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Fisher OJ, Donahoo C, Bosley E, du Cloux R, Garner S, Powell S, Pickard J, Grevis-James N, Wyder M. Barriers and enablers to implementing police mental health co-responder programs: A qualitative study using the consolidated framework for implementation research. Implement Res Pract 2024; 5:26334895231220259. [PMID: 38322801 PMCID: PMC10775732 DOI: 10.1177/26334895231220259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background Police and mental health co-responder programs operate internationally and can be effective in providing timely and appropriate assessment, brief intervention, and referral services for people experiencing mental health crises. However, these models vary greatly, and little is known about how the design and implementation of these programs impacts their effectiveness. Method This study was a qualitative, post hoc implementation determinant evaluation of mental health co-responder units in Brisbane, Australia, comprising of verbal or written interviews with police and mental health staff with an on-road role in the co-responder units, and their managers. The Consolidated Framework for Implementation Research was used to identify barriers and enablers to the program's implementation and effectiveness. Results Participants (n = 30) from all groups felt strongly that the co-responder units are a substantial improvement over the usual police management of mental health crisis cases, and lead to better outcomes for consumers and the service. Enablers included an information-sharing agreement; the Mental Health Co-Responder (MHCORE) program's compatibility with existing police and mental health services; and the learning opportunity for both organizations. Barriers included cultural differences between the organizations, particularly risk-aversion to suicidality for police and a focus on least-restrictive practices for health; extensive documentation requirements for health; and a lack of specific mental health training for police. Conclusions Using an evidence-based implementation science framework enabled identification of a broad range of contextual barriers and enablers to implementation of police mental health co-responder programs. Adapting the program to address these barriers and enablers during the planning, implementation, monitoring, and evaluation phases increases the likelihood of the service's effectiveness. These findings will inform the spread and scale of the co-responder program across Queensland, and will be relevant to police districts internationally considering implementing a co-responder program.
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Affiliation(s)
- O. J. Fisher
- Health Services Research, Wesley Research Institute, Brisbane, Australia
- Implementation Support, Research and Evaluation Unit, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
- Faculty of Health, Charles Darwin University, Brisbane, Australia
| | - C. Donahoo
- Implementation Support, Research and Evaluation Unit, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
| | - E. Bosley
- Implementation Support, Research and Evaluation Unit, Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
| | - R. du Cloux
- State Domestic, Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Australia
| | - S. Garner
- Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia
| | - S. Powell
- Addiction and Mental Health Service, Metro South Health, Queensland Health, Brisbane, Australia
| | - J. Pickard
- State Domestic, Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Australia
| | - N. Grevis-James
- State Domestic, Family Violence and Vulnerable Persons Unit, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, Australia
| | - M. Wyder
- Addiction and Mental Health Service, Metro South Health, Queensland Health, Brisbane, Australia
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Ryan B, Kako M, Fink R, Şimşek P, Barach P, Acosta J, Bhatia S, Brickhouse M, Fendt M, Fontenot A, Arenas Garcia N, Garner S, Gunduz A, Hardin DM, Hatch T, Malrey-Horne L, MacDermot M, Kayano R, McKone J, Noel C, Nomura S, Novak J, Stricklin A, Swienton R, Tayfur I, Brooks B. Strategies for Strengthening the Resilience of Public Health Systems for Pandemics, Disasters, and Other Emergencies. Disaster Med Public Health Prep 2023; 17:e479. [PMID: 37667881 DOI: 10.1017/dmp.2023.136] [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] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach. METHODS The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations. RESULTS Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions. CONCLUSIONS The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.
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Affiliation(s)
- Benjamin Ryan
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
- Frist College of Medicine, Belmont University, Nashville, Tennessee, USA
| | - Mayumi Kako
- Hiroshima University, School of Biomedical and Health Sciences, Division of Nursing Science, Hiroshima, Japan
| | - Rok Fink
- University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
| | - Perihan Şimşek
- Department of Emergency Aid and Disaster Management, Trabzon University, Trabzon, Turkey
| | - Paul Barach
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- University of Queensland School of Medicine, Brisbane, Australia
| | - Jose Acosta
- Engineering and Computer Science, Baylor University, Waco, Texas, USA
| | - Sanjaya Bhatia
- United Nations Office for Disaster Risk Reduction Global Education and Training Institute, Incheon, Republic of Korea
| | | | - Matthew Fendt
- Engineering and Computer Science, Baylor University, Waco, Texas, USA
| | - Alicia Fontenot
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Nahuel Arenas Garcia
- United Nations Office for Disaster Risk Reduction Regional Office for the Americas and Caribbean, Panama
| | - Shelby Garner
- Gordon E. Inman College of Health Sciences and Nursing, Belmont University, Nashville, Tennessee, USA
| | - Abdülkadir Gunduz
- Karadeniz Technical University, Faculty of Medicine, Department of Emergency Medicine, Trabzon, Turkey
| | | | - Tim Hatch
- Alabama Department of Public Health, Montgomery, Alabama, USA
| | | | - Makiko MacDermot
- World Health Organization Centre of Health Development, Kobe, Japan
| | - Ryoma Kayano
- World Health Organization Centre of Health Development, Kobe, Japan
| | - Joshua McKone
- Engineering and Computer Science, Baylor University, Waco, Texas, USA
| | - Chaverle Noel
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | | | - Andrew Stricklin
- Department of Emergency Medicine, UT Southwestern, Dallas, Texas, USA
| | - Raymond Swienton
- Department of Emergency Medicine, UT Southwestern, Dallas, Texas, USA
| | - Ismail Tayfur
- Department of Emergency Medicine, University of Health Sciences, Istanbul, Turkey
| | - Bryan Brooks
- Department of Environmental Science, Environmental Health Science Program, Baylor University, Waco, Texas, USA
- Department of Public Health, Baylor University, Waco, Texas, USA
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Pollard AJ, Garner S, Patel S, Jerreat M. A Retrospective Service- Evaluation of Implant Success, Survival, Periimplant Health and Prosthetic Complications in a Cohort of Head and Neck Cancer Patients. Eur J Prosthodont Restor Dent 2023; 31:92-103. [PMID: 35917210 DOI: 10.1922/ejprd_2441pollard12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine the success, survival, peri-implant health and prosthetic complications in head and neck cancer patients receiving oral rehabilitation utilising dental implants between 2008 and the present day. MATERIALS AND METHODS Service evaluation. Survival Group: Retrospective review of records to determine implant survival and prosthetic complications. Success Group: Examination to determine implant success and health. RESULTS Survival Group: 260 implants in 81 individuals, median follow up 49.2 months. 89.3% implant survival at 96 months, no further failures up to 133 months. 40.9% individuals required repair or remake of prosthesis by 72 months - mostly denture re-lines. Success group: 164 implants in 48 individuals, median follow up 56 months. Peri-implant mucositis detected in 22% of fixtures (37.5% individuals); peri-implantitis in 12.8% (25% individuals); 33.3% fixtures exhibiting periimplantitis at 120 months. Previous smoking significantly associated with development of peri-implantitis (HR 2.372, p=0.032, 95CI:1.232, 93.317). Compromised survival (e.g. peri-implantitis), absolute (not in mouth) or clinical failure estimated to occur in 28.1% fixtures at 101 months, mostly due to peri-implantitis. CONCLUSIONS There is a large burden of ongoing care in this cohort, requiring interventions to improve peri-implant health and maintain complex prostheses. Oral rehabilitation and ongoing maintenance in this cohort is complex and multi-disciplinary.
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Affiliation(s)
- A J Pollard
- University of Bristol Dental Hospital, Bristol
- Musgrove Park Hospital, Taunton
- Peninsula Dental School, University of Plymouth, Plymouth
| | - S Garner
- University of Bristol Dental Hospital, Bristol
- Musgrove Park Hospital, Taunton
| | - S Patel
- Musgrove Park Hospital, Taunton
| | - M Jerreat
- Musgrove Park Hospital, Taunton
- Peninsula Dental School, University of Plymouth, Plymouth
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Garner S. From value-based pricing to fair pricing: the role of HTA for UHC. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The UHC key concepts and relevant UN resolutions recommending transparency, including in relation to HTA and pricing. The role of innovation and intellectual property frameworks will be discussed, including financing and co-ordination of R&D for health technologies. Examples on the importance information exchange can play to improve negotiations will also be discussed, along with key considerations, commonalities and differences for for developed and developing countries.
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Affiliation(s)
- S Garner
- Health Technologies and Pharmaceuticals Programme, Division, WHO/Europe, Copenhagen, Denmark
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6
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Keshri S, Marín-Sáez J, Naydenova I, Murphy K, Atencia J, Chemisana D, Garner S, Collados MV, Martin S. Stacked volume holographic gratings for extending the operational wavelength range in LED and solar applications. Appl Opt 2020; 59:2569-2579. [PMID: 32225798 DOI: 10.1364/ao.383577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
A novel stacking procedure is presented for volume phase holographic gratings (VPHGs) recorded in photopolymer material using Corning Willow Glass as a flexible substrate in order to achieve broader angular and spectral selectivity in a diffractive device with high efficiency for solar and LED applications. For the first time to our knowledge, we have shown a device designed for use with a white LED that has the same input and output angles and high efficiency when illuminated by different wavelengths. In this paper, two VPHGs were designed, experimentally recorded, and tested when illuminated at normal incidence. The experimental approach is based on stacking two individual gratings in which the spatial frequency and slant have been tailored to the target wavelength and using real-time on-Bragg monitoring of the gratings in order to control the recorded refractive index modulation, thereby optimizing each grating efficiency for its design wavelength. Lamination of the two gratings together was enabled by using a flexible glass substrate (Corning Willow Glass). Recording conditions were studied in order to minimize the change in diffraction efficiency and peak diffraction angle during lamination and bleaching. The final fabricated stacked device was illuminated by a white light source, and its output was spectrally analyzed. Compared to a single grating, the stacked device demonstrated a twofold increase in angular and wavelength range. The angular and wavelength selectivity curves are in good agreement with the theoretical prediction for this design. This approach could be used to fabricate stacked lenses for white light LED or solar applications.
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Barbolla L, Nieto S, llamas P, Moreno C, Contreras M, Lubenko A, Garner S. Severe Immune Haemolytic Anaemia Caused by Intravenous Immunoglobulin Anti-D in the Treatment of Autoimmune Thrombocytopenia. Vox Sang 2017. [DOI: 10.1159/000462340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hirsch G, Trusheim M, Cobbs E, Bala M, Garner S, Hartman D, Isaacs K, Lumpkin M, Lim R, Oye K, Pezalla E, Saltonstall P, Selker H. Corrigendum: Adaptive biomedical innovation: Evolving our global system to sustainably and safely bring new medicines to patients in need. Clin Pharmacol Ther 2017; 101:542. [DOI: 10.1002/cpt.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 11/09/2022]
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9
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Hirsch G, Trusheim M, Cobbs E, Bala M, Garner S, Hartman D, Isaacs K, Lumpkin M, Lim R, Oye K, Pezalla E, Saltonstall P, Selker H. Adaptive Biomedical Innovation: Evolving Our Global System to Sustainably and Safely Bring New Medicines to Patients in Need. Clin Pharmacol Ther 2016; 100:685-698. [PMID: 27626610 PMCID: PMC5129677 DOI: 10.1002/cpt.509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/10/2023]
Abstract
The current system of biomedical innovation is unable to keep pace with scientific advancements. We propose to address this gap by reengineering innovation processes to accelerate reliable delivery of products that address unmet medical needs. Adaptive biomedical innovation (ABI) provides an integrative, strategic approach for process innovation. Although the term "ABI" is new, it encompasses fragmented "tools" that have been developed across the global pharmaceutical industry, and could accelerate the evolution of the system through more coordinated application. ABI involves bringing stakeholders together to set shared objectives, foster trust, structure decision-making, and manage expectations through rapid-cycle feedback loops that maximize product knowledge and reduce uncertainty in a continuous, adaptive, and sustainable learning healthcare system. Adaptive decision-making, a core element of ABI, provides a framework for structuring decision-making designed to manage two types of uncertainty - the maturity of scientific and clinical knowledge, and the behaviors of other critical stakeholders.
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Affiliation(s)
- G Hirsch
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - M Trusheim
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - E Cobbs
- Merck, Kenilworth, New Jersey, USA
| | - M Bala
- Sanofi, Seattle, Washington, USA
| | - S Garner
- National Institute for Health and Clinical Excellence (NICE), London, UK
| | - D Hartman
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - K Isaacs
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - M Lumpkin
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - R Lim
- Health Canada, Ottawa, Ontario, Canada
| | - K Oye
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - P Saltonstall
- National Organization for Rare Disorders (NORD), Danbury, Connecticut, USA
| | - H Selker
- Tufts University, Boston, Massachusetts, USA
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Schneeweiss S, Eichler HG, Garcia-Altes A, Chinn C, Eggimann AV, Garner S, Goettsch W, Lim R, Löbker W, Martin D, Müller T, Park BJ, Platt R, Priddy S, Ruhl M, Spooner A, Vannieuwenhuyse B, Willke RJ. Real World Data in Adaptive Biomedical Innovation: A Framework for Generating Evidence Fit for Decision-Making. Clin Pharmacol Ther 2016; 100:633-646. [DOI: 10.1002/cpt.512] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/24/2022]
Affiliation(s)
- S Schneeweiss
- Division of Pharmacoepidemiology (DoPE), Department of Medicine; Brigham & Women's Hospital; Boston Massachusetts USA
| | - H-G Eichler
- European Medicines Agency (EMA); London United Kingdom
| | - A Garcia-Altes
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Barcelona Spain
| | | | | | - S Garner
- National Institute for Health and Care Excellence (NICE); London United Kingdom
| | - W Goettsch
- National Health Care Institute, Diemen and Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences; Utrecht The Netherlands
| | - R Lim
- Health Products and Food Branch; Health Canada; Ottawa Ontario Canada
| | - W Löbker
- Gemeinsamer Bundesausschuss (GBA); Abteilung Arzneimittel; Berlin Germany
| | - D Martin
- Center for Drug Evaluation and Research; U.S. Food and Drug Administration; Silver Spring Maryland USA
| | - T Müller
- Gemeinsamer Bundesausschuss (GBA); Abteilung Arzneimittel; Berlin Germany
| | - BJ Park
- Seoul National University, College of Medicine, Department of Preventive Medicine; Seoul South Korea
| | - R Platt
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Healthcare Institute; Boston Massachusetts USA
| | - S Priddy
- Comprehensive Health Insights (CHI), Humana; Louisville Kentucky USA
| | - M Ruhl
- Aetion Inc.; New York NY USA
| | - A Spooner
- Health Products Regulatory Authority (HPRA); Dublin Ireland
| | - B Vannieuwenhuyse
- Innovative Medicine Initiative - European Medical Information Framework, Janssen Pharmaceutica Research and Development; Beerse Belgium
| | - RJ Willke
- International Society for Pharmacoeconomics and Outcomes Research; Lawrenceville New Jersey USA
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Bouvy JC, Jonsson P, Longson C, Crabb N, Garner S. Health Technology Assessment in the Context of Adaptive Pathways for Medicines in Europe: Challenges and Opportunities. Clin Pharmacol Ther 2016; 100:594-597. [DOI: 10.1002/cpt.448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/13/2023]
Affiliation(s)
- JC Bouvy
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - P Jonsson
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - C Longson
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - N Crabb
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
| | - S Garner
- National Institute for Health and Care Excellence (NICE); London England United Kingdom
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12
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Garner S, Barbour ME. Nanoparticles for controlled delivery and sustained release of chlorhexidine in the oral environment. Oral Dis 2015; 21:641-4. [DOI: 10.1111/odi.12328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S Garner
- Oral Nanoscience; School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - ME Barbour
- Oral Nanoscience; School of Oral and Dental Sciences; University of Bristol; Bristol UK
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13
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Eichler HG, Baird LG, Barker R, Bloechl-Daum B, Børlum-Kristensen F, Brown J, Chua R, Del Signore S, Dugan U, Ferguson J, Garner S, Goettsch W, Haigh J, Honig P, Hoos A, Huckle P, Kondo T, Le Cam Y, Leufkens H, Lim R, Longson C, Lumpkin M, Maraganore J, O'Rourke B, Oye K, Pezalla E, Pignatti F, Raine J, Rasi G, Salmonson T, Samaha D, Schneeweiss S, Siviero PD, Skinner M, Teagarden JR, Tominaga T, Trusheim MR, Tunis S, Unger TF, Vamvakas S, Hirsch G. From adaptive licensing to adaptive pathways: delivering a flexible life-span approach to bring new drugs to patients. Clin Pharmacol Ther 2015; 97:234-46. [PMID: 25669457 PMCID: PMC6706805 DOI: 10.1002/cpt.59] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [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: 12/01/2014] [Accepted: 12/04/2014] [Indexed: 12/15/2022]
Abstract
The concept of adaptive licensing (AL) has met with considerable interest. Yet some remain skeptical about its feasibility. Others argue that the focus and name of AL should be broadened. Against this background of ongoing debate, we examine the environmental changes that will likely make adaptive pathways the preferred approach in the future. The key drivers include: growing patient demand for timely access to promising therapies, emerging science leading to fragmentation of treatment populations, rising payer influence on product accessibility, and pressure on pharma/investors to ensure sustainability of drug development. We also discuss a number of environmental changes that will enable an adaptive paradigm. A life‐span approach to bringing innovation to patients is expected to help address the perceived access vs. evidence trade‐off, help de‐risk drug development, and lead to better outcomes for patients.
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Conrad JR, Wyneken J, Garner JA, Garner S. Experimental study of dune vegetation impact and control on leatherback sea turtle Dermochelys coriacea nests. ENDANGER SPECIES RES 2011. [DOI: 10.3354/esr00361] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wise R, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. The urgent need for new antibacterial agents. J Antimicrob Chemother 2011; 66:1939-40. [DOI: 10.1093/jac/dkr261] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Finch R, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Regulatory opportunities to encourage technology solutions to antibacterial drug resistance. J Antimicrob Chemother 2011; 66:1945-7. [DOI: 10.1093/jac/dkr259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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White AR, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Effective antibacterials: at what cost? The economics of antibacterial resistance and its control. J Antimicrob Chemother 2011; 66:1948-53. [DOI: 10.1093/jac/dkr260] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [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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Livermore DM, Blaser M, Carrs O, Cassell G, Fishman N, Guidos R, Levy S, Powers J, Norrby R, Tillotson G, Davies R, Projan S, Dawson M, Monnet D, Keogh-Brown M, Hand K, Garner S, Findlay D, Morel C, Wise R, Bax R, Burke F, Chopra I, Czaplewski L, Finch R, Livermore D, Piddock LJV, White T. Discovery research: the scientific challenge of finding new antibiotics. J Antimicrob Chemother 2011; 66:1941-4. [DOI: 10.1093/jac/dkr262] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tandon L, Hastings E, Banar J, Barnes J, Beddingfield D, Decker D, Dyke J, Farr D, FitzPatrick J, Gallimore D, Garner S, Gritzo R, Hahn T, Havrilla G, Johnson B, Kuhn K, LaMont S, Langner D, Lewis C, Majidi V, Martinez P, McCabe R, Mecklenburg S, Mercer D, Meyers S, Montoya V, Patterson B, Pereyra RA, Porterfield D, Poths J, Rademacher D, Ruggiero C, Schwartz D, Scott M, Spencer K, Steiner R, Villarreal R, Volz H, Walker L, Wong A, Worley C. Nuclear, chemical, and physical characterization of nuclear materials. J Radioanal Nucl Chem 2008. [DOI: 10.1007/s10967-008-0528-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic auto-immune disorder, in which the synovial lining of many joints and tendon sheaths are persistently inflamed. OBJECTIVES To assess the efficacy and toxicity of rofecoxib for treating RA. SEARCH STRATEGY We searched the following databases up to December 2000: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Research Register, NHS Economic Evaluation Database, Health Technology Assessment database. The bibliographies of retrieved papers were scanned for additional references. The manufacturers of rofecoxib, MSD, were also approached by the UK National Institue for Clincal Excellence to submit additional evidence to inform it's appraisal on the use of cyclo-oxygenase inibitors for arthritis. SELECTION CRITERIA Relevant studies were randomised controlled trials of parallel group design evaluating the efficacy and/or toxicity of rofecoxib in RA, both placebo based and comparative trials were eligible. Relevant outcome criteria had to be available to evaluate efficacy and/or toxicity, such as the OMERACT outcomes. DATA COLLECTION AND ANALYSIS Data were abstracted independently by two reviewers and the results were compared for the degree of agreement. A validated tool (Jadad 1995) was used to score the quality of the randomised controlled trials. The planned analysis was to pool, where appropriate, continuous outcome measures using mean or standardized mean differences, and dichotomous outcome measures using relative risk ratios. MAIN RESULTS Two randomised controlled trials evaluating the efficacy and toxicity of rofecoxib in RA were identified and met the criteria. One compared rofecoxib to placebo and the other compared rofecoxib to naproxen. The overall number of ACR 20 responders who had received 25mg (82/ 171 = 48%) or 50mg (86/161 = 53%) was statistically significantly more than those receiving placebo (58/168 = 35% ) (RR 1.39 CI: 1.07, 1.80 and RR 1.55 CI: 1.20, 1.99 respectively) with no statistically significant differences between the 25 and 50 mg doses. The safety profile of rofecoxib was similar to that of placebo. In the comparative trial, rofecoxib at a dosage of 50 mg/day demonstrated similar efficacy to naproxen at a dosage of 500 mg twice daily. However, the combined rate of clinically significant complicated gastro-intestinal events (GI) (perforations, ulcers, bleeds, or obstructions) was lower with rofecoxib than with naproxen (RR 0.46, 95% CI, 0.34 to 0.63) due to a reduction in the number of ulcers and bleeds. Patients taking rofecoxib had a greater risk of having a myocardial infarction (MI) than patients taking naproxen (RR 4.03, 95% CI, 2.86 to 5.68). REVIEWER'S CONCLUSIONS In patients with RA, rofecoxib demonstrates a greater degree of efficacy than placebo, while having a comparable safety profile. Rofecoxib demonstrates a similar degree of efficacy as naproxen, but with a significantly lower rate of ulceration and gastrointestinal bleeding. Rofecoxib was associated with a greater risk for MI, but the exact significance and pathophysiology of this possible relationship is unclear.
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Affiliation(s)
- S Garner
- National Institute for Clinical Excellence, 11 Strand, London, UK, WC1N 5HR.
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Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of potentially life threatening gastroduodenal perforations, ulcers and bleeds. The NSAIDs known as the selective Cox II inhibitors, of which celecoxib is a member, were developed in order to reduce the GI toxicity, but are more expensive. OBJECTIVES To establish the efficacy and safety of celecoxib in the management of RA by systematic review of available evidence. SEARCH STRATEGY We searched the following databases up to August 2002: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, National Research Register, NHS Economic Evaluation Database, Health Technology Assessment Database. The bibliographies of retrieved papers and content experts were consulted for additional references. SELECTION CRITERIA All eligible randomised controlled trials (RCTs) were included. No unpublished RCTs were included in this edition of the review. DATA COLLECTION AND ANALYSIS Data were abstracted independently by two reviewers. Data was analysed using a fixed effects model. A validated checklist was used to score the quality of the RCTs. The planned analysis was to pool, where appropriate continuous outcomes using mean differences and dichotomous outcomes using relative risk ratios. This was not however possible due to the lack of data. MAIN RESULTS Five RCTs were included (4465 participants); three of the studies also enrolled individuals with OA. The comparators were placebo, naproxen, diclofenac and ibuprofen. The evidence reviewed suggests that celecoxib controls the symptoms of RA to a similar degree to that of the active comparators examined (naproxen, diclofenac and ibuprofen). When compared to placebo, the percentage of patients showing improvement according to ACR 20 criteria at week 4 were 42/82 (51%) in the twice daily celecoxib 200mg group and 43/82 (52%) in the twice daily celecoxib 400mg group; these were significantly different from the placebo group in which 25/85 (29%) improved. The six month data reviewed support a reduced rate of UGI complications with celecoxib but there is also evidence to suggest that these benefits may not be evident in the long-term and that celecoxib offers no additional benefit in patients who are also receiving cardio-prophylactic low dose aspirin. REVIEWER'S CONCLUSIONS For an individual with RA the potential benefits of celecoxib need to be balanced against the uncertainty that the short-term reduced incidence of upper GI complications are maintained in the long-term and its increased cost in comparison to traditional NSAIDs.
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Affiliation(s)
- S Garner
- Department of Public Health, St. George's Hospital Medical School, Cranmer Terrace, London, UK, SW17 0RE.
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Abstract
This article presents a brief history of windsurfing, a relatively new recreational and competitive sport activity also known as sailboarding; a brief summary of physiologic studies of windsurfers; and a review of windsurfing injuries with a focus on the neurological complications of windsurfing.
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Affiliation(s)
- C K Jablecki
- Department of Neurosciences, University of California San Diego Medical School, USA
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Hughes D, Jackson D, Kumpel B, Garner S, Ouwehand WH. Induction of a secondary human HPA-5B alloimmune response in SCID mice engrafted with human lymphocytes and antigen-pulsed autologous dendritic cells. Transfus Med 2000. [DOI: 10.1046/j.1365-3148.2000.00261-20.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barnett D, Storie I, Granger V, Whitby L, Reilly JT, Brough S, Garner S, Lawry J, Richards S, Bell AE, Shenton BK. Standardization of lymphocyte antibody binding capacity - a multi-centre study. Clin Lab Haematol 2000; 22:89-96. [PMID: 10792398 DOI: 10.1046/j.1365-2257.2000.00286.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As quantitative flow cytometry is being increasingly used to characterize non-malignant and malignant disorders, interlaboratory standardization becomes an important issue. However, the lack of standardized methods and process controls with predefined antibody binding capacity values, limits direct interlaboratory comparison. The present study has addressed these issues using a stable whole blood product and a standardized antigen quantification protocol. It was demonstrated that: (i) a standard technical protocol can result in a high degree of interlaboratory concordance; (ii) interlaboratory variation of less than 12% can be achieved for CD4 antibody binding capacity values; and (iii) stable whole blood can be used as a process control with predefined antibody binding capacity values. Furthermore, using such an approach, a normal range was established for CD3, CD4 CD8 and CD19. These antigens appear to be expressed in a hierarchical manner, a factor that could be used as a procedural quality control measure.
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Affiliation(s)
- D Barnett
- UK NEQAS for Leucocyte Immunophenotyping, Royal Hallamshire Hospital (co-ordinating centre), Sheffield, UK.
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25
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Seager JM, Cullen DJ, Pearson G, Holmes S, Doherty M, Wilson JV, Garrud P, Garner S, Maynard A, Logan RF, Hawkey CJ. Ibuprofen versus other non-steroidal anti-inflammatory drugs: use in general practice and patient perception. Aliment Pharmacol Ther 2000; 14:187-91. [PMID: 10651659 DOI: 10.1046/j.1365-2036.2000.00699.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To investigate whether ibuprofen was as well-regarded by patients as other non-steroidal anti-inflammatory drugs (NSAIDs). DESIGN Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS Unselected patients receiving NSAIDs prescribed for all indications for use. MAIN OUTCOME MEASURES Effectiveness of ibuprofen and other NSAIDs, possible drug related adverse events, patients' overall satisfaction with ibuprofen and other NSAIDs, factors associated with choice of ibuprofen, drug costs of ibuprofen and other NSAIDs. RESULTS The main NSAIDs used were ibuprofen, diclofenac and naproxen. Ibuprofen use ranged from 1.0% of prescriptions in one practice to 69.1% in another. Although ibuprofen was generally prescribed in low doses, it was perceived by patients as being as effective as the other NSAIDs used, even after allowing for severity of the pre-treatment condition. Overall, 50.5% of patients rated their NSAID the best treatment they had received for their condition with no differences between individual drugs. CONCLUSIONS Ibuprofen is as highly regarded as other NSAIDs when used in similar circumstances. Switching patients to ibuprofen may be a realistic way of reducing financial and medical costs associated with NSAIDs.
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Affiliation(s)
- J M Seager
- Division of Gastroenterology, University Hospital, Nottingham, UK.
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Cullen DJ, Seager JM, Holmes S, Doherty M, Wilson JV, Garrud P, Garner S, Maynard A, Logan RF, Hawkey CJ. Pharmacoepidemiology of non-steroidal anti-inflammatory drug use in Nottingham general practices. Aliment Pharmacol Ther 2000; 14:177-85. [PMID: 10651658 DOI: 10.1046/j.1365-2036.2000.00700.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [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] [Indexed: 12/08/2022]
Abstract
AIM To investigate the pharmacoepidemiology of NSAID usage in Nottingham general practices. DESIGN Questionnaire sent to 1137 consecutive recipients of an NSAID prescription from 21 doctors in six general practices with computerized records. Patient responses were subsequently linked to data held on the practice records. SETTING General practices in and around Nottingham, selected to reflect local variations in number of partners, list size, geographical location, deprivation, prescribing burden and prescribing rate. SUBJECTS Unselected patients receiving NSAIDs prescribed for all indications. MAIN OUTCOME MEASURES Indication for treatment, differences in prescribing to different age groups, compliance and overall scheme drug exposure, drug effectiveness and tolerability, possible drug-related adverse events, patients' overall satisfaction with treatment and estimated costs of care. RESULTS NSAIDs were used for a wide range of conditions and only a small number of patients had rheumatoid arthritis. The main drugs used were ibuprofen, diclofenac and naproxen. Patients making short-term use of NSAIDs had low compliance if they experienced adverse drug effects, whilst conversely in long-term users, those with high compliance reported more adverse drug effects. Calculated compliance did not vary with age although older patients (over 65 years) claimed in their questionnaires to be more compliant than younger patients. Half the patients reported good or complete symptom relief. Half of those questions (and two thirds of those with good or complete symptom relief) rated their NSAID as the best treatment they had received for their current condition. The frequency of gastrointestinal adverse events was higher in the young and the old, which correlated with the use of anti-ulcer drugs, and increased with the total number of medications used. CONCLUSIONS NSAIDs are used for a wide-range of conditions. They give symptom relief to, and are perceived as effective by, most patients taking them.
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Affiliation(s)
- D J Cullen
- Division of Gastroenterology, University Hospital, Nottingham, UK.
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Robinson B, Dalton L, Harper A, Ren A, Wang F, Zhang C, Todorova G, Lee M, Aniszfeld R, Garner S, Chen A, Steier W, Houbrecht S, Persoons A, Ledoux I, Zyss J, Jen A. The molecular and supramolecular engineering of polymeric electro-optic materials. Chem Phys 1999. [DOI: 10.1016/s0301-0104(99)00079-8] [Citation(s) in RCA: 216] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Biopsies (biceps) were examined in 8 bodybuilders across a typical arm-curl training session (80% 1-RM). [PCr] and [glycogen] decreased 62 and 12% after 1 set (n = 4), and 50 and 24% after 3 sets (n = 4). [Lactate] was 91 and 118 mmol × kg-1, respectively, after 1 and 3 sets. Fatigue was probably partially caused by decreased [PCr] and increased [H+] (first set) and by decreased [H+] in subsequent sets.
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Affiliation(s)
- J D MacDougall
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1 Canada
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Abstract
Studies were conducted with rats to investigate whether exposure to CO at concentrations frequently found in the environment caused nitric oxide (NO)-mediated vessel wall changes. Exposure to CO at concentrations of 50 parts per million or higher for 1 h increased the concentration of nitrotyrosine in the aorta. Immunologically reactive nitrotyrosine was localized in a discrete fashion along the endothelial lining, and this was inhibited by pretreatment with the NO synthase (NOS) inhibitor Nomega-nitro-L-arginine methyl ester (L-NAME). The CO-induced elevations of aortic nitrotyrosine were not altered by neutropenia or thrombocytopenia, and CO caused no change in the concentration of endothelial NOS. Consequences from NO-derived stress on the vasculature included an enhanced transcapillary efflux of albumin within the first 3 h after CO exposure and leukocyte sequestration that became apparent 18 h after CO exposure. Oxidized plasma low-density lipoprotein was found immediately after CO exposure, but this was not inhibited by L-NAME pretreatment. We conclude that exposure to relatively low CO concentrations can alter vascular status by several mechanisms and that many changes are linked to NO-derived oxidants.
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Affiliation(s)
- S R Thom
- Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104-6068, USA
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Lee SS, Garner S, Steier WH, Shin SY. Integrated optical polarization splitter based on photobleaching-induced birefringence in azo dye polymers. Appl Opt 1999; 38:530-533. [PMID: 18305642 DOI: 10.1364/ao.38.000530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
An integrated optical polarization splitter has been fabricated by utilizing the photobleaching-induced birefringence in an azo dye polymer. It consists of a Y-branch waveguide formed by the reactive ion etching with one of the two arms photobleached. The refractive index of the photobleached arm is decreased for the TE mode and increased for the TM mode. The performance of the splitter was measured as a function of the energy of the photobleaching beam and compared to a wave propagation simulation of the device. The measured cross talks are less than -28 dB for the TM mode and -24 dB for the TE mode at a wavelength of 1310 nm. The measured excess losses for the TE and TM modes, which measure the effect of the Y branch and the photobleaching, are 0.3 and 0.4 dB, respectively. The insertion loss was 5 dB, which includes the input fiber to waveguide coupling loss.
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Affiliation(s)
- S S Lee
- Department of Electrical Engineering and Electrophysics, University of Southern California, Los Angeles, California 90089-0483, USA
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31
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Chen A, Chuyanov V, Garner S, Zhang H, Steier WH, Chen J, Zhu J, Wang F, He M, Mao SS, Dalton LR. Low-V(pi) electro-optic modulator with a high-microbeta chromophore and a constant-bias field. Opt Lett 1998; 23:478-480. [PMID: 18084550 DOI: 10.1364/ol.23.000478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A low half-wave voltage V(pi) of 1.57 V was obtained with a 2-cm-long birefringent polymer waveguide modulator at a wavelength of 1.3 microm by use of a modulator design with a constant-bias electric field and a high-microbeta chromophore. The design allows the maximum achievable electro-optic coefficient of the material to be utilized. This electro-optic coefficient can be more than twice as high as the residue value that is used by conventional modulator designs, after fast partial relaxation following poling.
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Abstract
OBJECTIVES To study the circumstances of death in sudden death in epilepsy. METHODS Self referred bereaved relatives of patients with epilepsy who had died suddenly were interviewed with information obtained substantiated through other sources-namely, coroners' officers' reports, postmortem reports, previous medical records, and EEG reports. RESULTS Of 34 cases, 26 were classified as sudden unexpected deaths in epilepsy (SUDEP). Twenty four of 26 cases of SUDEP were unwitnessed. Evidence indicative or suggestive of a seizure was found in most. In 11 of 26 the position of the head was such that breathing could have been compromised. Cases included both localisation related and idiopathic primary generalised epilepsy. Only three were in remission at the time of death. Most relatives expressed the view that they would have preferred to have known that epilepsy could be fatal. CONCLUSIONS Although the deaths in question were largely unwitnessed, the available evidence suggested that most cases of SUDEP represented ictal or postictal seizure deaths, occurring in people with a history of generalised tonic clonic seizures, and in both primary generalised and localisation related epilepsy. These interviews highlight the needs of bereaved relatives and their sense of isolation in the face of an entirely unexpected and apparently unexplained loss.
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Affiliation(s)
- L Nashef
- Epilepsy Research Group and the Department of Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK
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Regan F, Teesdale P, Garner S, Callaghan T, Brennan M, Contreras M. Comparison of in vivo red cell survival of donations collected by Haemonetics MCS versus conventional collection. Transfus Med 1997; 7:25-8. [PMID: 9089981 DOI: 10.1046/j.1365-3148.1997.d01-78.x] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Haemonetics Multicomponents System (MCS) cell separator allows concurrent donation of red cells in addition to platelets and/or plasma, thus increasing the versatility of apheresis donations. In vivo survival of autologous red cells obtained by MCS was compared with red cells collected conventionally. In this cross-over controlled study, five male volunteers donated one unit of red cells by MCS and one unit of whole blood by the conventional manual method, 3 months apart. After storing donations in SAG-M for 35 days under standard conditions, radioactive (51Cr)-labelled autologous red cells were injected into each donor. The post-transfusion recovery (PTR) of red cells at 24 and 48 h did not show any significant difference between red cells obtained manually and by MCS, indicating that processing differences have no detrimental effects on red cell survival.
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Affiliation(s)
- F Regan
- North London Blood Centre, Colindale, UK
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Shenton BK, Bell AE, Harmer AW, Boyce M, Briggs D, Cavanagh G, Culkin J, van Dam MG, Evans PR, Haynes P, Henderson N, Horsburgh T, Martin S, Preece K, Reynolds W, Robson A, Sutton M, Waters D, Younie M, Garner S. Importance of methodology in the flow cytometric crossmatch: a multicentre study. Transplant Proc 1997; 29:1454-5. [PMID: 9123378 DOI: 10.1016/s0041-1345(96)00563-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B K Shenton
- Department of Surgery, University of Newcastle Upon Tyne, Medical School, United Kingdom
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Abstract
Substantial psychological and neurobehavioural evidence is available to support the hypothesis that traumatic brain injury (TBI) is a risk factor for subsequent psychiatric disorders. However, studies utilizing established psychiatric diagnostic schemes to study these outcomes after TBI are scarce, and no studies have included an assessment of personality disorders in addition to the major psychiatric disorders. This study utilizes structured psychiatric interviews to measure the prevalence of DSM-III(R) disorders in a sample of 18 subjects derived from a TBI rehabilitation programme. Results revealed high rates for major depression, bipolar affective disorder, generalized anxiety disorder, borderline and avoidant personality disorders. Co-morbidity was also high. A preliminary study of postulated predictive factors revealed possible roles for sex and for initial severity of injury. The study supports the association between TBI and psychiatric disorder, and suggests the need for monitoring, for prevention, and for treatment of psychiatric disorders after TBI.
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Affiliation(s)
- R van Reekum
- Department of Psychiatry, University of Toronto, Canada
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36
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Harmer AW, Garner S, Bell AE, Anyanwu C, Cavanagh G, Culkin J, Evans PR, Horsburgh T, Martin S, McCloskey D, Reynolds WM, Robson A, Sutton M, Van Dam MG, Shenton BK. Evaluation of the flow cytometric crossmatch. Preliminary results of a multicenter study. Transplantation 1996; 61:1108-11. [PMID: 8623194 DOI: 10.1097/00007890-199604150-00021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 01/31/2023]
Abstract
The flow cytometric crossmatch is a technique that is increasingly being used by clinical transplant laboratories. In this multicenter study by the British Society for Histocompatibility and Immunogenetics Flow Cytometry Group, a series of crossmatches were carried out to determine whether different centers obtained same results when performing the same crossmatch. There was greater than 80% agreement among participating laboratories on the results of 35/54 tests. There was no clear agreement in the remaining 20 cases. Quantitative analysis, estimating the number of cell-bound fluorescein molecules, demonstrated that differences in the criteria used by each center to define a positive crossmatch were responsible for some discordant results. When applied, definition of positivity based on the molecules of fluorescein increased concordance from 57.5% to 81.4%.l. These results suggest that a criterion for the interpretation of results based on quantitative analysis of bound antibody may be more reliable than methods in current routine use.
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Affiliation(s)
- A W Harmer
- South Thames Tissue Typing, Guy's Hospital, London, UK
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37
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Abstract
Sudden death, often seizure related, may occur in patients with epilepsy. Population-based incidence is probably on the order of 1:1,000/year. The incidence is much higher in selected groups, however. We wished to establish the incidence of sudden unexpected death (SUD) in a young cohort with severe epilepsy and learning difficulties. The study cohort included 310 pupils with epilepsy enrolled at a special residential school between April 1970 and April 1993. The follow-up period totaling 4,135 person-years included a period of residence at the school as well as time after leaving. Age and sex standardized overall mortality ratio was 15.9 [95% confidence interval (CI) 10.6-23.0], with 20 of 28 deaths considered epilepsy related. An incidence of sudden death cases of 1:295/year was noted. All 14 sudden deaths occurred when the pupils were not under the close supervision of the school and most were unwitnessed, which has implications for prevention.
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Affiliation(s)
- L Nashef
- Department of Clinical Neurology, Institute of Neurology, London, England
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Van Reekum R, Bayley M, Garner S, Burke IM, Fawcett S, Hart A, Thompson W. N of 1 study: amantadine for the amotivational syndrome in a patient with traumatic brain injury. Brain Inj 1995; 9:49-53. [PMID: 7874096 DOI: 10.3109/02699059509004571] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.6] [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: 01/27/2023]
Abstract
Severe amotivation, apathy, and abulia, significantly retard rehabilitation following traumatic brain injury. Preliminary, uncontrolled research has suggested possible benefit with amantadine for this behavioural syndrome. This N of 1, double-blind, placebo-controlled study employed amantadine 100 mg three times daily in one such patient. Therapists and nurses completed inventories scoring efforts towards initiation of therapeutic activities during each session, progress in therapy, and participation in therapy. Four treatment periods (two active medication, two placebo), of 2 weeks duration, were completed. Across four therapists, and for both treatment pairs, the average effect score increased from 0.86 on placebo to 1.74 on amantadine (possible range 0-6, 3 = 'average'). There were no side-effects. The study suggests possible benefit with amantadine for patients with amotivational syndrome after traumatic brain injury; a randomized clinical trial appears warranted and required.
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Kung MP, Chumpradit S, Frederick D, Garner S, Burris KD, Molinoff PB, Kung HF. Characterization of binding sites for [125I]R(+)trans-7-OH-PIPAT in rat brain. Naunyn Schmiedebergs Arch Pharmacol 1994; 350:611-7. [PMID: 7708118 DOI: 10.1007/bf00169365] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Binding characteristics of a novel radioiodinated ligand, [125I]R(+)trans-7-hydroxy-2-(N-n-propyl-N-3'-iodo-2'-propenyl) aminotetralin ([125I]R(+)trans-7-OH-PIPAT), were evaluated using homogenate binding and autoradiographic techniques in rat brain. [125I]R(+)trans-7-OH-PIPAT bound to sites (dopamine receptors) in homogenates of rat basal forebrain (including caudate putamen, nucleus accumbens and olfactory tubercle) with a high affinity (Kd = 0.42 nM). A majority (70%) of the sites labeled by [125I]R(+)trans-7-OH-PIPAT in basal forebrain were GTP-sensitive. In rat hippocampal homogenates, specific and saturable binding of [125I]R(+)trans-7-OH-PIPAT to 5-HT1A receptors, with a Kd value of 1.4 nM and a Bmax value of 210 fmol/mg protein, was observed. Binding of [125I]R(+)trans-7-OH-PIPAT to sigma sites was also demonstrated in rat cerebellar homogenates. In the presence of GTP (to inhibit binding to D2 and 5-HT1A receptors) and DTG (to inhibit binding to sigma sites), dopamine D3 receptors could be selectively labeled with [125I]R(+)trans-7-OH-PIPAT. [125I]R(+)trans-7-OH-PIPAT offers several unique advantages, including high specific activity and high affinity binding, which make it an excellent probe for the investigation and characterization of the distribution of dopamine D3 receptors.
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Affiliation(s)
- M P Kung
- Department of Radiology, University of Pennsylvania, School of Medicine, Philadelphia 19104
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Ryan S, Sandler A, Trenhaile S, Ephgrave K, Garner S. Pancreatic enzyme elevations after blunt trauma. Surgery 1994; 116:622-7. [PMID: 7524175] [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: 01/25/2023]
Abstract
BACKGROUND Elevations in levels of the pancreatic enzymes amylase and lipase occur frequently after trauma. The purpose of this prospective study was to examine the incidence of these enzyme elevations in patients suffering blunt trauma, their natural history, and their relationship to posttraumatic pancreatitis. METHODS One hundred consecutive trauma patients were studied on admission to the surgical intensive care unit with daily serum amylase and lipase measurements, which were blinded to the clinical service. If the enzyme levels were elevated after 3 days, the patient was enrolled in the study and observed and examined daily, and enzyme levels were measured every other day. These patients were fed enterally by the clinical service if no symptoms of clinical pancreatitis were present. RESULTS In 17% of patients persistent pancreatic enzyme elevations developed. These patients more frequently had had hypotension, higher Injury Severity Scores, and were more likely to have had severe head injuries than those whose enzyme levels remained normal. Five percent of those studied displayed evidence of clinical pancreatitis, and none of these patients had only isolated head injuries. Lumbar spine injuries and retroperitoneal hematomas were present more frequently in the group in whom symptomatic pancreatitis developed. CONCLUSIONS After blunt trauma 17% of patients displayed persistent pancreatic enzyme elevations, but the majority remained asymptomatic despite enteral feeding. Retroperitoneal injury may identify patients at risk for pancreatitis. Patients with isolated head injuries should be fed enterally.
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Affiliation(s)
- S Ryan
- Department of Surgery, University of Iowa College of Medicine, Iowa City
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Abstract
AIMS To examine whether a therapeutic dose of ultrasound waves, when directed through the thoracic wall to the spleen, would significantly affect the platelet count in patients with stable immune thrombocytopenic purpura (ITP). METHODS Continuous ultrasound at 1 W/cm2 spatial average-time average (SATA) intensity for up to one minute/5 cm2 treatment field was well tolerated in 13 patients with ITP and one with non-Hodgkin's lymphoma. Five healthy controls were also similarly treated. Peak platelet increments occurred four to eight hours after ultrasound treatment in the ITP group (n = 16 treatments). RESULTS The mean peak platelet increment was 6.25 x 10(9)/l with a 5% confidence interval of the mean (95% CI) of 3.32 to 8.93 x 10(9)/l (p = 0.0004). The mean peak platelet increment of normal controls was 6.6 (n = 5; 95% CI = -2.3 to 15.5; p = 0.21) and for sham treated patients it was 0.66 (n = 11; 95% CI = -1.5 to 2.8; p = 0.60). There was a significant inverse correlation between patient age in the ITP group and peak platelet increment (r = -0.60; p = 0.015). CONCLUSIONS Splenic ultrasound is a novel approach to the treatment of ITP, and may find a place in its diagnosis or management.
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Barbolla L, Nieto S, Llamas P, Moreno C, Contreras M, Lubenko A, Garner S. Severe immune haemolytic anaemia caused by intravenous immunoglobulin anti-D in the treatment of autoimmune thrombocytopenia. Vox Sang 1993; 64:184-5. [PMID: 8484253 DOI: 10.1111/j.1423-0410.1993.tb05160.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Maximum M-waves (muscle compound action potentials) were studied in the abductor pollicis brevis (APB), extensor digitorum brevis (EDB), and tibialis anterior (TA) muscles of 12 patients with myotonic muscular dystrophy (MMD) and in the same number of control subjects, matched for age and sex. The peak-to-peak amplitudes and voltage-time areas of the responses were measured at rest, between 40 maximum voluntary contractions (each lasting 3 s) and also during a 2-min recovery period. In 34 of the 36 control muscles the M-waves potentiated during the period of intermittent voluntary contractions. In the MMD patients, however, the M waves exhibited initial declines in 25 of 30 muscles. In the APB and EDB muscles the normalized mean values for the smallest M-waves, recorded during the 350 s total observation periods, differed significantly between the 2 groups of subjects. It is suggested that the sarcolemmal Na(+)-K+ pump has a raised threshold for activation in MMD patients.
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Affiliation(s)
- J Fenton
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Abstract
Possible changes in muscle size and function due to resistance training were examined in prepubertal boys. Thirteen boys (9-11 yr) volunteered for each of the training and control groups. Progressive resistance training was performed three times weekly for 20 wk. Measurements consisted of the following: 1 repetition maximum (RM) bench press and leg press; maximal voluntary isometric and isokinetic elbow flexion and knee extension strength; evoked isometric contractile properties of the right elbow flexors and knee extensors; muscle cross-sectional area (CSA) by computerized tomography at the mid-right upper arm and thigh; and motor unit activation (MUA) by the interpolated twitch procedure. Training significantly increased 1 RM bench press (35%) and leg press (22%), isometric elbow flexion (37%) and knee extension strength (25% and 13% at 90 degrees and 120 degrees, respectively), isokinetic elbow flexion (26%) and knee extension (21%) strength, and evoked twitch torque of the elbow flexors (30%) and knee extensors (30%). There were no significant effects of training on the time-related contractile properties (time to peak torque, half-relaxation time), CSA, or %MUA of the elbow flexors or knee extensors. There was, however, a trend toward increased MUA for the elbow flexors and knee extensors in the trained group. Strength gains were independent of changes in muscle CSA, and the increases in twitch torque suggest possible adaptations in muscle excitation-contraction coupling. Improved motor skill coordination (especially during the early phase of training), a tendency toward increased MUA, and other undetermined neurological adaptations, including better coordination of the involved muscle groups, are likely the major determinants of the strength gains in this study.
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Affiliation(s)
- J A Ramsay
- School of Physical Education and Athletics, McMaster University, Hamilton, Ontario, Canada
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Sale DG, Jacobs I, MacDougall JD, Garner S. Comparison of two regimens of concurrent strength and endurance training. Med Sci Sports Exerc 1990; 22:348-56. [PMID: 2381303] [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: 12/31/2022]
Abstract
To compare the responses to doing strength (S) training on alternate days with endurance (E) training vs doing both types of training on the same days per week, seven young men (group A-2 d) did S and E training together in single sessions 2 d.wk-1 for 20 wk. A second group (B-4 d, N = 8) did the S training on 2 d.wk-1 and E training on 2 other d.wk-1. S training was six to eight sets of 15-20 RM on a leg press weight machine. E training was six to eight 3-min bouts of cycle ergometer exercise at 90-100% VO2max. B-4 d (25%) increased leg press 1 RM more (P less than 0.05) than A-2 d (13%), but the groups increased similarly (A-2 d, B-4 d) in knee extensor (31%, 34%) and flexor (12%, 14%) cross-sectional area and vastus lateralis mean fiber area (33%, 25%). Increases in VO2max (7%, 6%), repetitions with 80% 1 RM (39%, 64%), repetitions with the pre-training 1 RM (33, 55), and PFK (19%, 10%) and LDH (15%, 23%) activity did not differ (P greater than 0.05) between groups. CS activity increased significantly only in A-2 d (26%; B-4 d, 6%). It is concluded that same day (vs different day) concurrent strength and endurance training may impede strength development without impeding hypertrophy. On the other hand, same day training may enhance increases in CS activity but not VO2max or weight lifting endurance.
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Affiliation(s)
- D G Sale
- Department of Physical Education, McMaster University, Hamilton, Ontario, Canada
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Abstract
To assess the effects of concurrent strength (S) and endurance (E) training on S and E development, one group (4 young men and 4 young women) trained one leg for S and the other leg for S and E (S+E). A second group (4 men, 4 women) trained one leg for E and the other leg for E and S (E+S). E training consisted of five 3-min bouts on a cycle ergometer at a power output corresponding to that requiring 90-100% of oxygen uptake during maximal exercise (VO2 max). S training consisted of six sets of 15-20 repetitions with the heaviest possible weight on a leg press (combined hip and knee extension) weight machine. Training was done 3 days/wk for 22 wk. Needle biopsy samples from vastus lateralis were taken before and after training and were examined for histochemical, biochemical, and ultrastructural adaptations. The nominal S and E training programs were "hybrids", having more similarities as training stimuli than differences; thus S made increases (P less than 0.05) similar to those of S+E in E-related measures of VO2max (S, S+E: 8%, 8%), repetitions with the pretraining maximal single leg press lift [1 repetition maximum (RM)] (27%, 24%), and percent of slow-twitch fibers (15%, 8%); and S made significant, although smaller, increases in repetitions with 80% 1 RM (81%, 152%) and citrate synthase (CS) activity (22%, 51%). Similarly, E increased knee extensor area [computed tomography (CT) scans] as much as E+S (14%, 21%) and made significant, although smaller, increases in leg press 1 RM (20%, 34%) and thigh girth (3.4%, 4.8%). When a presumably stronger stimulus for an adaptation was added to a weaker one, some additive effects occurred (i.e., increases in 1 RM and thigh girth that were greater in E+S than E; increases in CS activity and repetitions with 80% 1 RM that were greater in S+E than S). When a weaker, although effective, stimulus was added to a stronger one, addition generally did not occur. Concurrent S and E training did not interfere with S or E development in comparison to S or E training alone.
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Affiliation(s)
- D G Sale
- Department of Physical Education, McMaster University, Hamilton, Ontario, Canada
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Abstract
The M wave (muscle compound action potential) has been shown to enlarge between successive 3-s voluntary contractions of the human thenar and extensor digitorum brevis (EDB) muscles. The changes, which affected both the amplitude and the area of the M wave, were more obvious in the thenar than in the EDB muscles. In the thenar muscles the mean amplitude was already significantly enlarged after the first voluntary contraction and close to the maximal value by the third (mean maximal increase 23.6 +/- 12.6% of control). The increase in mean M wave area was more gradual, reaching a maximum of 29.3 +/- 14.1% at 100 s. After the voluntary thenar contractions ceased, the amplitude of the M wave subsided more rapidly than the area and had regained the control value within 50 s. The magnitude and time course of the increase in EDB M wave area (maximum change 25.9 +/- 15.2%) were similar to those of the thenar muscles; however, the subsequent decline was slower. The amplitude of the EDB M wave showed the least change, and the maximum increase (11.4 +/- 9.6%) occurred early in the postcontraction period. In both muscles the changes in M wave amplitude and area were significantly different from the control values.
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Affiliation(s)
- A Hicks
- Department of Biomedical Sciences, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
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Correy JF, Watkins RA, Bradfield GF, Garner S, Watson S, Gray G. Spontaneous pregnancies and pregnancies as a result of treatment on an in vitro fertilization program terminating in ectopic pregnancies or spontaneous abortions. Fertil Steril 1988; 50:85-8. [PMID: 3384121 DOI: 10.1016/s0015-0282(16)60013-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Five hundred three patients were accepted for the in vitro fertilization (IVF) program from 1983 to 1986. Two hundred ninety-nine patients had a total of 678 IVF treatment cycles during this period. Eighty-one clinical pregnancies resulted, of which 8 were ectopic pregnancies and 19 spontaneous abortions (group A). During this period 82 patients accepted for IVF became pregnant spontaneously: 44 before treatment and 38 after a failed IVF treatment cycle (group B). Of these, 14 were ectopic pregnancies and 8 were miscarriages. The main indications for acceptance on the IVF program were similar in the two groups if those patients who had a bilateral salpingectomy are excluded from group A. Causative factors for the high ectopic pregnancy rate are discussed. The authors suggest that after embryo transfer, migration of the embryo or embryos into the fallopian tubes occurs more frequently than realized, and the diseased tube is less likely than a normal tube to propel the embryo back into the uterus. The abortion rate in group B was similar to the rate in the general population.
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Affiliation(s)
- J F Correy
- In Vitro Fertilization Unit, St Helen's Hospital, Hobart, Tasmania, Australia
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