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Mestrom A, Charlton KE, Thomas SJ, Larkin TA, Walton KL, Elgellaie A, Kent K. Higher anthocyanin intake is associated with lower depressive symptoms in adults with and without major depressive disorder. Food Sci Nutr 2024; 12:2202-2209. [PMID: 38455191 PMCID: PMC10916648 DOI: 10.1002/fsn3.3850] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024] Open
Abstract
Background Major depressive disorder (MDD) is a significant cause of disability globally and an emerging body of evidence suggests that dietary components, including flavonoids, may impact depression-related biochemical pathways. Further research that characterizes dietary intake of flavonoids in diverse population groups, including people with MDD and explores the relationship between flavonoid intake and depression is needed. This study aimed to determine dietary flavonoid and subclass intake and assess the association with depressive symptomatology in a sample of adults with and without MDD. Methodology Participants with and without MDD (determined using DSM 5) completed the Depression, Anxiety, and Stress Scale-21 (DASS-21). Diet history interviews were analyzed using PhenolExplorer to quantify flavonoid subclasses (flavan-3-ols, flavonols, anthocyanins, flavones, flavanones, isoflavones), and total flavonoid intake. Independent t-tests and linear regression, adjusting for age, sex, and BMI were performed. Results Participants (n = 93; 75% female) had a mean age of 26.0 ± 8.2 years. Participants with MDD had significantly higher DASS-depression scores (n = 44; DASS-depression 27.3 ± 9.8) compared to participants without MDD (n = 49; DASS-depression 3.1 ± 4.4; p < .001). Intakes of total flavonoids and subclasses were similar between groups, except for anthocyanins where participants with MDD reported lower intakes of anthocyanins compared to participants without MDD (median intake: 0.08 mg/day and 11.6 mg/day, respectively; p = .02). In the total sample, higher anthocyanin intake was associated with lower DASS-depression score (B = -4.1; SE = 1.8; 95% CI [-7.7, -0.4]; p = .029). Conclusion Intake of total flavonoids and most subclasses were similar between people with and without MDD. However, a dietary deficit of anthocyanins (found in purple/red fruits and vegetables) was evident in participants with MDD, and higher anthocyanin intake was associated with lower depressive symptomatology in the total sample. Further research in larger samples is warranted to explore if the documented association is independent of MDD status.
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Affiliation(s)
- Annika Mestrom
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Karen E. Charlton
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Susan J. Thomas
- Graduate School of Medicine, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Theresa A. Larkin
- Graduate School of Medicine, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Karen L. Walton
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Asmahan Elgellaie
- Graduate School of Medicine, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Katherine Kent
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
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Redwood L, Currow D, Kochovska S, Thomas SJ. Australian population norms for health-related quality of life measured using the EQ-5D-5L, and relationships with sociodemographic characteristics. Qual Life Res 2024; 33:721-733. [PMID: 38085452 PMCID: PMC10894099 DOI: 10.1007/s11136-023-03558-z] [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] [Accepted: 11/06/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Measuring health related quality-of-life (HRQoL) of the general population is essential to establish a reference for health outcome evaluations. This study sought to establish EQ-5D-5L population norms in Australia and to investigate the heterogeneity of HRQoL between sociodemographic variables. METHODS A cross-sectional study comprising of a representative sample of Australia's general population (n = 9958) aged 18 or older. Recruitment quotas were set for the Australian census population by age, sex, state/territory of residence and rurality. Participants were recruited by Qualtrics through its database of over 800,000 registered panel members and asked to value their own state of health using the EQ-5D-5L domains and the EuroQol-Visual Analogue Scale (EQ-VAS). An Australian value set developed using Discreet Choice Experiment was used to calculate utility scores. RESULTS The estimated mean EQ-5D-5L index for Australia's general population was 0.86 (standard deviation [SD] 0.19), and the EQ-VAS score was estimated as 73.2 (SD 21.7). 23.9% of the study population reported being in the best health state (11,111). Younger people, current smokers, people who are unemployed and people with more financial stress reported a lower EQ-5D-5L index score (p < 0.001). Residents in the major cities, inner regional and outer regional Australia reported higher health utility scores than those residing in remote and very remote Australia. CONCLUSIONS This is the first Australian study to apply the EQ-5D-5L in a nationally representative sample. The EQ-5D-5L Australian population norms obtained can be used as reference scores for future population health evaluations and comparisons. The findings facilitate a national reference for clinical, economic, and policy decision-making processes and provide a fuller understanding of the Australian population's HRQoL.
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Affiliation(s)
- Lisa Redwood
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Mental Illness in Nowra District: Goals and Prevention (MIND the GaP), University of Wollongong, Wollongong, NSW, Australia.
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Susan J Thomas
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Mental Illness in Nowra District: Goals and Prevention (MIND the GaP), University of Wollongong, Wollongong, NSW, Australia
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Redwood L, Saarinen K, Ivers R, Garne D, de Souza P, Bonney A, Rhee J, Mullan J, Thomas SJ. Alcohol consumption and health-related quality of life in regional, rural and metropolitan Australia: analysis of cross-sectional data from the Community Health and Rural/Regional Medicine (CHARM) study. Qual Life Res 2024; 33:349-360. [PMID: 37878225 PMCID: PMC10850261 DOI: 10.1007/s11136-023-03522-x] [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] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Relationships between alcohol consumption and health are complex and vary between countries, regions, and genders. Previous research in Australia has focused on estimating the effect of alcohol consumption on mortality. However, little is known about the relationships between alcohol consumption and health-related quality of life (QoL) in Australia. This study aimed to investigate the levels of alcohol intake and QoL in males and females in rural, regional and metropolitan areas of Australia. METHOD Participants (n = 1717 Australian adults) completed an online cross-sectional study. Males and females were compared on measures including the AUDIT-C and WHOQOL-BREF. Data were stratified into risk of alcohol use disorder (AUD) and associations were examined between alcohol consumption and QoL, adjusting for sociodemographic variables. RESULTS Males had higher alcohol consumption and were at greater risk of AUD than females (20% vs 8%). Relationships between alcohol consumption and QoL were positive or non-significant for low-moderate AUD risk categories and negative in the severe AUD risk category. Males in regional communities reported higher alcohol consumption (AUDIT-C score 6.6 vs 4.1, p < 0.01) than metropolitan areas. Regression analyses identified that after adjusting for sociodemographic variables, alcohol consumption was positively related to overall, environmental, and physical QoL and general health. CONCLUSION The results indicate that alcohol consumption is negatively related to QoL only in those with severe risk of AUD. Males in regional areas reported higher alcohol consumption than those in metropolitan areas. These results provide further information about relationships between alcohol intake and health in Australia that can help inform prevention, screening and delivery of interventions.
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Affiliation(s)
- Lisa Redwood
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- MIND the GaP, University of Wollongong, Wollongong, NSW, Australia
| | - Karli Saarinen
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - David Garne
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Paul de Souza
- Nepean Clinical School, University of Sydney, Kingswood, NSW, Australia
| | - Andrew Bonney
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Joel Rhee
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Discipline of General Practice, School of Population Health, UNSW Sydney, Kensington, NSW, Australia
| | - Judy Mullan
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Susan J Thomas
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- MIND the GaP, University of Wollongong, Wollongong, NSW, Australia.
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Zhang Z, Yu P, Yin M, Chang HC, Thomas SJ, Wei W, Song T, Deng C. Developing an ontology of non-pharmacological treatment for emotional and mood disturbances in dementia. Sci Rep 2024; 14:1937. [PMID: 38253678 PMCID: PMC10803746 DOI: 10.1038/s41598-023-46226-5] [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: 06/23/2022] [Accepted: 10/30/2023] [Indexed: 01/24/2024] Open
Abstract
Emotional and mood disturbances are common in people with dementia. Non-pharmacological interventions are beneficial for managing these disturbances. However, effectively applying these interventions, particularly in the person-centred approach, is a complex and knowledge-intensive task. Healthcare professionals need the assistance of tools to obtain all relevant information that is often buried in a vast amount of clinical data to form a holistic understanding of the person for successfully applying non-pharmacological interventions. A machine-readable knowledge model, e.g., ontology, can codify the research evidence to underpin these tools. For the first time, this study aims to develop an ontology entitled Dementia-Related Emotional And Mood Disturbance Non-Pharmacological Treatment Ontology (DREAMDNPTO). DREAMDNPTO consists of 1258 unique classes (concepts) and 70 object properties that represent relationships between these classes. It meets the requirements and quality standards for biomedical ontology. As DREAMDNPTO provides a computerisable semantic representation of knowledge specific to non-pharmacological treatment for emotional and mood disturbances in dementia, it will facilitate the application of machine learning to this particular and important health domain of emotional and mood disturbance management for people with dementia.
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Affiliation(s)
- Zhenyu Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia.
| | - Mengyang Yin
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
- Systems and Reporting Residential Care, Catholic Healthcare Ltd, Wollongong, Australia
| | - Hui Chen Chang
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Susan J Thomas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Wenxi Wei
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Northfield Ave, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
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Guracho YD, Thomas SJ, Win KT. Smartphone application use patterns for mental health disorders: A systematic literature review and meta-analysis. Int J Med Inform 2023; 179:105217. [PMID: 37748330 DOI: 10.1016/j.ijmedinf.2023.105217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Mobile mental health applications play a significant role in mental health care to fill gaps in care for mental disorders. Despite the growth in mobile phone apps for mental health conditions, patients' mental health smartphone application use, perceived usefulness, and future interest in using apps for mental disorders have not been systematically examined. METHODS The authors designed and conducted this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Articles reporting mobile/smartphone applications used for mental disorders describing ownership, application use, perceived helpfulness, future interest to use, use patterns, and attitudes were included. PubMed/MEDLINE, EMBASE, PsychINFO, Scopus, and Google Scholar were searched. Published articles from 2014 up to October 2022 were included. The methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. The heterogeneity test, publication bias, funnel plots and Egger's test were applied. The outcome was calculated by metaprop command using a random-effects model. RESULTS Ten studies met the eligibility criteria. The pooled prevalence of smartphone ownership, application use for current mental health disorders, perceived usefulness, and future interest in using the app for their mental health problem was 88.63%, 23.29%, 72.80%, and 78.97%, respectively. Heterogeneity and publication bias were detected. CONCLUSIONS The results of this study indicate that despite a considerable number of smartphone users, perceived usefulness, and future interest in using smartphone mental health applications among patients with mental disorders, only about one-fifth use an application for mental health disorders. The results show that there is a large potential to increase the use of apps for patients to support self-care in the growing era of digital mental health. Further research with consumers and mental health professionals is recommended to address barriers and improve mhealth app utilization. REGISTRATION Prospero international prospective register of systematic reviews with ID: CRD42022359416.
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Affiliation(s)
- Yonas Deressa Guracho
- University of Wollongong, Faculty of Engineering and Information Sciences, Wollongong, Australia; Bahir Dar University, College of Medical and Health Sciences, Bahir Dar, Ethiopia.
| | - Susan J Thomas
- University of Wollongong, Faculty of Science Medicine and Health, Wollongong, Australia
| | - Khin Than Win
- University of Wollongong, Faculty of Engineering and Information Sciences, Wollongong, Australia
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Dyson T, Thomas SJ, Townsend ML, Finch A, South A, Barkus E, Walter E, Mendonca C, Grenyer BFS, Pickard JA. Salivary testosterone and cortisol levels in borderline personality disorder before and after a 12-week group dialectical behavior therapy intervention. Front Psychol 2023; 14:1195187. [PMID: 37529315 PMCID: PMC10389657 DOI: 10.3389/fpsyg.2023.1195187] [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: 03/28/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background Borderline Personality Disorder (BPD) is a chronic, debilitating, and difficult to treat condition. BPD has recently been linked to steroid hormone dysregulation and medical conditions characterized by disturbed androgen metabolism. This study aimed to investigate cortisol and testosterone levels in BPD, and changes in hormones following psychological treatment. Methods Participants with BPD (n = 33) completed a 12-week Dialectical Behavior Therapy group program. Pre and post salivary testosterone and cortisol were analyzed. Baseline hormones in the BPD group were compared to age-and-sex matched controls (n = 33). Non-parametric tests were utilized to investigate group differences, pre-post treatment hormone and symptom changes, and associations between symptoms and hormone levels. Results Participants with BPD had significantly higher testosterone levels than controls. Mean testosterone levels in females with BPD were double that of female controls. Testosterone and cortisol levels were related, and some BPD symptoms were associated with with hormone levels. BPD symptoms reduced significantly with treatment, however pre to post hormone levels did not change. Conclusions This study supports an association between BPD symptoms and neuroendocrine dysfunction at baseline, however we found no reduction in hormone dysfunction post treatment. Further research into relationships between stress signaling and neuroendocrine disturbances in BPD may inform aetiological and treatment models. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018.
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Affiliation(s)
- Tori Dyson
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Susan J. Thomas
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | | | - Adam Finch
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Alexandra South
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Emma Barkus
- Department of Psychology, Northumbria University, Newcastle upon Tyne, North East England, United Kingdom
| | - Emma Walter
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Carley Mendonca
- School of Psychology, University of Technology Sydney, Sydney, NSW, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Judy A. Pickard
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
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Teo JT, Johnstone SJ, Thomas SJ. Use of portable devices to measure brain and heart activity during relaxation and comparative conditions: Electroencephalogram, heart rate variability, and correlations with self-report psychological measures. Int J Psychophysiol 2023; 189:1-10. [PMID: 37094613 DOI: 10.1016/j.ijpsycho.2023.04.002] [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: 02/14/2023] [Revised: 03/31/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
Recent technological advancements have enabled the development of portable devices that facilitate psychophysiological measurement in ecologically valid settings. The aim of the present study was to establish normative heart rate (HR), heart rate variability (HRV), and electroencephalogram (EEG) power during relaxation and comparative conditions. Fifty healthy adult participants completed baseline psychological questionnaires and subjective ratings of relaxation while portable devices measured continuous EEG, HR, and HRV data during eyes-open (EO) and eyes-closed (EC) resting, relaxation induction, and patting a toy dog (TD). Subjective relaxation levels were higher after the relaxation and TD compared to EO and EC resting conditions. Psychophysiological indications of relaxation included higher HRV during relaxation, and higher delta, theta, and alpha power during the TD condition. EEG recorded using a portable wireless single-channel device showed frontal EC versus EO differences comparable with those reported using traditional laboratory-based EEG equipment. Additionally, alpha power was positively correlated with resilience and negatively correlated with depression, anxiety, and stress. Delta power correlated positively with subjective relaxation levels during relaxation. Overall, the results suggest that portable devices can provide valid measurements of psychophysiological activity during relaxation outside of laboratory settings. Changes in HRV and EEG waveforms reveal more information about physiological relaxation and show promise for real-world monitoring in fields of study that investigate human arousal, stress, and health.
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Affiliation(s)
- Jillian T Teo
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Stuart J Johnstone
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Susan J Thomas
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, 2522, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Australia.
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South AJ, Barkus E, Walter EE, Mendonca C, Thomas SJ. Dark Triad Personality Traits, Second-to-Forth Digit Ratio (2D:4D) and Circulating Testosterone and Cortisol Levels. Biol Psychol 2023; 179:108567. [PMID: 37086902 DOI: 10.1016/j.biopsycho.2023.108567] [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: 01/04/2023] [Revised: 03/05/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Dark Triad (DT) personality traits (psychopathy, Machiavellianism, and narcissism) show sex differences and associations with hormones. Understanding aetiology may assist in mitigating the harm of these potentially adverse characteristics. Low second-to-fourth digit ratio (2D:4D) is hypothesised to be a marker of high prenatal testosterone exposure and may provide important information about organisational hormones. The aim of the present study was to measure Dark Triad and Big 5 personality traits in relation to digit ratio, salivary testosterone, and cortisol. METHODS A non-clinical sample (N=268; 49.25% Female, age M25.20 ± 8.77yrs) completed the Short Dark Triad and International Personality Inventory Pool - Mini. Afternoon saliva was analysed for testosterone and cortisol, and 2D:4D finger ratios were measured. RESULTS Males scored higher on DT traits than females. Females scored higher on Big 5 agreeableness and neuroticism. Males had higher testosterone and cortisol levels and lower 2D:4D than females. Digit ratio correlated inversely with salivary testosterone, Machiavellianism, and psychopathy. Testosterone levels correlated positively with cortisol levels and psychopathy and negatively with agreeableness, neuroticism, and Machiavellianism. CONCLUSIONS These results provide indications that Machiavellianism and psychopathy (Dark Triad) traits, but not narcissism or Big 5 traits, are linked to markers of prenatal testosterone exposure. Results also replicate sex differences seen in 2D:4D digit ratios, with males having a shorter second-relative-to-forth finger. Links between circulating testosterone, digit ratios, cortisol and personality traits provide further information about potential biological bases of personality.
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Affiliation(s)
- Alexandra J South
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia, 2522; School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia, 2522; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia, 2522.
| | - Emma Barkus
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia, 2522; Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Emma E Walter
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia, 2522; School of Psychology, Western Sydney University, Bankstown, NSW, Australia, 2214.
| | - Carley Mendonca
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia, 2522
| | - Susan J Thomas
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia, 2522; Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia, 2522.
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Elgellaie A, Thomas SJ, Kaelle J, Bartschi J, Larkin T. Pro-inflammatory cytokines IL-1α, IL-6 and TNF-α in major depressive disorder: Sex-specific associations with psychological symptoms. Eur J Neurosci 2023. [PMID: 37070163 DOI: 10.1111/ejn.15992] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023]
Abstract
The pro-inflammatory cytokines IL-1α, IL-6 and TNF-α are associated with major depressive disorder, psychological distress, cardiovascular health, and obesity. However, there is limited research that has examined multiple associations between these variables, particularly among individuals with major depressive disorder who are treatment free, in comparison to a control cohort, and including analyses of sex differences. In this study, data was analysed from 60 individuals with major depressive disorder and 60 controls, including plasma IL-1α, IL-6 and TNF-α, adiposity measures (body mass index; waist circumference), cardiovascular health indices (blood pressure; heart rate) and psychological symptoms (depressive severity; anxiety; hostility; stress). The cytokines were compared by group and sex, and correlated with measures of adiposity, cardiovascular health indices and psychological health. Plasma IL-1α and IL-6 were higher in major depressive disorder group versus control, but with a sex interaction for IL-6, with this group difference only among females. TNF-α did not differ between groups. IL-1α and IL-6 correlated with depressive severity, anxiety, hostility, and stress, while TNF-α correlated only with anxiety and hostility. Psychopathology was associated with IL-1α in males only, and with IL-6 and TNF-α in females only. None of the cytokines correlated with body mass index, waist circumference, blood pressure or heart rate. The result of group by sex interaction for IL-6, and sex specific associations between pro-inflammatory cytokines and psychometrics could be aetiologically important in depression interventions and treatments for females versus males, warranting further investigation.
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Affiliation(s)
- Asmahan Elgellaie
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Susan J Thomas
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Jacqueline Kaelle
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- Illawarra community mental health
| | - Jessica Bartschi
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Theresa Larkin
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
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Römer SS, Bliokas V, Teo JT, Thomas SJ. Food addiction, hormones and blood biomarkers in humans: A systematic literature review. Appetite 2023; 183:106475. [PMID: 36716820 DOI: 10.1016/j.appet.2023.106475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Food addiction may play a role in rising obesity rates in connection with obesogenic environments and processed food availability, however the concept of food addiction remains controversial. While animal studies show evidence for addictive processes in relation to processed foods, most human studies are psychologically focussed and there is a need to better understand evidence for biological mechanisms of food addiction in humans. Several key hormones are implicated in models of food addiction, due to their key roles in feeding, energy metabolism, stress and addictive behaviours. This systematic literature review examines evidence for relationships between food addiction, hormones and other blood biomarkers. METHODS A series of literature searches was performed in Scopus, PsychInfo, MedLine, ProQuest, CINAHL and Web of Science. A total of 3111 articles were found, of which 1045 were duplicates. Articles were included if they contained a psychometric measurement of food addiction, such as the Yale Food Addiction Scale, as well as addressed the association between FA and hormones or blood biomarkers in humans. Articles were assessed for eligibility by two independent reviewers. RESULTS Sixteen studies were identified that examined relationships between food addiction and blood biomarkers, published between 2015 and 2021. Significant findings were reported for leptin, ghrelin, cortisol, insulin and glucose, oxytocin, cholesterol, plasma dopamine, thyroid stimulating hormone (TSH), haemoglobin A1c (HbA1c), triglyceride (TG), amylin, tumour necrosis factor alpha (TNF- α) and cholecystokinin (CCK). Methodological issues included small sample sizes and variation in obesity status, sex and mental health-related comorbidities. Due to methodological limitations, definite connections between FA, hormones and other blood biomarkers cannot yet be determined. CONCLUSION This systematic review identified preliminary evidence linking FA symptoms to hormones and other blood biomarkers related to feeding, addiction, and stress. However, due to the small number of studies and methodological limitations, further research is needed to evaluate biopsychosocial models of FA and to resolve controversies.
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Affiliation(s)
- Stephanie Sophie Römer
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Vida Bliokas
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Australia.
| | - Jillian Terese Teo
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Australia.
| | - Susan J Thomas
- Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Australia; Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Australia.
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Galea CA, Swanson CPS, Cohen SA, Thomas SJ. Use of a Mylar filter to eliminate vacuum ultraviolet pulse pileup in low-energy x-ray measurements. Rev Sci Instrum 2022; 93:093531. [PMID: 36182492 DOI: 10.1063/5.0101712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
We describe a method to reduce vacuum ultraviolet (VUV) pulse pileup (PPU) in x-ray pulse-height Silicon Drift Detector (SDD) signals. An Amptek FAST SDD, with C1 (Si3N4) window, measures bremsstrahlung emitted from PFRC-2 plasma to extract the electron temperature (Te) and density (ne). The C1 window has low transmissivity for photons with energy below 200 eV though will transmit some VUV and soft x-ray photons, which PFRC-2 plasmas abundantly emit. Multi-VUV-photon PPU contaminates the interpretation of x rays with energy > 100 eV, particularly in a low-energy exponential tail. The predicted low transmissivity of ∼1 μm thick Mylar [polyethylene terephthalate (PET)] to photons of energy <100 eV led to the selection of Mylar as the candidate filter to reduce VUV PPU. Experiments were conducted on an x-ray tube with a graphite target and on a quasi-Maxwellian tenuous plasma (ne ∼ 109 cm-3) with effective temperatures reaching 1500 eV. A Mylar filter thickness of 850 nm is consistent with the results. The Mylar-filter-equipped SDD was then used on the PFRC-2 plasma, showing a substantial reduction in the low-energy x-ray signal, supporting our hypothesis of the importance of VUV PPU. We describe the modeling and experiments performed to characterize the effect of the Mylar filter on SDD measurements.
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Affiliation(s)
- C A Galea
- Princeton Fusion Systems, Plainsboro, New Jersey 08536, USA
| | - C P S Swanson
- Princeton Plasma Physics Laboratory, Princeton University, Princeton, New Jersey 08543, USA
| | - S A Cohen
- Princeton Plasma Physics Laboratory, Princeton University, Princeton, New Jersey 08543, USA
| | - S J Thomas
- Princeton Fusion Systems, Plainsboro, New Jersey 08536, USA
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12
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Gormley M, Gray E, Richards C, Gormley A, Richmond RC, Vincent EE, Dudding T, Ness AR, Thomas SJ. An update on oral cavity cancer: epidemiological trends, prevention strategies and novel approaches in diagnosis and prognosis. Community Dent Health 2022; 39:197-205. [PMID: 35852216 DOI: 10.1922/cdh_00032gormley09] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the UK, the incidence of oral cavity cancer continues to rise, with an increase of around 60% over the past 10 years. Many patients still present with advanced disease, often resulting in locoregional recurrence and poor outcomes, which has not changed significantly for over four decades. Changes in aetiology may also be emerging, given the decline of smoking in developed countries. Therefore, new methods to better target prevention, improve screening and detect recurrence are needed. High-throughput 'omics' technologies appear promising for future individual-level diagnosis and prognosis. However, given this is a relatively rare cancer with significant intra-tumour heterogeneity and variation in patient response, reliable biomarkers have been difficult to elucidate. From a public health perspective, implementing these novel technologies into current services would require substantial practical, financial and ethical considerations. This may be difficult to justify and implement at present, therefore focus remains on early detection using new patient-led follow-up strategies. This paper reviews the latest evidence on epidemiological trends in oral cavity cancer to help identify at risk groups, population-based approaches for prevention, in addition to potential cutting-edge approaches in the diagnosis and prognosis of this disease.
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Affiliation(s)
- M Gormley
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - E Gray
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - C Richards
- Oral Surgery, School of Dentistry, Cardiff University, UK
| | - A Gormley
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - R C Richmond
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - E E Vincent
- Translational Health Sciences, Bristol Medical School, University of Bristol, UK
| | - T Dudding
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - A R Ness
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - S J Thomas
- University of Bristol Dental School, University Hospitals Bristol and Weston NHS Foundation Trust, UK
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13
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Teo JT, Johnstone SJ, Römer SS, Thomas SJ. Psychophysiological mechanisms underlying the potential health benefits of human-dog interactions: A systematic literature review. Int J Psychophysiol 2022; 180:27-48. [PMID: 35901904 DOI: 10.1016/j.ijpsycho.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/22/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
While the symbiotic nature of human-dog relationships and perceived benefits to human health have attracted much scientific interest, the mechanisms through which human-dog interactions may confer health benefits to humans are still poorly understood. The aim of this systematic literature review was to synthesize evidence of physiological changes associated with human-dog interactions with relevance to human health. Electronic databases were systematically searched (PubMed, MEDLINE with full text, Scopus, PsycINFO, CINAHL Plus with Full Text, and Web of Science Core Collection) for relevant studies. Of the 13,072 studies identified, 129 met the inclusion criteria, with approximately half being randomized trials (Level 2) based on the Oxford Centre for Evidence Based Medicine level system. Measures employed to study human physiological changes associated with human-dog interactions most commonly involved cardiac parameters and hormones, with negligible research of brain activity. The main positive findings were increases in heart rate variability and oxytocin, and decreases in cortisol with human-dog interactions. These physiological indicators are consistent with activation of the parasympathetic nervous system (PNS) and oxytocinergic system (OTS), and down-regulation of hypothalamic-pituitary-adrenal (HPA) axis activity. These results provide evidence of specific pathways through which human-dog contact may confer health benefits, likely through relaxation, bonding, and stress reduction. However, these findings should be interpreted contextually due to limitations and methodological differences. Previous research using other biological variables was limited in quantity and quality, thus impeding firm conclusions on other possible mechanisms. Further research is needed in some psychophysiological domains, particularly electroencephalography, to better understand central nervous system (CNS) effects. The findings of this review have implications for human-dog interactions to positively affect several stress-sensitive physiological pathways and thus confer health benefits. This supports their incorporation in various clinical, non-clinical, and research settings to develop evidence-based interventions and practices for cost-effective and efficacious ways to improve human health.
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Affiliation(s)
- Jillian T Teo
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Stuart J Johnstone
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Stephanie S Römer
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Susan J Thomas
- School of Medicine, Faculty of Science, Medicine and Health, Illawarra Health and Medical Research Institute, University of Wollongong, 2522, Australia.
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14
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Mills JG, Larkin TA, Deng C, Thomas SJ. Cortisol in relation to problematic eating behaviours, adiposity and symptom profiles in Major Depressive Disorder. Comprehensive Psychoneuroendocrinology 2021; 7:100067. [PMID: 35757061 PMCID: PMC9216397 DOI: 10.1016/j.cpnec.2021.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/06/2022] Open
Abstract
Aims Major Depressive Disorder (MDD) is associated with an increased risk of chronic disease related to weight gain, problematic eating behaviours and neuroendocrine changes. MDD is frequently associated with altered hypothalamic-pituitary-adrenal axis activity and cortisol secretion, where cortisol has been implicated in regulating energy balance, food intake and depressogenic weight changes. However, little research has examined the relationships between cortisol, adiposity and depressogenic problematic eating behaviours. Method Plasma cortisol concentrations were compared between 37 participants with MDD reporting appetite/weight loss, 43 participants with MDD reporting appetite/weight gain, and 60 healthy controls, by sex. Associations between cortisol, indices of adiposity and problematic eating behaviours were then assessed after accounting for demographic variables and depressive symptoms. Depressive symptoms were assessed using the Depression subscale of the Depression, Anxiety and Stress Scale, and eating behaviours with the Dutch Eating Behaviours Questionnaire and Yale Food Addiction Scale. Results Participants with MDD reporting appetite/weight loss had higher cortisol compared to controls, and marginally higher cortisol than those with MDD reporting appetite/weight gain. Cortisol negatively and significantly accounted for unique variance in body mass index and waist circumference after accounting for variance associated with age, sex and depressive symptoms, however it was not a significant predictor of problematic eating behaviours, such as emotional eating or food addiction. Cortisol concentrations did not differ between sexes. Conclusion The results indicate that cortisol is related to lower indices of adiposity and depressogenic symptoms of appetite/weight loss but is not related to problematic eating behaviours and appetite increases in MDD. These findings provide further evidence that the melancholic and atypical subtypes of MDD are associated with differential neuroendocrine and anthropometric indices, as well as behavioural and symptom profiles. Further research investigating the temporal nature of the identified relationships may assist in facilitating the development of improved interventions for individuals affected by weight changes in MDD. Appetite changes, adiposity and problematic eating in Major Depressive Disorder (MDD) were examined relative to cortisol. Cortisol was higher in those with MDD with decreased/unchanged appetite/weight than controls, and marginally higher than those with MDD with increased appetite/weight. Cortisol was a negative predictor of indices of adiposity, but was not associated with problematic eating. Cortisol may be more relevant to melancholic compared to atypical MDD, supporting differential neuroendocrine and behavioural symptom profiles between depressogenic subtypes.
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15
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Butler MJ, Spruill TM, Johnson DA, Redline S, Sims M, Jenkins BC, Booth JN, Thomas SJ, Abdalla M, O'Brien EC, Mentz RJ, Ogedegbe G, Williams NJ. Suboptimal sleep and incident cardiovascular disease among African Americans in the Jackson Heart Study (JHS). Sleep Med 2020; 76:89-97. [PMID: 33129011 DOI: 10.1016/j.sleep.2020.09.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Suboptimal sleep, including insufficient/long sleep duration and poor sleep quality, is a risk factor for cardiovascular disease (CVD) common but there is little information among African Americans, a group with a disproportionate CVD burden. The current study examined the association between suboptimal sleep and incident CVD among African Americans. METHODS This study included 4,522 African Americans without CVD at baseline (2000-2004) of the Jackson Heart Study (JHS). Self-reported sleep duration was defined as very short (<6 h/night), short (6 h/night), recommended (7-8 h/night), and long (≥9 h/night). Participants' self-reported sleep quality was defined as "high" and "low" quality. Suboptimal sleep was defined by low quality sleep and/or insufficient/long sleep duration. Incident CVD was a composite of incident coronary heart disease and stroke. Associations between suboptimal sleep and incident CVD were examined using Cox proportional hazards models over 15 follow-up years with adjustment for predictors of CVD risk and obstructive sleep apnea. RESULTS Sample mean age was 54 years (SD = 13), 64% female and 66% reported suboptimal sleep. Suboptimal sleep was not associated with incident CVD after covariate adjustment [HR(95% CI) = 1.18(0.97-1.46)]. Long [HR(95%CI) = 1.32(1.02-1.70)] and very short [HR(95% CI) = 1.56(1.06-2.30)] sleep duration were associated with incident CVD relative to recommended sleep duration. Low quality sleep was not associated with incident CVD (p = 0.413). CONCLUSIONS Long and very short self-reported sleep duration but not self-reported sleep quality were associated with increased hazard of incident CVD.
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Affiliation(s)
- M J Butler
- NYU Grossman School of Medicine School of Medicine, New York, NY, USA
| | - T M Spruill
- NYU Grossman School of Medicine School of Medicine, New York, NY, USA
| | - D A Johnson
- Rollins School of Public Health, Emory University, Atlanta, GA, USA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M Sims
- University of Mississippi Medical Center, Jackson, MS, USA
| | - B C Jenkins
- Jackson State University School of Public Health, Jackson, MS, USA
| | - J N Booth
- University of Alabama at Birmingham, CTI Clinical Trials and Consulting Services, Inc., Covington, KY, Birmingham, AL, USA
| | - S J Thomas
- University of Alabama at Birmingham, CTI Clinical Trials and Consulting Services, Inc., Covington, KY, Birmingham, AL, USA
| | - M Abdalla
- Columbia University Medical Center, New York, NY, USA
| | - E C O'Brien
- Duke University School of Medicine, Durham, NC, USA
| | - R J Mentz
- Duke University School of Medicine, Durham, NC, USA
| | - G Ogedegbe
- NYU Grossman School of Medicine School of Medicine, New York, NY, USA
| | - N J Williams
- NYU Grossman School of Medicine School of Medicine, New York, NY, USA.
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Pang LHG, Thomas SJ. Exposure to Domestic Violence during Adolescence: Coping Strategies and Attachment Styles as Early Moderators and their Relationship to Functioning during Adulthood. J Child Adolesc Trauma 2020; 13:185-198. [PMID: 32549930 PMCID: PMC7289929 DOI: 10.1007/s40653-019-00279-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The present study aimed to investigate the impact of exposure to domestic violence during adolescence on an individual's psychological health, ability to regulate emotions, and sense of satisfaction with life, during adulthood. Additionally, it aimed to investigate the long-term role of different coping strategies and attachment with primary caregiver, during adolescence, as potential moderators in the relationship between severity of domestic violence exposure during adolescence and an individual's functioning during adulthood. A total of 218 adult participants completed measures regarding exposure to domestic violence, engagement in coping strategies, and attachment with primary caregiver, during adolescence, and psychological health, ability to regulate emotions, and sense of satisfaction with life, during adulthood. Ninety-two participants reported domestic violence exposure during adolescence. Two-way analyses of variance indicated that participants who were exposed to domestic violence during adolescence were more likely to report negative functioning during adulthood. Correlational analysis indicated that severity of domestic violence exposure during adolescence was positively correlated with engagement in avoidance-focused coping strategies and insecure attachment, during adolescence, and negative functioning during adulthood. Moderation analyses indicated that engagement in avoidance-focused coping strategies and insecure attachment with primary caregiver, during adolescence, moderated the relationship between severity of domestic violence exposure during adolescence and functioning during adulthood, but only in low-moderate severity of exposure to domestic violence. These findings confirm the long-term impact of domestic violence exposure during adolescence on an individual's functioning during adulthood, and provide new information that certain coping strategies and attachment with primary caregiver during adolescence may buffer against the impact.
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Affiliation(s)
- Linda Hui Gin Pang
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, New South Wales Australia
| | - Susan J. Thomas
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, New South Wales Australia
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Abstract
OBJECTIVE Understanding whether medical students feel safe in mental health placements is important to delivering effective and engaging training experiences. METHOD Second year students completed anonymous online surveys before (n = 37) and after (n = 41) mental health placements, to gather qualitative and quantitative data about their sense of physical and emotional safety, and factors that positively and negatively influenced their experiences. Data were analysed using chi square and content analysis. RESULTS There was a disparity between students' expectations of physical and emotional safety before placements and their actual experience. Following placement, no students reported that they felt physically 'unsafe' or 'very unsafe'. Conversely, over 20% of students indicated that they had felt emotionally unsafe during their placement. When asked to compare their expectations prior to placement with their actual experience, over 13% felt 'much less safe' emotionally, where no participants felt 'much less safe' physically. Qualitative content identified included exposure to patients' tragic life stories, aggression, the physical ward environment and adequacy of supports. CONCLUSIONS The distinction between physical and emotional safety is a valuable framework through which to understand the student experience of clinical placements in psychiatry and to seek to best support students. The data provide rich insight into students' experiences, particularly emotional challenges, on psychiatry wards.
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Affiliation(s)
- Ben Gallan
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Kerry Dawes
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Susan J Thomas
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
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18
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Mills JG, Larkin TA, Deng C, Thomas SJ. Weight gain in Major Depressive Disorder: Linking appetite and disordered eating to leptin and ghrelin. Psychiatry Res 2019; 279:244-251. [PMID: 30878306 DOI: 10.1016/j.psychres.2019.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 01/12/2023]
Abstract
Major Depressive Disorder (MDD) involves changes in appetite and weight, with a subset of individuals at an increased risk of weight gain. Pathways to weight gain may include appetite disturbances, excess eating, and dysregulation of appetite hormones. However, little research has simultaneously examined relationships between hormones, eating behaviours and MDD symptoms. Plasma ghrelin and leptin, biometrics, eating behaviours and psychopathology were compared between depressed (n = 60) and control (n = 60) participants. Depressed participants were subcategorised into those with increased or decreased appetite/weight for comparison by subtype. The Dutch Eating Behaviours Questionnaire and Yale Food Addiction Scale measured eating behaviours. Disordered eating was higher in MDD than controls, in females than males, and in depressed individuals with increased, compared to decreased, appetite/weight. Leptin levels were higher in females only. Leptin levels correlated positively, and ghrelin negatively, with disordered eating. The results provide further evidence for high levels of disordered eating in MDD, particularly in females. The correlations suggest that excessive eating in MDD is significantly linked to appetite hormones, indicating that it involves physiological, rather than purely psychological, factors. Further, longitudinal, research is needed to better understand whether hormonal factors play a causal role in excessive eating in MDD.
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Affiliation(s)
- Jessica G Mills
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Theresa A Larkin
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Chao Deng
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Antipsychotic Research Laboratory, University of Wollongong, Australia
| | - Susan J Thomas
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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19
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Abstract
PURPOSE Quality of life (QoL) is greatly impaired in major depressive disorder (MDD). These impairments are not fully accounted for by symptom severity, may persist beyond depressive episodes, and are a risk factor for poor outcomes. MDD is often associated with prominent neuroendocrine changes and increased risk of chronic disease. However, there is a lack of research examining whether biological factors are related to QoL in MDD. This research examined relationships between cortisol, oxytocin, symptom severity, and QoL in MDD. METHODS Sixty adults meeting DSM-5 criteria for MDD and 60 healthy controls provided morning plasma samples which were analysed for cortisol and oxytocin levels, and completed measures of QoL and psychopathology. RESULTS Participants with MDD had lower QoL than controls. Cortisol correlated negatively with overall QoL and all QoL domains. Oxytocin correlated positively with overall QoL, and Psychological and Social-Relationships domains. Additionally, cortisol levels were inversely related to psychological QoL, and oxytocin was positively related to social QoL, after controlling for symptom severity and demographic variables. CONCLUSIONS This study provides novel evidence linking neuroendocrine pathways to particular domains of QoL in MDD. The results indicate that activity of the hypothalamic-pituitary-adrenal axis is linked to poor psychological QoL, and that oxytocin is important to social QoL, independently of severity of psychopathology. Biopsychosocial approaches to QoL associated with mental health conditions may lead to greater understanding of the underlying mechanisms and to improved, tailored interventions.
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Affiliation(s)
- Ai Ling Tang
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Susan J Thomas
- Graduate Medicine, Faculty of Science, Medicine and Health & Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Theresa Larkin
- Graduate Medicine, Faculty of Science, Medicine and Health & Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, 2522, Australia
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20
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Sideris E, Thomas SJ. Patients' sun practices, perceptions of skin cancer and their risk of skin cancer in rural Australia. Health Promot J Austr 2019; 31:84-92. [PMID: 30980690 DOI: 10.1002/hpja.253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/17/2018] [Accepted: 04/09/2019] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Skin cancer affects nearly one in three Australians. As a preventable disease there have been many public awareness campaigns targeting skin cancer knowledge and sun protection in Australia in the last 30 years to increase knowledge of the disease and how to prevent it. Despite higher incidence and mortality of skin cancer in regional Australia and adults over 65 years though, little research exists examining this high-risk population's skin cancer knowledge and sun behaviours, with most previous research conducted in urban Australia or overseas. This study aimed to examine adults' skin cancer knowledge, sun behaviours and demographic factors in a regional Australian town. METHODS Cross-sectional study design was utilised. Adult patients of a Mudgee General Practice (n = 179, 18-89 years) completed a survey based on their skin cancer knowledge and sun behaviours. Chi-squared tests were used to analyse responses. RESULTS Poor non-melanoma skin cancer awareness, risky sun behaviours and inadequate sun protection behaviours were found. Males and those at greatest current risk of skin cancer in Australia, those over 60 years, had the poorest skin cancer knowledge and were least likely to recognise skin cancer or use some sun protection measures. CONCLUSIONS Greater non-melanoma skin cancer and sun protection education and research is needed, particularly targeting older and male Australians. SO WHAT?: The findings suggest rural men and older Australians would benefit from more targeted campaigns and education to increase their skin cancer awareness and use of sun protection in order to minimise future skin cancer.
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Affiliation(s)
- Emily Sideris
- RACGP, North Sydney, NSW, Australia.,Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Susan J Thomas
- Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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21
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Shelley LEA, Sutcliffe MPF, Harrison K, Scaife JE, Parker MA, Romanchikova M, Thomas SJ, Jena R, Burnet NG. Autosegmentation of the rectum on megavoltage image guidance scans. Biomed Phys Eng Express 2019; 5:025006. [PMID: 31057946 PMCID: PMC6466640 DOI: 10.1088/2057-1976/aaf1db] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/12/2022]
Abstract
Autosegmentation of image guidance (IG) scans is crucial for streamlining and optimising delivered dose calculation in radiotherapy. By accounting for interfraction motion, daily delivered dose can be accumulated and incorporated into automated systems for adaptive radiotherapy. Autosegmentation of IG scans is challenging due to poorer image quality than typical planning kilovoltage computed tomography (kVCT) systems, and the resulting reduction of soft tissue contrast in regions such as the pelvis makes organ boundaries less distinguishable. Current autosegmentation solutions generally involve propagation of planning contours to the IG scan by deformable image registration (DIR). Here, we present a novel approach for primary autosegmentation of the rectum on megavoltage IG scans acquired during prostate radiotherapy, based on the Chan-Vese algorithm. Pre-processing steps such as Hounsfield unit/intensity scaling, identifying search regions, dealing with air, and handling the prostate, are detailed. Post-processing features include identification of implausible contours (nominally those affected by muscle or air), 3D self-checking, smoothing, and interpolation. In cases where the algorithm struggles, the best estimate on a given slice may revert to the propagated kVCT rectal contour. Algorithm parameters were optimised systematically for a training cohort of 26 scans, and tested on a validation cohort of 30 scans, from 10 patients. Manual intervention was not required. Comparing Chan-Vese autocontours with contours manually segmented by an experienced clinical oncologist achieved a mean Dice Similarity Coefficient of 0.78 (SE < 0.011). This was comparable with DIR methods for kVCT and CBCT published in the literature. The autosegmentation system was developed within the VoxTox Research Programme for accumulation of delivered dose to the rectum in prostate radiotherapy, but may have applicability to further anatomical sites and imaging modalities.
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Affiliation(s)
- L E A Shelley
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- Addenbrooke's Hospital, Department of Medical Physics and Clinical Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - M P F Sutcliffe
- University of Cambridge, Department of Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - K Harrison
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Cambridge, Cavendish Laboratory, Cambridge, United Kingdom
| | - J E Scaife
- Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, United Kingdom
| | - M A Parker
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Cambridge, Cavendish Laboratory, Cambridge, United Kingdom
| | - M Romanchikova
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- National Physical Laboratory, Teddington, United Kingdom
| | - S J Thomas
- Addenbrooke's Hospital, Department of Medical Physics and Clinical Engineering, Cambridge, United Kingdom
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
| | - R Jena
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- Addenbrooke's Hospital, Oncology Centre, Cambridge, United Kingdom
| | - N G Burnet
- Cambridge University Hospitals NHS Foundation Trust, Cancer Research UK VoxTox Research Group, Cambridge, United Kingdom
- University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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22
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Mills JG, Thomas SJ, Larkin TA, Pai NB, Deng C. Problematic eating behaviours, changes in appetite, and weight gain in Major Depressive Disorder: The role of leptin. J Affect Disord 2018; 240:137-145. [PMID: 30071417 DOI: 10.1016/j.jad.2018.07.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/22/2018] [Accepted: 07/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Appetite and weight changes are core symptoms of Major Depressive Disorder (MDD), and those with MDD are at increased risk of obesity, cardiovascular disease and metabolic disorders. Leptin promotes satiety, with leptin dysregulation and resistance noted in obesity. However, the role of leptin in weight changes in MDD is not established. This study investigates leptin levels in relation to appetite and weight changes and problematic eating behaviours in MDD. METHODS Plasma leptin levels, psychopathology and biometrics were compared between participants meeting DSM-5 diagnostic criteria for MDD (n = 63) and healthy controls (n = 60). Depressed participants were also sub-categorised according to increased, decreased or unchanged appetite and weight. The Dutch Eating Behaviour Questionnaire and Yale Food Addiction Scale were examined in a subset of participants with MDD. RESULTS Females with increased appetite/weight had higher leptin levels than those with stable or reduced appetite/weight, however males showed the opposite effect. Leptin levels were positively correlated with problematic eating behaviours. One quarter of the depressed subset, all females, met the Yale criteria for food addiction, approximately double the rates reported in general community samples. LIMITATIONS The study is limited by a cross sectional design and a small sample size in the subset analysis of eating behaviours. CONCLUSIONS The results provide new information about associations between leptin, sex-specific weight and appetite changes and problematic eating behaviours, which may be risk factors for cardiovascular and metabolic diseases in MDD, particularly in females. Future longitudinal research investigating leptin as a risk factor for weight gain in MDD is warranted, and may lead to early interventions aimed at preventing weight gain in at-risk individuals.
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Affiliation(s)
- Jessica G Mills
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia.
| | - Susan J Thomas
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Theresa A Larkin
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Nagesh B Pai
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Chao Deng
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Australia; Antipsychotic Research Laboratory, University of Wollongong, Australia
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23
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Coleman O, Walker TWM, Kerai A, van der Valk R, Thomas SJ. #JawSurgery: Analysis of social media use in orthognathic surgery patients. Br Dent J 2018; 224:638-4. [PMID: 29651096 DOI: 10.1038/sj.bdj.2018.266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/09/2022]
Affiliation(s)
- O Coleman
- Guy's Dental Hospital, Great Maze Pond, London, SE1 9RT
| | - T W M Walker
- Dept. of Oral and Maxillofacial Surgery, Bristol Royal Infirmary, Dental Hospital and Children's Hospital, University Hospitals Trust, Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, BS12LY
| | - A Kerai
- Dept. of Oral and Maxillofacial Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU
| | - R van der Valk
- Dept. of Oral and Maxillofacial Surgery, Ground Floor, Dental Institute, Denmark Hill, SE5 9RS
| | - S J Thomas
- Dept. of Oral and Maxillofacial Surgery, Bristol Royal Infirmary, Dental Hospital and Children's Hospital, University Hospitals Trust, Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, BS12LY
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24
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Brochu F, Romanchikova M, Thomas SJ, Hoole ACF, Noble DJ, Simmons MPD, Gurnell M, Parker MA, Burnet NG. Reduction in Total Radiation Exposure Using X-ray Image Guidance Illustrated in a Patient Receiving Pituitary Radiotherapy. Clin Oncol (R Coll Radiol) 2017; 30:199-200. [PMID: 29254603 DOI: 10.1016/j.clon.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- F Brochu
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, UK; University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - M Romanchikova
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - A C F Hoole
- Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
| | - D J Noble
- University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - M P D Simmons
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, UK
| | - M Gurnell
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - M A Parker
- University of Cambridge, Department of Physics, Cavendish Laboratory, Cambridge, UK
| | - N G Burnet
- University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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25
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Abstract
In treatment planning we depend upon accurate knowledge of geometric and range uncertainties. If the uncertainty model is inaccurate then the plan will produce under-dosing of the target and/or overdosing of OAR. We aim to provide a method for which centre and site-specific population range uncertainty due to inter-fraction motion can be quantified to improve the uncertainty model in proton treatment planning. Daily volumetric MVCT data from previously treated radiotherapy patients has been used to investigate inter-fraction changes to water equivalent path-length (WEPL). Daily image-guidance scans were carried out for each patient and corrected for changes in CTV position (using rigid transformations). An effective depth algorithm was used to determine residual range changes, after corrections had been applied, throughout the treatment by comparing WEPL within the CTV at each fraction for several beam angles. As a proof of principle this method was used to quantify uncertainties for inter-fraction range changes for a sample of head and neck patients of [Formula: see text] mm, [Formula: see text] mm and overall [Formula: see text] mm. For prostate [Formula: see text] mm, [Formula: see text] mm and overall [Formula: see text] mm. The choice of beam angle for head and neck did not affect the inter-fraction range error significantly; however this was not the same for prostate. Greater range changes were seen using a lateral beam compared to an anterior beam for prostate due to relative motion of the prostate and femoral heads. A method has been developed to quantify population range changes due to inter-fraction motion that can be adapted for the clinic. The results of this work highlight the importance of robust planning and analysis in proton therapy. Such information could be used in robust optimisation algorithms or treatment plan robustness analysis. Such knowledge will aid in establishing beam start conditions at planning and for establishing adaptive planning protocols.
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Affiliation(s)
- S M Holloway
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom. Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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26
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Yeap PL, Noble DJ, Harrison K, Bates AM, Burnet NG, Jena R, Romanchikova M, Sutcliffe MPF, Thomas SJ, Barnett GC, Benson RJ, Jefferies SJ, Parker MA. Automatic contour propagation using deformable image registration to determine delivered dose to spinal cord in head-and-neck cancer radiotherapy. Phys Med Biol 2017; 62:6062-6073. [PMID: 28573978 PMCID: PMC5952263 DOI: 10.1088/1361-6560/aa76aa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine delivered dose to the spinal cord, a technique has been developed to propagate manual contours from kilovoltage computed-tomography (kVCT) scans for treatment planning to megavoltage computed-tomography (MVCT) guidance scans. The technique uses the Elastix software to perform intensity-based deformable image registration of each kVCT scan to the associated MVCT scans. The registration transform is then applied to contours of the spinal cord drawn manually on the kVCT scan, to obtain contour positions on the MVCT scans. Different registration strategies have been investigated, with performance evaluated by comparing the resulting auto-contours with manual contours, drawn by oncologists. The comparison metrics include the conformity index (CI), and the distance between centres (DBC). With optimised registration, auto-contours generally agree well with manual contours. Considering all 30 MVCT scans for each of three patients, the median CI is \documentclass[12pt]{minimal}
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}{}$0.759 \pm 0.003$ \end{document}0.759±0.003, and the median DBC is (\documentclass[12pt]{minimal}
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}{}$0.87 \pm 0.01$ \end{document}0.87±0.01) mm. An intra-observer comparison for the same scans gives a median CI of \documentclass[12pt]{minimal}
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}{}$0.820 \pm 0.002$ \end{document}0.820±0.002 and a DBC of (\documentclass[12pt]{minimal}
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}{}$0.64 \pm 0.01$ \end{document}0.64±0.01) mm. Good levels of conformity are also obtained when auto-contours are compared with manual contours from one observer for a single MVCT scan for each of 30 patients, and when they are compared with manual contours from six observers for two MVCT scans for each of three patients. Using the auto-contours to estimate organ position at treatment time, a preliminary study of 33 patients who underwent radiotherapy for head-and-neck cancers indicates good agreement between planned and delivered dose to the spinal cord.
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Affiliation(s)
- P L Yeap
- Cavendish Laboratory, University of Cambridge, JJ Thomson Avenue, Cambridge, CB3 0HE, United Kingdom
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27
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Coyle C, Crawford G, Wilkinson J, Thomas SJ, Bytzer P. Randomised clinical trial: addition of alginate-antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms. Aliment Pharmacol Ther 2017; 45:1524-1533. [PMID: 28464343 DOI: 10.1111/apt.14064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/09/2017] [Accepted: 03/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Symptomatic breakthrough in proton pump inhibitor (PPI)-treated gastro-oesophageal reflux disease (GERD) patients is a common problem with a range of underlying causes. The nonsystemic, raft-forming action of alginates may help resolve symptoms. AIM To assess alginate-antacid (Gaviscon Double Action, RB, Slough, UK) as add-on therapy to once-daily PPI for suppression of breakthrough reflux symptoms. METHODS In two randomised, double-blind studies (exploratory, n=52; confirmatory, n=262), patients taking standard-dose PPI who had breakthrough symptoms, assessed by Heartburn Reflux Dyspepsia Questionnaire (HRDQ), were randomised to add-on Gaviscon or placebo (20 mL after meals and bedtime). The exploratory study endpoint was change in HRDQ score during treatment vs run-in. The confirmatory study endpoint was "response" defined as ≥3 days reduction in the number of "bad" days (HRDQ [heartburn/regurgitation] >0.70) during treatment vs run-in. RESULTS In the exploratory study, significantly greater reductions in HRDQ scores (heartburn/regurgitation) were observed in the Gaviscon vs placebo (least squares mean difference [95% CI] -2.10 [-3.71 to -0.48]; P=.012). Post hoc "responder" analysis of the exploratory study also revealed significantly more Gaviscon patients (75%) achieved ≥3 days reduction in "bad" days vs placebo patients (36%), P=.005. In the confirmatory study, symptomatic improvement was observed with add-on Gaviscon (51%) but there was no significant difference in response vs placebo (48%) (OR (95% CI) 1.15 (0.69-1.91), P=.5939). CONCLUSIONS Adding Gaviscon to PPI reduced breakthrough GERD symptoms but a nearly equal response was observed for placebo. Response to intervention may vary according to whether symptoms are functional in origin.
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Affiliation(s)
| | | | | | | | - P Bytzer
- Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
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28
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Shelley LEA, Scaife JE, Romanchikova M, Harrison K, Forman JR, Bates AM, Noble DJ, Jena R, Parker MA, Sutcliffe MPF, Thomas SJ, Burnet NG. Delivered dose can be a better predictor of rectal toxicity than planned dose in prostate radiotherapy. Radiother Oncol 2017; 123:466-471. [PMID: 28460825 PMCID: PMC5486775 DOI: 10.1016/j.radonc.2017.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 01/23/2023]
Abstract
Background and purpose For the first time, delivered dose to the rectum has been calculated and accumulated throughout the course of prostate radiotherapy using megavoltage computed tomography (MVCT) image guidance scans. Dosimetric parameters were linked with toxicity to test the hypothesis that delivered dose is a stronger predictor of toxicity than planned dose. Material and methods Dose–surface maps (DSMs) of the rectal wall were automatically generated from daily MVCT scans for 109 patients within the VoxTox research programme. Accumulated-DSMs, representing total delivered dose, and planned-DSMs, from planning CT data, were parametrised using Equivalent Uniform Dose (EUD) and ‘DSM dose-width’, the lateral dimension of an ellipse fitted to a discrete isodose cluster. Associations with 6 toxicity endpoints were assessed using receiver operator characteristic curve analysis. Results For rectal bleeding, the area under the curve (AUC) was greater for accumulated dose than planned dose for DSM dose-widths up to 70 Gy. Accumulated 65 Gy DSM dose-width produced the strongest spatial correlation (AUC 0.664), while accumulated EUD generated the largest AUC overall (0.682). For proctitis, accumulated EUD was the only reportable predictor (AUC 0.673). Accumulated EUD was systematically lower than planned EUD. Conclusions Dosimetric parameters extracted from accumulated DSMs have demonstrated stronger correlations with rectal bleeding and proctitis, than planned DSMs.
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Affiliation(s)
- L E A Shelley
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom; Department of Engineering, University of Cambridge, United Kingdom.
| | - J E Scaife
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - M Romanchikova
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - K Harrison
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cavendish Laboratory, University of Cambridge, United Kingdom
| | - J R Forman
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - A M Bates
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - D J Noble
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - R Jena
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
| | - M A Parker
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Cavendish Laboratory, University of Cambridge, United Kingdom
| | - M P F Sutcliffe
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Engineering, University of Cambridge, United Kingdom
| | - S J Thomas
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Medical Physics and Clinical Engineering, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | - N G Burnet
- Cambridge University Hospitals NHS Foundation Trust, Department of Oncology, United Kingdom; Department of Oncology, University of Cambridge, United Kingdom
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29
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Thomas SJ, Siddiqui M, Harding S, Oparil S, Calhoun D. 1059 POLYSOMNOGRAPHIC CHARACTERISTICS OF PATIENTS WITH REFRACTORY HYPERTENSION COMPARED TO CONTROLLED RESISTANT HYPERTENSION. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1058] [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: 11/13/2022] Open
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30
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Freedman BR, Gordon JA, Bhatt PB, Pardes AM, Thomas SJ, Sarver JJ, Riggin CN, Tucker JJ, Williams AW, Zanes RC, Hast MW, Farber DC, Silbernagel KG, Soslowsky LJ. Nonsurgical treatment and early return to activity leads to improved Achilles tendon fatigue mechanics and functional outcomes during early healing in an animal model. J Orthop Res 2016; 34:2172-2180. [PMID: 27038306 PMCID: PMC5047851 DOI: 10.1002/jor.23253] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/29/2016] [Indexed: 02/04/2023]
Abstract
Achilles tendon ruptures are common and devastating injuries; however, an optimized treatment and rehabilitation protocol has yet to be defined. Therefore, the objective of this study was to investigate the effects of surgical repair and return to activity on joint function and Achilles tendon properties after 3 weeks of healing. Sprague-Dawley rats (N = 100) received unilateral blunt transection of their Achilles tendon. Animals were then randomized into repaired or non-repaired treatments, and further randomized into groups that returned to activity after 1 week (RTA1) or after 3 weeks (RTA3) of limb casting in plantarflexion. Limb function, passive joint mechanics, and tendon properties (mechanical, organizational using high frequency ultrasound, histological, and compositional) were evaluated. Results showed that both treatment and return to activity collectively affected limb function, passive joint mechanics, and tendon properties. Functionally, RTA1 animals had increased dorsiflexion ROM and weight bearing of the injured limb compared to RTA3 animals 3-weeks post-injury. Such functional improvements in RTA1 tendons were evidenced in their mechanical fatigue properties and increased cross sectional area compared to RTA3 tendons. When RTA1 was coupled with nonsurgical treatment, superior fatigue properties were achieved compared to repaired tendons. No differences in cell shape, cellularity, GAG, collagen type I, or TGF-β staining were identified between groups, but collagen type III was elevated in RTA3 repaired tendons. The larger tissue area and increased fatigue resistance created in RTA1 tendons may prove critical for optimized outcomes in early Achilles tendon healing following complete rupture. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2172-2180, 2016.
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Affiliation(s)
- BR Freedman
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - JA Gordon
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - PB Bhatt
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - AM Pardes
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - SJ Thomas
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA,Department of Kinesiology, Temple University, Philadelphia, PA, USA
| | - JJ Sarver
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA,Department of Biomedical Engineering, Drexel University, Philadelphia, PA, USA
| | - CN Riggin
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - JJ Tucker
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - AW Williams
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - RC Zanes
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - MW Hast
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - DC Farber
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - KG Silbernagel
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - LJ Soslowsky
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
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Thomas SJ, Leeson PR, Larkin T, Deng C, Pai BN, Mills J, McLennan P. Modelling complex relationships between physiological and psychosocial factors in depression. Int J Psychophysiol 2016. [DOI: 10.1016/j.ijpsycho.2016.07.323] [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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32
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Thomas SJ, Gonsalvez CJ, Johnstone SJ. Neural correlates of paranoia: An ERP study of clinically anxious and healthy participants. Int J Psychophysiol 2016. [DOI: 10.1016/j.ijpsycho.2016.07.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Wilson MH, Robinson JP, Sisson RT, Revington PJ, Thomas SJ. The effect of deprivation on the incidence of mandibular fractures in a British city. Surgeon 2016; 15:65-68. [PMID: 27167904 DOI: 10.1016/j.surge.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/30/2016] [Indexed: 11/17/2022]
Abstract
AIM To examine the relationship between social and material deprivation and mandibular fractures. METHOD Three hundred and forty three consecutive patients who underwent mandibular fracture fixation were selected for the study. After exclusions, 290 were divided into age groups and ranked according to their Index of Multiple Deprivation (IMD) score. Rankings were determined using postcodes, and divided into quintiles for statistical analysis. RESULTS Ages ranged from 7 to 82 with 146 (50%) patients aged between 20 and 29. Males accounted for 85% of cases. The most common site of fracture was the angle (n = 195) and assault was shown to be the most common mechanism of injury (63.3%). A strong relationship was demonstrated between fractures of the mandible and worsening deprivation, with the most striking relationship seen with fractures sustained as a consequence of assault. Females were less likely than males to sustain a fracture of the mandible as a consequence of assault; however, when assault was the mechanism of injury they were also likely to be from a deprived background. CONCLUSION This study has demonstrated that a strong relationship exists between deprivation and the incidence of mandibular fractures in our catchment area. Fractures that resulted from interpersonal violence were shown to have a particularly strong correlation with deprivation.
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Affiliation(s)
- M H Wilson
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol, United Kingdom.
| | - J P Robinson
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol, United Kingdom
| | - R T Sisson
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol, United Kingdom
| | - P J Revington
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol, United Kingdom
| | - S J Thomas
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol, United Kingdom
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34
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Atkinson C, Penfold CM, Ness AR, Longman RJ, Thomas SJ, Hollingworth W, Kandiyali R, Leary SD, Lewis SJ. Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection. Br J Surg 2016; 103:962-70. [PMID: 27146793 PMCID: PMC5084762 DOI: 10.1002/bjs.10194] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
Background Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs. Methods This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar‐free gum for at least 10 min, four times per day on days 1–5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS. Results Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5–11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D‐3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo–Demartines–Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed. Conclusion Chewing gum did not alter the return of bowel function or LOS after colorectal resection. Registration number: ISRCTN55784442 (http://www.controlled-trials.com). No advantage observed
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Affiliation(s)
- C Atkinson
- Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK
| | - C M Penfold
- Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK
| | - A R Ness
- Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK
| | - R J Longman
- Department of Coloproctology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S J Thomas
- Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK
| | - W Hollingworth
- Schools of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Kandiyali
- Schools of Social and Community Medicine, University of Bristol, Bristol, UK
| | - S D Leary
- Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK
| | - S J Lewis
- National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.,Department of Gastroenterology, Derriford Hospital, Plymouth, UK
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Abstract
BACKGROUND There is increasing reference to complex patient needs in health care. However, little is known about how to measure patient complexity or the relationship between it and district nursing activity. AIM To illustrate the use of group concept mapping (GCM) to conceptualise and develop items for a patient complexity assessment instrument to be used by district nurses. DISCUSSION The first phase of this research used GCM conceptualisation and consensus methodology to identify items for a community-based patient complexity instrument. GCM helped to provide a conceptual understanding of community-based patient complexity through focused exploration of the term. RESULTS indicated that a number of environmental, sociological, psychological, behavioural, physical and organisational factors needed to be included. This, in turn, showed that an existing taxonomy did not contain the relevant items. Consequently, amendments were made and a new instrument developed. CONCLUSION GCM is a suitable consensus method for use in nursing theory and developing instruments. It proved successful in achieving consensus with no loss of participants' views. IMPLICATIONS FOR PRACTICE GCM is a suitable method for nurses to use in research or practice development activities as it is based on a facilitative and engagement-led approach.
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Ness AR, Waylen A, Hurley K, Jeffreys M, Penfold C, Pring M, Leary SD, Allmark C, Toms S, Ring S, Peters TJ, Hollingworth W, Worthington H, Nutting C, Fisher S, Rogers SN, Thomas SJ. Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000. Clin Otolaryngol 2016; 41:804-809. [PMID: 26436654 PMCID: PMC5111771 DOI: 10.1111/coa.12548] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A R Ness
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - K Hurley
- Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C Penfold
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Pring
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - S D Leary
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C Allmark
- National Cancer Research Institute Consumer Liaison Group (NCRI CLG), Independent Cancer Patients Voice (ICPV), London, UK
| | - S Toms
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Ring
- MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, Bristol, UK
| | - T J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H Worthington
- Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
| | - C Nutting
- Royal Marsden Hospital and the Institute for Cancer Research, London, UK
| | - S Fisher
- Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
| | - S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - S J Thomas
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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Townsley E, O'Connor G, Cosgrove C, Woda M, Co M, Thomas SJ, Kalayanarooj S, Yoon IK, Nisalak A, Srikiatkhachorn A, Green S, Stephens HAF, Gostick E, Price DA, Carrington M, Alter G, McVicar DW, Rothman AL, Mathew A. Interaction of a dengue virus NS1-derived peptide with the inhibitory receptor KIR3DL1 on natural killer cells. Clin Exp Immunol 2015; 183:419-30. [PMID: 26439909 PMCID: PMC4750593 DOI: 10.1111/cei.12722] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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] [Accepted: 10/04/2015] [Indexed: 12/26/2022] Open
Abstract
Killer immunoglobulin-like receptors (KIRs) interact with human leucocyte antigen (HLA) class I ligands and play a key role in the regulation and activation of NK cells. The functional importance of KIR-HLA interactions has been demonstrated for a number of chronic viral infections, but to date only a few studies have been performed in the context of acute self-limited viral infections. During our investigation of CD8(+) T cell responses to a conserved HLA-B57-restricted epitope derived from dengue virus (DENV) non-structural protein-1 (NS1), we observed substantial binding of the tetrameric complex to non-T/non-B lymphocytes in peripheral blood mononuclear cells (PBMC) from a long-standing clinical cohort in Thailand. We confirmed binding of the NS1 tetramer to CD56(dim) NK cells, which are known to express KIRs. Using depletion studies and KIR-transfected cell lines, we demonstrated further that the NS1 tetramer bound the inhibitory receptor KIR3DL1. Phenotypical analysis of PBMC from HLA-B57(+) subjects with acute DENV infection revealed marked activation of NS1 tetramer-binding natural killer (NK) cells around the time of defervescence in subjects with severe dengue disease. Collectively, our findings indicate that subsets of NK cells are activated relatively late in the course of acute DENV illness and reveal a possible role for specific KIR-HLA interactions in the modulation of disease outcomes.
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Affiliation(s)
- E Townsley
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - G O'Connor
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - C Cosgrove
- Ragon Institute at MGH, MIT And Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Woda
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - M Co
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - S J Thomas
- Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - S Kalayanarooj
- Queen Sirikit National Institute for Child Health, Bangkok, Thailand
| | - I-K Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - A Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - A Srikiatkhachorn
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - S Green
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
| | - H A F Stephens
- Centre for Nephrology and the Anthony Nolan Trust, Royal Free Campus, University College, London, UK
| | - E Gostick
- Cardiff University School of Medicine, Institute of Infection and Immunity, Cardiff, UK
| | - D A Price
- Cardiff University School of Medicine, Institute of Infection and Immunity, Cardiff, UK.,Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - M Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA.,Ragon Institute at MGH, MIT And Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - G Alter
- Ragon Institute at MGH, MIT And Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D W McVicar
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - A L Rothman
- Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, USA
| | - A Mathew
- Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
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Burnet NG, Nasr P, Yip G, Scaife JE, Thomas SJ, Harris F, Owen PJ, Hull P. Prophylactic Radiotherapy against Heterotopic Ossification around Acetabular Fractures requiring Surgical Reconstruction. Clin Oncol (R Coll Radiol) 2015; 28:69. [PMID: 26345250 DOI: 10.1016/j.clon.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - P Nasr
- Department of Orthopaedics and Trauma, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - G Yip
- Department of Orthopaedics and Trauma, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J E Scaife
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - F Harris
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P J Owen
- Department of Orthopaedics and Trauma, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Hull
- Department of Orthopaedics and Trauma, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Scaife JE, Barnett GC, Noble DJ, Jena R, Thomas SJ, West CML, Burnet NG. Exploiting biological and physical determinants of radiotherapy toxicity to individualize treatment. Br J Radiol 2015; 88:20150172. [PMID: 26084351 PMCID: PMC4628540 DOI: 10.1259/bjr.20150172] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/07/2015] [Accepted: 05/21/2015] [Indexed: 12/16/2022] Open
Abstract
The recent advances in radiation delivery can improve tumour control probability (TCP) and reduce treatment-related toxicity. The use of intensity-modulated radiotherapy (IMRT) in particular can reduce normal tissue toxicity, an objective in its own right, and can allow safe dose escalation in selected cases. Ideally, IMRT should be combined with image guidance to verify the position of the target, since patients, target and organs at risk can move day to day. Daily image guidance scans can be used to identify the position of normal tissue structures and potentially to compute the daily delivered dose. Fundamentally, it is still the tolerance of the normal tissues that limits radiotherapy (RT) dose and therefore tumour control. However, the dose-response relationships for both tumour and normal tissues are relatively steep, meaning that small dose differences can translate into clinically relevant improvements. Differences exist between individuals in the severity of toxicity experienced for a given dose of RT. Some of this difference may be the result of differences between the planned dose and the accumulated dose (DA). However, some may be owing to intrinsic differences in radiosensitivity of the normal tissues between individuals. This field has been developing rapidly, with the demonstration of definite associations between genetic polymorphisms and variation in toxicity recently described. It might be possible to identify more resistant patients who would be suitable for dose escalation, as well as more sensitive patients for whom toxicity could be reduced or avoided. Daily differences in delivered dose have been investigated within the VoxTox research programme, using the rectum as an example organ at risk. In patients with prostate cancer receiving curative RT, considerable daily variation in rectal position and dose can be demonstrated, although the median position matches the planning scan well. Overall, in 10 patients, the mean difference between planned and accumulated rectal equivalent uniform doses was -2.7 Gy (5%), and a dose reduction was seen in 7 of the 10 cases. If dose escalation was performed to take rectal dose back to the planned level, this should increase the mean TCP (as biochemical progression-free survival) by 5%. Combining radiogenomics with individual estimates of DA might identify almost half of patients undergoing radical RT who might benefit from either dose escalation, suggesting improved tumour cure or reduced toxicity or both.
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Affiliation(s)
- J E Scaife
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - G C Barnett
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D J Noble
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - R Jena
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - S J Thomas
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
- Cancer Research UK VoxTox Research Group, University of Cambridge Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
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Thomas SJ, Gonsalvez CJ, Johnstone SJ. Electrophysiology of facilitation priming in obsessive-compulsive and panic disorders. Clin Neurophysiol 2015; 127:464-478. [PMID: 26111486 DOI: 10.1016/j.clinph.2015.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 04/01/2015] [Accepted: 05/26/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Repeated experience with stimuli often primes faster, more efficient neuronal and behavioural responses. Exaggerated repetition priming effects have previously been reported in obsessive-compulsive disorder (OCD), however little is known of their underlying neurobiology or disorder-specificity, hence we investigated these factors. METHODS We examined event-related potentials (ERPs) and behaviour while participants with OCD, panic disorder and healthy controls (20 per group) performed a Go/NoGo task which manipulated target repetition sequences. RESULTS Both clinical groups showed stronger reaction time (RT) priming than HCs, which in OCD was greater in a checking, than washing, subgroup. Both clinical groups had similar RT deficits and ERP anomalies across several components, which correlated with psychopathology and RT priming. In OCD alone, N1 latency tended to increase to repeated stimuli, correlated with O-C symptoms, whereas it decreased in other groups. OCD-checkers had smaller target P2 amplitude than all other groups. CONCLUSIONS Enhanced neural priming is not unique to OCD and may contribute to salient sensory-cognitive experiences in anxiety generally. These effects are related to symptom severity and occur to neutral stimuli and in the context of overall RT impairment, suggesting they may be clinically relevant and pervasive. The results indicate overlapping information-processing and neurobiological factors across disorders, with indications of OCD-specific trends and subgroup differences. SIGNIFICANCE This first electrophysiological investigation of OCD priming in OCD to include anxious controls and OCD subgroups allows for differentiation between overlapping and OCD-specific phenomena, to advance neurobiological models of OCD.
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Affiliation(s)
- Susan J Thomas
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Graduate School of Medicine, University of Wollongong, NSW, Australia.
| | - Craig J Gonsalvez
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Centre for Psychophysics, Psychophysiology & Psychopharmacology, University of Wollongong, NSW, Australia; University of Western Sydney, NSW, Australia
| | - Stuart J Johnstone
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, NSW, Australia; Centre for Psychophysics, Psychophysiology & Psychopharmacology, University of Wollongong, NSW, Australia
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McGowan SE, Albertini F, Thomas SJ, Lomax AJ. Defining robustness protocols: a method to include and evaluate robustness in clinical plans. Phys Med Biol 2015; 60:2671-84. [PMID: 25768095 DOI: 10.1088/0031-9155/60/7/2671] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We aim to define a site-specific robustness protocol to be used during the clinical plan evaluation process. Plan robustness of 16 skull base IMPT plans to systematic range and random set-up errors have been retrospectively and systematically analysed. This was determined by calculating the error-bar dose distribution (ebDD) for all the plans and by defining some metrics used to define protocols aiding the plan assessment. Additionally, an example of how to clinically use the defined robustness database is given whereby a plan with sub-optimal brainstem robustness was identified. The advantage of using different beam arrangements to improve the plan robustness was analysed. Using the ebDD it was found range errors had a smaller effect on dose distribution than the corresponding set-up error in a single fraction, and that organs at risk were most robust to the range errors, whereas the target was more robust to set-up errors. A database was created to aid planners in terms of plan robustness aims in these volumes. This resulted in the definition of site-specific robustness protocols. The use of robustness constraints allowed for the identification of a specific patient that may have benefited from a treatment of greater individuality. A new beam arrangement showed to be preferential when balancing conformality and robustness for this case. The ebDD and error-bar volume histogram proved effective in analysing plan robustness. The process of retrospective analysis could be used to establish site-specific robustness planning protocols in proton therapy. These protocols allow the planner to determine plans that, although delivering a dosimetrically adequate dose distribution, have resulted in sub-optimal robustness to these uncertainties. For these cases the use of different beam start conditions may improve the plan robustness to set-up and range uncertainties.
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Affiliation(s)
- S E McGowan
- Department of Oncology, University of Cambridge, Cambridge, UK
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Martin AGR, Thomas SJ, Harden SV, Burnet NG. Evaluating competing and emerging technologies for stereotactic body radiotherapy and other advanced radiotherapy techniques. Clin Oncol (R Coll Radiol) 2015; 27:251-9. [PMID: 25727646 DOI: 10.1016/j.clon.2015.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/09/2015] [Accepted: 01/29/2015] [Indexed: 12/12/2022]
Abstract
Stereotactic body radiotherapy (SBRT) refers to the precise irradiation of an image-defined extracranial lesion, using a high total radiation dose delivered in a small number of fractions. A significant proportion of SBRT treatment has been successfully delivered using conventional gantry-based linear accelerators with appropriate image guidance and motion management techniques, although a number of specialist systems are also available. Evaluating the competing SBRT technologies is difficult due to frequent refinements to all major platforms. Comparison of geometric accuracy or treatment planning performance can be hard to interpret and may not provide much useful information. Nevertheless, a general specification overview can provide information that may help radiotherapy providers decide on an appropriate system for their centre. A number of UK randomised controlled trials (RCTs) have shown that better radiotherapy techniques yield better results. RCTs should play an important part in the future evaluation of SBRT, especially where there is a smaller volume of existing data, and where outcomes from conventional radiotherapy are very good. RCT comparison of SBRT with surgery is more difficult due to the radically different treatment arms, although successful recruitment can be possible if the lessons from previous failed trials are learned. The evaluation of new technology poses a number of challenges to the conventional RCT methodology, and there may be situations where it is genuinely not possible, with careful observational studies or decision modelling being more appropriate. Further development in trial design may have an important role in providing clinical evidence in a more timely manner.
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Affiliation(s)
- A G R Martin
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - S J Thomas
- Medical Physics Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S V Harden
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N G Burnet
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
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Brochu FM, Burnet NG, Jena R, Plaistow R, Parker MA, Thomas SJ. Geant4 simulation of the Elekta XVI kV CBCT unit for accurate description of potential late toxicity effects of image-guided radiotherapy. Phys Med Biol 2014; 59:7601-8. [PMID: 25415354 DOI: 10.1088/0031-9155/59/24/7601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper describes the modelisation of the Elekta XVI Cone Beam Computed Tomography (CBCT) machine components with Geant4 and its validation against calibration data taken for two commonly used machine setups. Preliminary dose maps of simulated CBCTs coming from this modelisation work are presented. This study is the first step of a research project, GHOST, aiming to improve the understanding of late toxicity risk in external beam radiotherapy patients by simulating dose depositions integrated from different sources (imaging, treatment beam) over the entire treatment plan. The second cancer risk will then be derived from different models relating irradiation dose and second cancer risk.
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Affiliation(s)
- F M Brochu
- University of Cambridge, Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK. University of Cambridge, Department of Physics, Cavendish Laboratory, J J Thomson Avenue, Cambridge, UK
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Burnet NG, Nasr P, Yip G, Scaife JE, House T, Thomas SJ, Harris F, Owen PJ, Hull P. Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk. Br J Radiol 2014; 87:20140398. [PMID: 25089852 DOI: 10.1259/bjr.20140398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Radiotherapy (RT) is effective in preventing heterotopic ossification (HO) around acetabular fractures requiring surgical reconstruction. We audited outcomes and estimated risks from RT prophylaxis, and alternatives of indometacin or no prophylaxis. METHODS 34 patients underwent reconstruction of acetabular fractures through a posterior approach, followed by a 8-Gy single fraction. The mean age was 44 years. The mean time from surgery to RT was 1.1 days. The major RT risk is radiation-induced fatal cancer. The International Commission on Radiological Protection (ICRP) method was used to estimate risk, and compared with a method (Trott and Kemprad) specifically for estimating RT risk for benign disease. These were compared with risks associated with indometacin and no prophylaxis. RESULTS 28 patients (82%) developed no HO; 6 developed Brooker Class I; and none developed Class II-IV HO. The ICRP method suggests a risk of fatal cancer in the range of 1 in 1000 to 1 in 10,000; the Trott and Kemprad method suggests 1 in 3000. For younger patients, this may rise to 1 in 2000; and for elderly patients, it may fall to 1 in 6000. The risk of death from gastric bleeding or perforation from indometacin is 1 in 180 to 1 in 900 in older patients. Without prophylaxis risk of death from reoperation to remove HO is 1 in 4000 to 1 in 30,000. CONCLUSION These results are encouraging, consistent with much larger series and endorse our multidisciplinary management. Risk estimates can be used in discussion with patients. ADVANCES IN KNOWLEDGE The risk from RT prophylaxis is small, it is safer than indometacin and substantially overlaps with the range for no prophylaxis.
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Affiliation(s)
- N G Burnet
- 1 Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Thomas SJ, Aspradakis MM, Byrne JP, Chalmers G, Duane S, Rogers J, Thomas RAS, Tudor GSJ, Twyman N. Reference dosimetry on TomoTherapy: an addendum to the 1990 UK MV dosimetry code of practice. Phys Med Biol 2014; 59:1339-52. [DOI: 10.1088/0031-9155/59/6/1339] [Citation(s) in RCA: 16] [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: 11/12/2022]
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Mammen MP, Lyons A, Innis BL, Sun W, McKinney D, Chung RCY, Eckels KH, Putnak R, Kanesa-thasan N, Scherer JM, Statler J, Asher LV, Thomas SJ, Vaughn DW. Evaluation of dengue virus strains for human challenge studies. Vaccine 2014; 32:1488-94. [PMID: 24468542 DOI: 10.1016/j.vaccine.2013.12.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 12/06/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
Discordance between the measured levels of dengue virus neutralizing antibody and clinical outcomes in the first-ever efficacy study of a dengue tetravalent vaccine (Lancet, Nov 2012) suggests a need to re-evaluate the process of pre-screening dengue vaccine candidates to better predict clinical benefit prior to large-scale vaccine trials. In the absence of a reliable animal model and established correlates of protection for dengue, a human dengue virus challenge model may provide an approach to down-select vaccine candidates based on their ability to reduce risk of illness following dengue virus challenge. We report here the challenge of flavivirus-naïve adults with cell culture-passaged dengue viruses (DENV) in a controlled setting that resulted in uncomplicated dengue fever (DF). This sets the stage for proof-of-concept efficacy studies that allow the evaluation of dengue vaccine candidates in healthy adult volunteers using qualified DENV challenge strains well before they reach field efficacy trials involving children. Fifteen flavivirus-naïve adult volunteers received 1 of 7 DENV challenge strains (n=12) or placebo (n=3). Of the twelve volunteers who received challenge strains, five (two DENV-1 45AZ5 and three DENV-3 CH53489 cl24/28 recipients) developed DF, prospectively defined as ≥2 typical symptoms, ≥48h of sustained fever (>100.4°F) and concurrent viremia. Based on our study and historical data, we conclude that the DENV-1 and DENV-3 strains can be advanced as human challenge strains. Both of the DENV-2 strains and one DENV-4 strain failed to meet the protocol case definition of DF. The other two DENV-4 strains require additional testing as the illness approximated but did not satisfy the case definition of DF. Three volunteers exhibited effusions (1 pleural/ascites, 2 pericardial) and 1 volunteer exhibited features of dengue (rash, lymphadenopathy, neutropenia and thrombocytopenia), though in the absence of fever and symptoms. The occurrence of effusions in milder DENV infections counters the long-held belief that plasma leakage syndromes are restricted to dengue hemorrhagic fever/dengue shock syndromes (DHF/DSS). Hence, the human dengue challenge model may be useful not only for predicting the efficacy of vaccine and therapeutic candidates in small adult cohorts, but also for contributing to our further understanding of the mechanisms behind protection and virulence.
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Affiliation(s)
- M P Mammen
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - A Lyons
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - B L Innis
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - W Sun
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - D McKinney
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - R C Y Chung
- Infectious Disease Service, Walter Reed Army Medical Center (WRAMC), Washington, DC 20307, United States.
| | - K H Eckels
- Translational Medicine Branch, WRAIR, Silver Spring, MD 20910, United States.
| | - R Putnak
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - N Kanesa-thasan
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - J M Scherer
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - J Statler
- Radiology Service, Walter Reed Army Medical Center (WRAMC), Washington, DC 20307, United States.
| | - L V Asher
- Translational Medicine Branch, WRAIR, Silver Spring, MD 20910, United States.
| | - S J Thomas
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
| | - D W Vaughn
- Divisions of Viral Diseases, Regulated Activities, Veterinary Services Program, and Pathology, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD 20910, United States.
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Thomas SJ, Gonsalvez CJ, Johnstone SJ. Neural time course of threat-related attentional bias and interference in panic and obsessive–compulsive disorders. Biol Psychol 2013; 94:116-29. [DOI: 10.1016/j.biopsycho.2013.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 05/10/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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Pirraglia PA, Peterson JC, Hartman GS, Yao FS, Thomas SJ, Charlson ME. The efficacy and safety of a pharmacologic protocol for maintaining coronary artery bypass patients at a higher mean arterial pressure during cardiopulmonary bypass. 1998. J Extra Corpor Technol 2013; 45:198-206. [PMID: 24303604 PMCID: PMC4393745] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A recent randomized trial of higher versus lower mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) showed that higher MAP on CPB was associated with a lower incidence of overall cardiac and neurologic morbidity and mortality in coronary artery bypass graft surgery (CABG) patients. Cardiopulmonary bypass MAP was controlled pharmacologically while CPB flow was held constant for any given period. The objective of the present study was to assess the efficacy and safety of this pharmacologic protocol. Two hundred forty-eight patients participated in the study; the mean age was 65.8 ± 9.4 years, 20% were women, and the mean preoperative ejection fraction was 48%. The low-flow corrected CPB MAP attained for the low and high MAP groups was 56.7 ± 5.0 mmHg and 77.7 ± 7.1 mmHg, respectively (p = 0.0001). Major cardiac and neurologic outcomes, postoperative blood loss, renal dysfunction, intensive care unit (ICU) stay, and duration of intubation were not found to be significantly associated with any drug in the pharmacologic protocol. These findings support that the pharmacologic protocol used to maintain CABG patients at higher MAP on CPB is both efficacious and safe.
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Affiliation(s)
- P A Pirraglia
- Cornell Coronary Artery Bypass Outcomes Trial Group, NEw York Hospital-Cornell Medical Center, Department of Medicine, New York, NY, USA
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Thomas SJ, Caputi P, Wilson CJ. Specific Attitudes Which Predict Psychology Students’ Intentions to Seek Help for Psychological Distress. J Clin Psychol 2013; 70:273-82. [DOI: 10.1002/jclp.22022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Thomas SJ, Pai BN, Dawes K. It's time to examine the status of our undergraduate mental health curricula. Med J Aust 2013; 198:533-4. [DOI: 10.5694/mja12.11383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 03/05/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Susan J Thomas
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Brahmavar N Pai
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
| | - Kerry Dawes
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW
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