria of human origin: correlation with in vivo findings. Am J Clin Nutr 2001; 73:386S-392S. [PMID: 11157346 DOI: 10.1093/ajcn/73.2.386s] [Citation(s) in RCA: 475] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The enteric flora comprises approximately 95% of the total number of cells in the human body and can elicit immune responses while protecting against microbial pathogens. However, the resident bacterial flora of the gastrointestinal tract may also be implicated in the pathogenesis of diseases such as inflammatory bowel disease (ulcerative colitis and Crohn disease). The objectives of the Probiotic Research Group based at University College Cork were to isolate and identify lactic acid bacteria exhibiting beneficial probiotic traits, such as bile tolerance in the absence of deconjugation activity, acid resistance, adherence to host epithelial tissue, and in vitro antagonism of pathogenic microorganisms or those suspected of promoting inflammation. To isolate potentially effective probiotic bacteria, we screened the microbial population adhering to surgically resected segments of the gastrointestinal tract (the environment in which they may subsequently be reintroduced and required to function). In total, 1500 bacterial strains from resected human terminal ilea were assessed. From among these organisms, Lactobacillus salivarius subsp. salivarius strain UCC118 was selected for further study. In mouse feeding trials, milk-borne L. salivarius strain UCC118 could successfully colonize the murine gastrointestinal tract. A human feeding study conducted in 80 healthy volunteers showed that yogurt can be used as a vehicle for delivery of strain UCC118 to the human gastrointestinal tract with considerable efficacy in influencing gut flora and colonization. In summary, we developed criteria for in vitro selection of probiotic bacteria that may reflect certain in vivo effects on the host such as modulation of gastrointestinal tract microflora.
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Affiliation(s)
- C Dunne
- Department of Microbiology, and the National Food Biotechnology Center, University College, Cork, Ireland
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Walker LS, Gulbranson-Judge A, Flynn S, Brocker T, Lane PJ. Co-stimulation and selection for T-cell help for germinal centres: the role of CD28 and OX40. Immunol Today 2000; 21:333-7. [PMID: 10871874 DOI: 10.1016/s0167-5699(00)01636-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Given the importance of responding to infections with the right defensive strategy, much interest has focused on cytokine differentiation in CD4+ T cells. However, relatively little is known of the logistics of T-cell help for B cells. Here, Lucy Walker and colleagues propose key roles for CD28 and OX40 in coordinating the selection, expansion and migration of CD4+ T cells to B-cell follicles.
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Affiliation(s)
- L S Walker
- MRC Centre for Immune Regulation, University of Birmingham, UK.
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Affiliation(s)
- S Flynn
- Clare Dixon project manager, Tim Amos clinical research fellow, Louis Appleby professor, School of Psychiatry and Behavioural Sciences, University of Manchester
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Abstract
Eighteen epileptic patients with unilateral temporal lobe epilepsy (9 left, 9 right) were evaluated with a verbal memory task involving recall of 2 stories, 1 with affective content and 1 that was neutral. A trend for better performance by the group with intact left hemispheres was found for a quantitative score of number of story units recalled. For a qualitative score of number of symbolic distortions, a main effect of affective load was found, such that more distortions were made for the story with affective than neutral content. This effect remained significant when the left temporal lobe epilepsy patients were analyzed separately and was not found for the right temporal lobe epilepsy patients alone. Additional analyses for the subset of 5 patients with left and 6 patients with right temporal lobectomies involving removal of the hippocampus and amygdala were in the same direction as the analyses for all 18 participants. These findings are consistent with other reports of material-specific memory deficits, such that verbal memory deficits are associated with left temporal lobe epilepsy. The differences between performance on the affective and neutral stories for the left and right temporal lobe epilepsy patients are discussed and related to the role of the amygdala in affective processing.
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Affiliation(s)
- L A Burton
- Psychology Department, Fordham University, Bronx, New York 10458, USA
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Dunne C, Murphy L, Flynn S, O'Mahony L, O'Halloran S, Feeney M, Morrissey D, Thornton G, Fitzgerald G, Daly C, Kiely B, Quigley EM, O'Sullivan GC, Shanahan F, Collins JK. Probiotics: from myth to reality. Demonstration of functionality in animal models of disease and in human clinical trials. Antonie Van Leeuwenhoek 1999. [PMID: 10532384 DOI: 10.1023/a:1002065931997] [Citation(s) in RCA: 261] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The enteric flora comprise approximately 95% of the total number of cells in the human body and are capable of eliciting immune responses while also protecting against microbial pathogens. However, the resident bacterial flora of the gastrointestinal tract (GIT) may also be implicated in the pathogenesis of several chronic conditions such as inflammatory bowel disease (IBD). The University College Cork-based Probiotic Research Group has successfully isolated and identified lactic acid bacteria (LAB) which exhibit beneficial probiotic traits. These characteristics include the demonstration of bile tolerance; acid resistance; adherence to host epithelial tissue; and in vitro antagonism of potentially-pathogenic micro-organisms or those which have been implicated in promoting inflammation. The primary objective of this report is to describe the strategy adopted for the selection of potentially effective probiotic bacteria. The study further describes the evaluation of two members of the resulting panel of micro-organisms (Lactobacillus salivarius subsp. salivarius UCC118 and Bifidobacterium longum infantis 35624) under in vitro conditions and throughout in vivo murine and human feeding trials. Specifically, an initial feeding study completed in Balb/c mice focused upon (i) effective delivery of the probiotic micro-organisms to the GIT and evaluation of the ability of the introduced strains to survive transit through, and possibly colonise, the murine GIT; (ii) accepting the complexity of the hostile GIT and faecal environments, development of a method of enumerating the introduced bacterial strains using conventional microbiological techniques; and (iii) assessment of the effects of administered bacterial strains on the numbers of specific recoverable indigenous bacteria in the murine GIT and faeces. Additional research, exploiting the availability of murine models of inflammatory bowel disease, demonstrated the beneficial effects of administering probiotic combinations of Lactobacillus salivarius UCC118 and Bifidobacterium longum infantis 35624 in prevention of illness-related weight loss. A further ethically-approved feeding trial, successfully conducted in 80 healthy volunteers, demonstrated that yoghurt can be used as a vehicle for delivery of Lactobacillus salivarius strain UCC118 to the human GIT with considerable efficacy in influencing gut flora and colonisation.
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Affiliation(s)
- C Dunne
- Department of Microbiology, University College, Cork, Ireland
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Abstract
Two kindreds with familial medullary thyroid carcinoma (MTC) are described in which affected family members had variable clinical and pathologic manifestations. Genetic testing in 2 children from one kindred revealed a mutation in exon 10, codon 618 (TGC to AGC) in the extracellular cysteine-rich region of the RET gene. In this kindred an 11-year-old had microscopic evidence of MTC; however, a 17-year-old had no evidence of pathology on thyroidectomy. In a second kindred a rare mutation in exon 14, codon 804 (GTG to TTG) of the intracellular tyrosine kinase region of the RET gene was detected. In this kindred MTC has occurred in the 4th to 5th decades of life, with a clinical spectrum in mutation-positive family members ranging from no disease and C-cell hyperplasia to carcinoma with lymph node metastasis; a 7-year-old with the mutation and a normal response to provocative testing was also identified. Management recommendations in children from families with clearly defined familial MTC may be individualized to reflect emerging genotype-phenotype correlations.
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Affiliation(s)
- R A Heptulla
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8000, USA
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48
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Dunne C, Murphy L, Flynn S, O'Mahony L, O'Halloran S, Feeney M, Morrissey D, Thornton G, Fitzgerald G, Daly C, Kiely B, Quigley EM, O'Sullivan GC, Shanahan F, Collins JK. Probiotics: from myth to reality. Demonstration of functionality in animal models of disease and in human clinical trials. Antonie Van Leeuwenhoek 1999; 76:279-92. [PMID: 10532384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The enteric flora comprise approximately 95% of the total number of cells in the human body and are capable of eliciting immune responses while also protecting against microbial pathogens. However, the resident bacterial flora of the gastrointestinal tract (GIT) may also be implicated in the pathogenesis of several chronic conditions such as inflammatory bowel disease (IBD). The University College Cork-based Probiotic Research Group has successfully isolated and identified lactic acid bacteria (LAB) which exhibit beneficial probiotic traits. These characteristics include the demonstration of bile tolerance; acid resistance; adherence to host epithelial tissue; and in vitro antagonism of potentially-pathogenic micro-organisms or those which have been implicated in promoting inflammation. The primary objective of this report is to describe the strategy adopted for the selection of potentially effective probiotic bacteria. The study further describes the evaluation of two members of the resulting panel of micro-organisms (Lactobacillus salivarius subsp. salivarius UCC118 and Bifidobacterium longum infantis 35624) under in vitro conditions and throughout in vivo murine and human feeding trials. Specifically, an initial feeding study completed in Balb/c mice focused upon (i) effective delivery of the probiotic micro-organisms to the GIT and evaluation of the ability of the introduced strains to survive transit through, and possibly colonise, the murine GIT; (ii) accepting the complexity of the hostile GIT and faecal environments, development of a method of enumerating the introduced bacterial strains using conventional microbiological techniques; and (iii) assessment of the effects of administered bacterial strains on the numbers of specific recoverable indigenous bacteria in the murine GIT and faeces. Additional research, exploiting the availability of murine models of inflammatory bowel disease, demonstrated the beneficial effects of administering probiotic combinations of Lactobacillus salivarius UCC118 and Bifidobacterium longum infantis 35624 in prevention of illness-related weight loss. A further ethically-approved feeding trial, successfully conducted in 80 healthy volunteers, demonstrated that yoghurt can be used as a vehicle for delivery of Lactobacillus salivarius strain UCC118 to the human GIT with considerable efficacy in influencing gut flora and colonisation.
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Affiliation(s)
- C Dunne
- Department of Microbiology, University College, Cork, Ireland
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49
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Jensen CA, Flynn S, Cozza MA, Karabin J. Including the ultimate: a spiritual focus treatment program in an inpatient psychiatric area of a hospital in partnership with a pastoral counseling center. J Pastoral Care 1999; 52:339-48. [PMID: 10344826 DOI: 10.1177/002234099805200403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Describes how an American Association of Pastoral Counselor (AAPC) accredited pastoral counseling center and a community medical center developed in inpatient psychiatric treatment program which integrated the spiritual/religious resources of patients. Outlines the process of collaboration, some basic principles of the integration of faith resources, the ways that staff resistance surfaced and substantially was overcome, and the positive responses of patients. Notes the decision to base treatment on the religious/spiritual position of patients (rather than of therapists), the role of the therapist in this model, and some relevant isomorphic replications.
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Affiliation(s)
- C A Jensen
- Pittsburgh Pastoral Institute, PA 15206, USA
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50
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Brocker T, Gulbranson-Judge A, Flynn S, Riedinger M, Raykundalia C, Lane P. CD4 T cell traffic control: in vivo evidence that ligation of OX40 on CD4 T cells by OX40-ligand expressed on dendritic cells leads to the accumulation of CD4 T cells in B follicles. Eur J Immunol 1999; 29:1610-6. [PMID: 10359115 DOI: 10.1002/(sici)1521-4141(199905)29:05<1610::aid-immu1610>3.0.co;2-8] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report here that CD40- but not lipopolysaccharide (LPS)-activated murine dendritic cells (DC) express OX40-ligand (OX40L) as has been reported in humans. To understand how OX40 ligation affects differentiation of CD4 T cells at the time of priming, we constitutively expressed OX40L on DC using the DC-specific promoter of CD11c. Transgenic mice showed greatly increased numbers of CD4 but not CD8 T cells in their B cell areas. This effect was to a great extent immunization dependent, as spleen and lymphoid tissue with no germinal center reactions from mice which had not been deliberately immunized did not show marked CD4 T cell accumulation. The increased numbers of CD4+ CD62low cells in transgenic mice suggest that it is activated CD4 T cells that accumulate within B cell follicles. These data are consistent with the notion that physiological engagement of OX40 (CD134) on activated CD4 T cells either initiates their migration into or causes them to be retained in B follicles. In contrast, LPS-treated CD did not up-regulate OX40L expression. This dichotomy provides a molecular explanation of how DC might integrate environmental and accessory signals to control cytokine differentiation and migration in CD4 effector cells.
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Affiliation(s)
- T Brocker
- Max-Planck-Institute for Immunbiology, Freiburg, Germany
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