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Healy D, Rizkallal C, Rossanese M, McLarnon P, Vallefuoco R, Murgia D, Ryan T, Howes C, Anderson O, Charlesworth T, Cinti F, Martin S, Das S, Cantatore M. Surgical treatment of canine urethral prolapse via urethropexy or resection and anastomosis. J Small Anim Pract 2024; 65:206-213. [PMID: 38081729 DOI: 10.1111/jsap.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/07/2023] [Accepted: 11/05/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The objective was to report and compare the complications and recurrence rates of urethral prolapse in dogs when treated with urethropexy, resection and anastomosis or a combined surgical technique. STUDY DESIGN Retrospective study. MATERIALS AND METHODS A total of 86 dogs were identified from the medical records of 10 veterinary referral hospitals from February 2012 and October 2022. Dogs were included if they underwent surgery for a urethral prolapse at first presentation. Complications were classified as minor or major based on the necessity of further surgical intervention. Complications leading to death were also considered major complications. RESULTS Seventy-nine dogs were included, urethropexy (n=44), resection and anastomosis (n=27) and a combined surgical technique (n=8). Minor complications were identified in 41 of 79 dogs (51.9%): urethropexy 19 of 44 (43.2%), resection and anastomosis 18 of 27 (66.6%) and a combined surgical technique four of eight (50%). Major complications occurred in 23 dogs (29.1%), of which 21 were recurrence (26.6%). Recurrence occurred in 17 of 44 dogs following a urethropexy (38.6%), three of 27 dogs following resection and anastomosis (11.1%) and one of eight dogs treated with a combined surgical technique (12.5%). Recurrence of a urethral prolapse was significantly more likely following urethropexy in comparison to resection and anastomosis. CLINICAL SIGNIFICANCE Resection and anastomosis was associated with a lower recurrence rate in comparison to urethropexy for the surgical treatment of urethral prolapse. Based on these results, we concluded that resection and anastomosis may be preferable to urethropexy for treatment of urethral prolapse at first presentation. Urethropexy, and resection and anastomosis combined surgical technique was associated with low recurrence rate; however, further studies will be needed to clarify if it provides any benefit over resection and anastomosis.
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Affiliation(s)
- D Healy
- Anderson Moores Veterinary Specialists, Winchester, UK
| | | | - M Rossanese
- Queen Mother Hospital for Animals Royal Veterinary College, Hatfield, UK
| | - P McLarnon
- Davies Veterinary Specialists, Hertfordshire, UK
| | | | - D Murgia
- Dick White Referrals, Cambridgeshire, UK
| | - T Ryan
- Southern Counties Veterinary Specialists, Ringwood, UK
| | - C Howes
- Bristol Veterinary Specialists, Central Park, Avonmouth, Bristol, UK
| | - O Anderson
- Bristol Veterinary Specialists, Central Park, Avonmouth, Bristol, UK
| | | | - F Cinti
- San Marco Veterinary Clinic and Laboratory, 35130 Veggiano, Padova, Italy
| | - S Martin
- Veterinary Specialists Ireland, Meath, Ireland
| | - S Das
- Davies Veterinary Specialists, Hertfordshire, UK
| | - M Cantatore
- Anderson Moores Veterinary Specialists, Winchester, UK
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Zurita M, Herrmann A, Ryan T, Carrera I, Di Bella A. Jejunal arteriovenous malformation and multiple acquired extrahepatic portosystemic shunts in a juvenile dog, presenting with melena. J Small Anim Pract 2023; 64:485-489. [PMID: 37185981 DOI: 10.1111/jsap.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023]
Abstract
A juvenile dog referred with a 1-month history of persistent melena and severe anaemia, was diagnosed with a jejunal arteriovenous malformation, and multiple acquired extrahepatic portosystemic shunts. A midline coeliotomy was performed, the jejunal arteriovenous malformation was localised intraoperatively and was successfully removed via an enterectomy. Histopathology confirmed a true arteriovenous malformation. Despite the initial improvement, the patient developed seizure episodes secondary to hepatic encephalopathy 8 months after surgery. Fifteen months after surgery, the owner opted for euthanasia due to the ongoing seizure episodes. Post-mortem histologic examination of the liver showed features consistent with portal vein hypoplasia. A congenital arteriovenous malformation should be considered as a differential diagnosis in juvenile patients with a chronic history of haemorrhage from the gastrointestinal tract. In addition, acquired portosystemic shunts may occur in patients with portal vein hypoplasia and jejunal arteriovenous malformations.
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Affiliation(s)
- M Zurita
- Southern Counties Veterinary Specialists, Ringwood, BH24 3JW, UK
| | - A Herrmann
- Southern Counties Veterinary Specialists, Ringwood, BH24 3JW, UK
| | - T Ryan
- Southern Counties Veterinary Specialists, Ringwood, BH24 3JW, UK
| | - I Carrera
- Southern Counties Veterinary Specialists, Ringwood, BH24 3JW, UK
| | - A Di Bella
- Southern Counties Veterinary Specialists, Ringwood, BH24 3JW, UK
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Ryan T, Um J, Castleberry A, Lowes B, Moody M, Urban M. Economic Impact of Donation after Circulatory Death Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Nandi D, Wright L, Sublett-Smith J, Brax A, Almond C, Bansal N, Azeka E, Butts R, Conway J, Chen C, Cunningham C, Fisher L, Hall E, Hunter T, Kobayashi R, Patterson D, Peng D, Simpson K, Ryan T, Spinner J, Wisotzkey B, Zangwill S, Gajarski R, O'Connor M. Suboptimal Titration of Heart Failure Medications in Pediatric Patients: Baseline Data from the ACTION Network. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ryan T. LYMPHSPIRATION: A RETURN AND RESONANCE OF TWO LYMPHOLOGISTS AT OXFORD IN 2022. Lymphology 2022. [DOI: 10.2458/lymph.5406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An "incurable" lymphologist reflects on his life, unanswered questions, patients who became friends, and lessons learned during a brief encounter with a lymphatic soul-mate.
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Hadzic D, Ryan T, Murphy D. 165 PHARMACIST-LED MEDICINES RECONCILIATION: AN OBSERVATIONAL STUDY TO EVALUATE INFORMATION SOURCES AS A QUALITY INDICATOR OF THE SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Medicines Reconciliation (MR) involves obtaining a Best-Possible Medication History (BPMH) and is essential for reducing medication errors and adverse events. Recommendations on how best to undertake MR range from utilising the patient alone to using ≥2 sources (in addition to the patient). Few studies evaluate the use of >1 source as a measure of MR quality.
Methods
This observational study was undertaken in a major teaching hospital that provides a dedicated pharmacist-led MR service. Eligible patients (aged ≥65 years, admitted through the Emergency Department) were randomly recruited. MRs were compiled using 2 sources and compared to individual 1-source MRs (both in addition to patient/carer interview). Additional Medication Discrepancies (AMDs), or differences between 1-source and 2-source MR, were assessed and potential predictors analysed.
Results
A total of 114 patients were included. Community pharmacy was the most frequently used and most accurate source (full agreement in 97.4% of BPMHs). Two-thirds of MRs would not differ if either of the two sources were used in isolation, alongside patient/carer interview. The remaining MRs identified a total of 85 AMDs (1–6 per MR). The majority were drug omissions (49.4%). Most were deemed “low” potential clinical significance (59%). Higher patient/carer reliability was associated with lower incidence (p=0.001) and fewer AMDs (p=0.001).
Conclusion
Contrary to some international guidelines, using >1 source (in addition to patient/carer interview) does not add value to the BPMH in the majority of cases.
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Affiliation(s)
- D Hadzic
- Mater Misericordiae University Hospital Pharmacy Department, , Dublin, Ireland
- Trinity College School of Pharmacy and Pharmaceutical Sciences, The University of Dublin, , Dublin, Ireland
| | - T Ryan
- Trinity College School of Pharmacy and Pharmaceutical Sciences, The University of Dublin, , Dublin, Ireland
| | - D Murphy
- Mater Misericordiae University Hospital Pharmacy Department, , Dublin, Ireland
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Meyer L, Roy RP, Huang B, Kimura S, Polonen P, Delgado-Martin C, Vincent T, Ryan T, Wood B, Liu Y, Zhang J, Mullighan C, Horton T, Loh M, Devidas M, Raetz E, Hayashi R, Winter S, Dunsmore K, Hunger S, Teachey D, Hermiston M, Olshen AB. A TARGETED GENE EXPRESSION CLASSIFIER IDENTIFIES PEDIATRIC T-ALL PATIENTS AT HIGH RISK FOR END INDUCTION MINIMAL RESIDUAL DISEASE POSITIVITY. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00243-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lundgren S, Diederich T, Pozehl B, Ryan T, Burdorf A. LVAD OPTIMIZE Clinic Improves Medication Use and Reduces Hospitalizations Post-Implant. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Brincin C, Ryan T, Harris K. Gastroesophageal intussusception secondary to induction of emesis with subsequent development of septic pericardial effusion after corrective surgery. J Small Anim Pract 2021; 63:72-77. [PMID: 34370318 DOI: 10.1111/jsap.13395] [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: 01/23/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
A juvenile boxer dog was diagnosed with gastroesophageal intussusception that occurred after the induction of emesis with apomorphine. A ventral midline coeliotomy and diaphragmotomy were performed and the intussusception was manually reduced. Despite initial satisfactory recovery, the dog was diagnosed with cardiac tamponade 1 week post-operatively. Escherichia coli was cultured from pericardial and pleural effusion samples. During subtotal pericardiectomy surgery the pericardium was found to be markedly thickened with adhesions to the epicardium, thoracic wall and diaphragm. Substantial haemorrhage and refractory hypotension necessitated the administration of a blood transfusion during surgery. The dog entered cardiac arrest in the immediate post-operative period and cardiopulmonary resuscitation was unfortunately unsuccessful. Gastroesophageal intussusception should be considered a possible severe adverse effect of administering apomorhine to induce emesis in dogs. Additionally, septic pericardial and pleural effusions may occur post-reduction of gastroesophageal intussusception.
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Affiliation(s)
- C Brincin
- Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, Hangerlsey, Ringwood, BH24 3JW, UK
| | - T Ryan
- Highcroft Veterinary Referrals, 615 Wells Rd, Bristol, BS14 9BE, UK
| | - K Harris
- Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, Hangerlsey, Ringwood, BH24 3JW, UK
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Alonso W, Ryan T, Lundgren S, Schroeder S, Pozehl B. Clinicians Call for Physical Activity Guidelines for Pre- and Post- LVAD Implantation. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.399] [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: 11/29/2022] Open
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Dean B, Anderson T, Garcia-Pertierra S, Jenkins G, Cantatore M, Craig A, Harris K, Ryan T. Diaphragmotomy to aid exposure during hepatobiliary surgery: a multi-centre retrospective review of 31 dogs. J Small Anim Pract 2020; 61:278-284. [PMID: 32077119 DOI: 10.1111/jsap.13121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To report surgical technique, intra- and post-operative complications, and short- and long-term outcome following canine hepatobiliary surgery in which exposure of intra-abdominal hepatobiliary lesions was aided by diaphragmotomy. MATERIALS AND METHODS Clinical records from four multi-disciplinary UK-based small animal referral hospitals were retrospectively reviewed for dogs in which diaphragmotomy was performed between January 2014 and May 2019. Signalment, diagnosis, surgery performed, diaphragmotomy technique, management of diaphragmotomy and pneumothorax, intra- and post-operative complications, short-term outcome and long-term outcome were recorded. RESULTS Thirty-one cases were identified. The most common hepatobiliary surgeries performed alongside diaphragmotomy were single hepatic lobectomy (14/31) and cholecystectomy (11/31). The most common diagnoses were hepatocellular carcinoma (10/31), gall bladder mucocoele (7/31) and hepatic nodular hyperplasia (4/31). Peri-operative mortality rate was 9.7% (3/31 cases) though none of these deaths were considered attributable to diaphragmotomy. Post-operative complications were encountered in 67.9% (19/28) cases that survived the peri-operative period, of which 25.0% (7/28) suffered complications that were considered attributable or likely attributable to diaphragmotomy. These seven complications resolved following non-surgical intervention. Follow-up was available for 26 of 28 patients that survived to discharge at a median of 4-months (range 10 days to 24 months) following surgery and revealed no evidence of complications related to diaphragmotomy. CLINICAL SIGNIFICANCE Diaphragmotomy appears safe and increases abdominal exposure of hepatobiliary lesions. The benefit of improved exposure must be carefully weighed up against the risks inherent in inducing pneumothorax.
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Affiliation(s)
- B Dean
- Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, Hangersley, BH24 3JW, UK
| | - T Anderson
- Dick White Referrals, Cambridgeshire, CB8 0UH, UK
| | - S Garcia-Pertierra
- The Royal (Dick) School of Veterinary Studies, Hospital for Small Animals, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - G Jenkins
- Anderson Moores Veterinary Specialists, Hampshire, SO21 2LL, UK
| | - M Cantatore
- Anderson Moores Veterinary Specialists, Hampshire, SO21 2LL, UK
| | - A Craig
- Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, Hangersley, BH24 3JW, UK
| | - K Harris
- Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, Hangersley, BH24 3JW, UK
| | - T Ryan
- Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm, Hangersley, BH24 3JW, UK
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Hansen CB, Kerrouche A, Tatari K, Rasmussen A, Ryan T, Summersgill P, Desmulliez MPY, Bridle H, Albrechtsen HJ. Monitoring of drinking water quality using automated ATP quantification. J Microbiol Methods 2019; 165:105713. [PMID: 31476354 DOI: 10.1016/j.mimet.2019.105713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 11/28/2022]
Abstract
A microfluidic based system was developed for automated online method for the rapid detection and monitoring of drinking water contamination utilising microbial Adrenosine-5'-Triphosphate (ATP) as a bacterial indicator. The system comprises a polymethyl methacrylate based microfluidic cartridge inserted into an enclosure incorporating the functions of fluid storage and delivery, lysis steps and real-time detection. Design, integration and operation of the resulting automated system are reported, including the lysis method, the design of the mixing circuit, the choices of flow rate, temperature and reagent amount. Calibration curves of both total and free ATP were demonstrated to be highly linear over a range from 2.5-5000 pg/mL with the limit of detection being lower than 2.5 pg/mL of total ATP. The system was trialled in a lab study with different types of water, with lysis efficiency being found to be strongly dependent upon water type. Further development is required before online implementation.
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Affiliation(s)
- C B Hansen
- Technical University of Denmark, Lyngby, Denmark
| | | | - K Tatari
- Technical University of Denmark, Lyngby, Denmark
| | - A Rasmussen
- Technical University of Denmark, Lyngby, Denmark
| | | | | | - M P Y Desmulliez
- Multi-Modal Sensing and Micro-Manipulation Centre (CAPTURE), Institute of Sensors, Signals and Systems (ISSS), Heriot-Watt University, Edinburgh, Scotland EH14 4AS, UK
| | - H Bridle
- Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot-Watt University, Edinburgh, Scotland EH14 4AS, UK.
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Ryan T, Wexler D, Wawrzonek A, Mahdavi S, Westdal J, Fine J. C-64 The Verbal Shift Social Assessment: Examining Differences in Emotion Recognition, Attention, and Event Prediction Between Children with HFASD, ADHD, and Typically Developing Peers. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
A pilot study of an experimental instrument extending the ‘verbal shift’ hypothesis indicating HFASD bias towards language over nonverbal cues (Grossman, Klin, Carter & Volkmar, 2000). We hypothesized HFASD differentiates from ADHD in social video interpretation in the degree of reliance on semantic content for correct responses.
Method
68 children ages 7-13 were recruited from the community (21 HFASD, 20 ADHD, 27 Control). Children viewed video pairs of social interaction. A “masked” version preserved prosody and visual cues, but not words. An “unmasked” version was naturalistic, with interpretable spoken language. Three questions were asked following each video scene (masked presented first): 1) the emotion of an actor, 2) a question to verify child was attending, 3) prediction about what might happen next. MANCOVA with post-hoc analysis was used to examine the between-group differences on performance as measured by the number of correct responses gained when the videos were unmasked.
Results
There were no group differences in age, gender, and WASI PRI. With WASI VCI controlled, emotion recognition and prediction questions differed significantly between groups (F = 3.907, p = .025, pEta2 = .109; F = 4.725, p = .012, pEta2 = .129), with ASD having the largest unmasked>masked correct gain compared to ADHD (p = .05; p = .029) and controls (p = .009; p = .004) There were no differences between ADHD and controls. The attention question did not differ among groups; focus on the details of the videos was similar in participants regardless of diagnosis.
Conclusions
Results of this pilot study indicate that emotion recognition and event prediction may be useful diagnostic predictors when differentiating HFASD from ADHD using naturalistic video stimuli.
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Urban M, Merritt-Genore H, Siddique A, Moulton M, Ryan T, Um J. Impact of Veno-Arterial Membrane Oxygenation on Outcome of “Crash and Burn” Patients Transitioned to Durable Left Ventricular Assist Device. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ryan T, Rice V, Saunders J, Limbrick S. Measuring the effectiveness of workplace health management programs: An Australian example. Prev Med Rep 2018; 11:56-62. [PMID: 29984139 PMCID: PMC6030229 DOI: 10.1016/j.pmedr.2018.04.018] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/20/2018] [Accepted: 04/21/2018] [Indexed: 11/13/2022] Open
Abstract
The workplace can provide opportunities to support workers in adopting and sustaining health enhancing behaviours. Health promotion programs based at the workplace need not only to achieve this goal but also the continuing support of the employers. This can best be achieved by demonstrating a return on their investment. The aim of this study therefore was to develop an integrated workplace health management program which could be associated with measurable outcomes related to benefitting the institution's "bottom line". This program was based in a metropolitan surgical hospital in Melbourne, Australia from 2006 to 2010 with a total workforce of 1400 employees aged 18-74 years (86% female 14% male), The program followed two key principles of 1) building safe and familiar support networks in order to build a workplace culture where all the workers felt valued. 2) Providing time for individual workers to focus on themselves as a means to achieve early intervention and management of injuries. Insurance data generated by the Workers Compensation Authority identified the following 'bottom line' benefits over three years: injury management costs reduced by 56%; number of compensation Injury claims dropped by 46%; time to return to work post injury reduced by 68%, and; a reduction. in premiums of 43% achieved over a six-year period. Insurers world-wide calculate workers' compensation insurance premiums on injury claims history. It is concluded that such data as these can offer a reliable and 'persuasive' measure of health and injury outcomes, in workplace interventions of this nature.
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Affiliation(s)
- T. Ryan
- Australian Catholic University, 115 Victoria St, Fitzroy, Melbourne, Australia
| | - V. Rice
- Australian Catholic University, 115 Victoria St, Fitzroy, Melbourne, Australia
| | - J. Saunders
- Australian Catholic University, 115 Victoria St, Fitzroy, Melbourne, Australia
| | - S. Limbrick
- St. Vincents Private Hospital, 59 Victoria St, Fitzroy, Melbourne, Australia
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Luksan A, Berkheim D, Ryan T, Lyden E, Um J, Siddique A, Moulton M, Merritt H. Time is on Your Side: A Comparison of OR Times with ECMO Survival in Post Cardiotomy Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1226] [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: 10/17/2022] Open
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Ryan T, Taylor E, Morris C, Wood C, Chieng D, Sanfilippo F, Haseler L, Shetty S, Rankin J, Dwivedi G, Yong G. Do Opportunistic Radiological Markers of Frailty on Pre–Transcatheter Aortic Valve Implantation Computed Tomography Predict Outcomes? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.430] [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: 11/15/2022]
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Ryan T, Taylor E, Morris C, Gahungu N, Wood C, Sanfilippo F, Haseler L, Shetty S, Rankin J, Yong G, Dwivedi G. Are There Any Echocardiographic or Clinical Markers of Adverse Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation for Low-Gradient Aortic Stenosis? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.891] [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: 10/28/2022]
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Piller N, Clodius L, Campisi C, Eliska O, Ohkuma M, Pissas A, Papendieck CM, Swedborg I, Ryan T, Witte MH. In Memoriam Prof. Prof. h.c. Dr. med. Michael Földi, January 10, 1920 - October 20, 2018 "Father of Lymphology". Lymphology 2018; 51:184-192. [PMID: 31119908] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In Memoriam: With deep sadness the world of Lymphology learned of the death of Prof. Prof. h.c. Dr. med. Michael Földi, a ground breaking pioneer of modern Lymphology. Words alone will never fully describe or capture the breadth and depth of Michael's contribution to our lymphatic knowledge and the legacy he has left for us all.
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Affiliation(s)
- N Piller
- Department of Surgery, Flinders University Bedford Park, South Australia
| | - L Clodius
- Plastic Surgeon (retired), University Hospital Zurich, Switzerland
| | - C Campisi
- Operative Unit of Lymphatic Surgery, Lymphology and Microsurgery Section, University Hospital S. Martino Genoa, Italy
| | - O Eliska
- Department of Anatomy, 1st Medical Faculty, Charles University Prague, Czech Republic
| | - M Ohkuma
- Department of Dermatology, Kinki University, School of Medicine, Osaka, Japan
| | - A Pissas
- Department of Surgery, Montpelier, France
| | - C M Papendieck
- Fundacion Angiopediatria, Fronteras de la Linfologia, Buenos Aires, Argentina
| | - I Swedborg
- Department of Physical Medicine and Rehabilitation and Radiumhemmet, Karolinska Hospital (Retired) Stockholm, Sweden
| | - T Ryan
- Department of Dermatology Emeritus Fellow, Oxford University (Retired) and Oxford Brookes University Oxford, United Kingdom
| | - M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
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Swinbourne F, Jeffery N, Tivers M, Artingstall R, Bird F, Charlesworth T, Doran I, Freeman A, Hall J, Hattersley R, Henken J, Hughes J, de la Puerta B, Rutherford L, Ryan T, Williams H, Woods S, Nicholson I. The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors. J Small Anim Pract 2017; 58:495-503. [DOI: 10.1111/jsap.12696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- F. Swinbourne
- Willows Referral Service; Shirley Solihull B90 4NH UK
| | - N. Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station Texas 77843 USA
| | - M.S. Tivers
- School of Veterinary Sciences; University of Bristol; Langford Bristol BS40 5DU UK
| | - R. Artingstall
- Vale Referrals; The Animal Hospital; Stinchcombe Dursley GL11 6AJ UK
| | - F. Bird
- Pride Veterinary Hospital; Derby DE24 8HY UK
| | | | - I. Doran
- School of Veterinary Sciences; University of Bristol; Langford Bristol BS40 5DU UK
| | - A. Freeman
- Small Animal Teaching Hospital, Institute of Veterinary Science; University of Liverpool; Neston Wirral CH64 7TE UK
| | - J. Hall
- Northwest Surgeons; Sutton Weaver Cheshire WA7 3FW UK
| | | | - J. Henken
- Village Vet Highgate; London NW51BX UK
| | - J. Hughes
- North Downs Specialist Referrals; Bletchingley Surrey RH1 4QP UK
| | - B. de la Puerta
- Department of Clinical Services, Royal Veterinary College; Queen Mother Hospital for Animals; North Mymms Hatfield AL9 7TA UK
| | - L. Rutherford
- Southern Counties Veterinary Specialists; Ringwood Hampshire BH24 3JW UK
| | - T. Ryan
- Easter Bush Veterinary Centre, Royal (Dick) School of Veterinary Studies; University of Edinburgh; Roslin Midlothian EH25 9RG UK
| | - H. Williams
- School of Veterinary Sciences; University of Bristol; Langford Bristol BS40 5DU UK
| | - S. Woods
- Northwest Surgeons; Sutton Weaver Cheshire WA7 3FW UK
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Vlok R, Melhuish TM, Chong C, Ryan T, White LD. Adjuncts to local anaesthetics in tonsillectomy: a systematic review and meta-analysis. J Anesth 2017; 31:608-616. [PMID: 28120104 DOI: 10.1007/s00540-017-2310-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
Abstract
The infiltration of local anaesthetic agents has been shown to reduce post-tonsillectomy pain. A number of recent studies have shown that the addition of agents such as clonidine and dexamethasone improve the efficacy of nerve blocks and spinal anaesthesia. The aim of this review was to determine whether additives to local anaesthetic agents improve post-tonsillectomy outcomes. Four major databases were systematically searched for all relevant studies published up to August 2016. All study designs with a control group receiving local anaesthetic infiltration and an intervention receiving the same infiltration with an added agent were included in this review. These studies were then assessed for level of evidence and risk of bias. The data were then analysed both qualitatively and where appropriate by meta-analysis. We reviewed 11 randomised controlled trial (RCTs) that included 854 patients. Due to inconsistencies in the methods used to report outcomes, both quantitative and qualitative comparisons were required to analyse the extracted data. Overall, we found that dexamethasone, magnesium, pethidine and tramadol reduce post-operative pain and analgesia use, with dexamethasone in particular significantly reducing post-operative nausea and vomiting and magnesium infiltration significantly reducing the incidence of laryngospasm. This systematic review of RCTs provides strong evidence that the use of dexamethasone and magnesium as additives to local anaesthetics reduces post-tonsillectomy pain and analgesia requirement. There is limited evidence that pethidine and tramadol have a similar effect on pain and analgesia requirement. The studies in this pooled analysis are sufficiently strong to make a level one recommendation that the addition of magnesium to local anaesthetics reduces the incidence of laryngospasm, a potentially lethal post-operative complication. Review level of evidence: 1.
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Affiliation(s)
- R Vlok
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia.,School of Medicine, Sydney, University of Notre Dame, Fremantle, NSW, Australia
| | - T M Melhuish
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia.,School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C Chong
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - T Ryan
- School of Medicine, Sydney, University of Notre Dame, Fremantle, NSW, Australia
| | - Leigh D White
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, NSW, Australia. .,School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
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O'Neil B, O'Reilly S, Kasbari S, Kim R, McDermott R, Moore D, Grogan W, Cohn A, Bekaii-Saab T, Ivanova A, Olowokure O, Fernando N, McCaffrey J, El-Rayes B, Horgan A, Ryan T, Sherrill G, Yacoub G, Goldberg R, Sanoff H. A multi-center, randomized, double-blind phase II trial of FOLFIRI + regorafenib or placebo for patients with metastatic colorectal cancer who failed one prior line of oxaliplatin-containing therapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Holmes S, Ryan T, Young D, Harries M. Frontal Fibrosing Alopecia Severity Index (FFASI): a validated scoring system for assessing frontal fibrosing alopecia. Br J Dermatol 2016; 175:203-7. [PMID: 26847608 DOI: 10.1111/bjd.14445] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, U.K..
| | - T Ryan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, U.K
| | - D Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, U.K
| | - M Harries
- The Dermatology Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester, U.K
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Burdorf A, Varnado S, Balk J, Ryan T, Raichlin E, Vongooru H, Lowes B, Zolty R, Um J, Merritt-Genore H, Moulton M, Siddique A. Myocarditis Treated with VA-ECMO: A Single Centers Experience. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bowsher K, Civillico EF, Coburn J, Collinger J, Contreras-Vidal JL, Denison T, Donoghue J, French J, Getzoff N, Hochberg LR, Hoffmann M, Judy J, Kleitman N, Knaack G, Krauthamer V, Ludwig K, Moynahan M, Pancrazio JJ, Peckham PH, Pena C, Pinto V, Ryan T, Saha D, Scharen H, Shermer S, Skodacek K, Takmakov P, Tyler D, Vasudevan S, Wachrathit K, Weber D, Welle CG, Ye M. Brain–computer interface devices for patients with paralysis and amputation: a meeting report. J Neural Eng 2016; 13:023001. [DOI: 10.1088/1741-2560/13/2/023001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Glanville K, Ryan T, Tomlinson M, Muriuki G, Ronan M, Pollett A. A Method for Catchment Scale Mapping of Groundwater-Dependent Ecosystems to Support Natural Resource Management (Queensland, Australia). Environ Manage 2016; 57:432-449. [PMID: 26404433 DOI: 10.1007/s00267-015-0612-z] [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] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
Immediate and foreseeable threats to groundwater-dependent ecosystems (GDEs) are widely acknowledged, many linked to altered groundwater regimes including changes in groundwater flow, flux, pressure, level and/or quality (Eamus et al. in Aust J Bot 54:97-114, 2006a). Natural resource managers and other decision-makers often lack sufficient information at an appropriate scale to understand the groundwater dependency of ecosystems and ensure that GDEs are adequately considered in decision-making processes. This paper describes a new catchment scale mapping method for GDEs based on the integration of local expert knowledge with detailed spatial datasets to delineate GDEs at a scale compatible with management and planning activities. This overcomes one of the key criticisms often levelled at broader scale mapping methods-that information from local and regional experts, with significant understanding of landscape processes and ecosystems, is not incorporated into the datasets used by decision-makers. Expert knowledge is conveyed in the form of pictorial conceptual models representing the components, processes and interrelationships of groundwater within a catchment and the ecosystems dependent on it. Each mapped GDE is linked to a pictorial conceptual model and a mapping rule-set to provide decision-makers with valuable information about where, how and why GDEs exist in a landscape.
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Affiliation(s)
- K Glanville
- Department of Natural Resources and Mines, Queensland Government, 400 George Street, Brisbane, QLD, 4000, Australia.
- Department of Science, Information Technology, and Innovation, Queensland Government, Queensland Herbarium, Mount Coot-tha Road, Toowong, QLD, 4066, Australia.
| | - T Ryan
- Department of Science, Information Technology, and Innovation, Queensland Government, Queensland Herbarium, Mount Coot-tha Road, Toowong, QLD, 4066, Australia
| | - M Tomlinson
- Department of Natural Resources and Mines, Queensland Government, 400 George Street, Brisbane, QLD, 4000, Australia
- Department of the Environment, Australian Government, John Gorton Building, King Edward Terrace, Parkes, ACT, 2600, Australia
| | - G Muriuki
- Department of Science, Information Technology, and Innovation, Queensland Government, Queensland Herbarium, Mount Coot-tha Road, Toowong, QLD, 4066, Australia
- The University of Queensland, St Lucia, QLD, 4072, Australia
| | - M Ronan
- Department of Environment and Heritage Protection, Queensland Government, 400 George Street, Brisbane, QLD, 4000, Australia
| | - A Pollett
- Department of Natural Resources and Mines, Queensland Government, 52-64 Currie Street, Nambour, QLD, 4560, Australia
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Selwyn AP, Vita JA, Vekshtein VI, Yeung A, Ryan T, Ganz P. Myocardial ischemia: pathogenic role of disturbed vasomotion and endothelial dysfunction in coronary atherosclerosis. Adv Cardiol 2015; 37:42-52. [PMID: 2220464 DOI: 10.1159/000418816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A P Selwyn
- Department of Medicine, Brigham and Women's Hospital, Boston, Mass
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Conroy MJ, Mac Nicholas R, Grealy R, Taylor M, Otegbayo JA, O'Dea S, Mulcahy F, Ryan T, Norris S, Doherty DG. Circulating CD56dim natural killer cells and CD56+ T cells that produce interferon-γ or interleukin-10 are expanded in asymptomatic, E antigen-negative patients with persistent hepatitis B virus infection. J Viral Hepat 2015; 22:335-45. [PMID: 25186004 DOI: 10.1111/jvh.12299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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] [Indexed: 12/19/2022]
Abstract
Infection with hepatitis B virus (HBV) can result in spontaneous resolution or chronic infection, which can remain asymptomatic or can progress to cirrhosis and/or hepatocellular carcinoma. The host immune response is thought to be a major determinant of the outcome of HBV infection and virus-specific cytotoxic T lymphocytes (CTL) can mediate immunity against the virus and cause liver pathology. Antigen-nonspecific innate lymphocytes may also contribute to HBV infection and liver disease, therefore, we examined the frequencies, phenotypes, cytolytic activities and cytokine profiles of circulating natural killer (NK) cells, CD1d-restricted invariant natural killer T (iNKT) cells and CD56(+) T cells in 102 asymptomatic HBV-infected patients and compared them with those in 66 uninfected control subjects. NK cells expressing low levels of CD56 (CD56(dim)) and CD56(+) T cells were significantly expanded in the circulation of HBV-infected patients compared with control subjects. CD1d expression and iNKT cell frequencies were similar in both groups. Despite these expansions, we did not detect augmented natural or cytokine-induced cytotoxicity in the HBV-infected subjects. All lymphocyte populations studied produced interferon-γ (IFN-γ) significantly more frequently when taken from HBV-infected patients compared with when taken from healthy controls. Additionally, NK cells from the patients more frequently produced interleukin-10. As our HBV-infected cohort consisted of asymptomatic patients with low viral loads, we propose that CD56(dim) NK cells and CD56(+) T cells control HBV infection by noncytolytic mechanisms.
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Affiliation(s)
- M J Conroy
- Department of Immunology, School of Medicine, Trinity College, Dublin 2, Ireland; Institute of Immunology, National University of Ireland, Maynooth, Ireland
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Mainzer A, Bauer J, Cutri RM, Grav T, Masiero J, Beck R, Clarkson P, Conrow T, Dailey J, Eisenhardt P, Fabinsky B, Fajardo-Acosta S, Fowler J, Gelino C, Grillmair C, Heinrichsen I, Kendall M, Kirkpatrick JD, Liu F, Masci F, McCallon H, Nugent CR, Papin M, Rice E, Royer D, Ryan T, Sevilla P, Sonnett S, Stevenson R, Thompson DB, Wheelock S, Wiemer D, Wittman M, Wright E, Yan L. INITIAL PERFORMANCE OF THENEOWISEREACTIVATION MISSION. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/792/1/30] [Citation(s) in RCA: 303] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jonker WR, Hanumanthiah D, Ryan T, Cook TM, Pandit JJ, O'Sullivan EP. Who operates when, where and on whom? A survey of anaesthetic-surgical activity in Ireland as denominator of NAP5. Anaesthesia 2014; 69:961-8. [DOI: 10.1111/anae.12763] [Citation(s) in RCA: 12] [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: 05/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- W. R. Jonker
- Department of Anaesthesia and Intensive Care Medicine; Sligo Regional Hospital; Sligo Ireland
| | - D. Hanumanthiah
- Department of Anaesthesia and Intensive Care Medicine; Galway University Hospital; Galway Ireland
| | - T. Ryan
- Department of Anaesthesia and Intensive Care Medicine; St James's Hospital; Dublin Ireland
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care Medicine; Royal United Hospital; Bath UK
| | - J. J. Pandit
- Nuffield Department of Anaesthetics; Oxford University Hospitals; Oxford UK
| | - E. P. O'Sullivan
- Department of Anaesthesia and Intensive Care Medicine; St James's Hospital; Dublin Ireland
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Johnson K, Noschka E, Allen K, Tilbrook A, Ryan T, Franklin S. Effect of Head and Neck Position on Upper Airway Function in Standardbred Racehorses. Equine Vet J 2014. [DOI: 10.1111/evj.12267_67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Johnson
- University of Adelaide; Roseworthy Australia
| | - E Noschka
- University of Adelaide; Roseworthy Australia
| | - K Allen
- University of Bristol; Bristol United Kingdom
| | - A Tilbrook
- University of Adelaide; Roseworthy Australia
| | - T Ryan
- Ryanracing; Roseworthy Australia
| | - S Franklin
- University of Adelaide; Roseworthy Australia
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Dumitru I, Burdorf A, Turner T, Um J, Ryan T, Haglund N. Inhaled Milrinone Plasma Level Implications in Patients with RV Dysfunction Receiving Heartmate II LVAD. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.241] [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: 10/25/2022] Open
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Gott M, Ingleton C, Gardiner C, Richards N, Cobb M, Ryan T, Noble B, Bennett M, Seymour J, Ward S, Parker C. Transitions to palliative care for older people in acute hospitals: a mixed-methods study. Health Services and Delivery Research 2013. [DOI: 10.3310/hsdr01110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundImproving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.Aims(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.DesignA mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.ResultsOf the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.ConclusionsPatients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- M Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - C Ingleton
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - C Gardiner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - N Richards
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - M Cobb
- Directorate of Professional Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - T Ryan
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - B Noble
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - M Bennett
- School of Medicine, University of Leeds, Leeds, UK
| | - J Seymour
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - S Ward
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - C Parker
- No affiliation (retired) – medical statistician
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Lee H, Rose S, Rutter M, Sawnani H, Ryan T, Rybalsky I, Wong B. P.2.19 Long term growth hormone therapy in Duchenne Muscular Dystrophy (DMD): A case report. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Campbell F, Croot E, Read J, Ryan T, Venables G. PP58 Prevention of Stroke following a TIA – who Receives Care? A descriptive study of Patients Referred to TIA Clinics between 2007-2010 in a NHS Foundation Trust. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Waksman R, Torguson R, Kaneshige K, Kirtane A, Ryan T, Applegate R, Waxman S, Cohen D, Gordon P. Who is at risk to develop late drug-eluting stent thrombosis while on dual antiplatelet therapy? A subset analysis from the Drug Eluting Stent Event Registry of Thrombosis (DESERT). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Saxena S, Um J, Dumitru I, Pilmaier S, Ryan T, Yannone S, Moulton M, Lowes B, Raichlin E. Late Right Heart Failure after Left Ventricular Assist Device Implantation: Clinical Predictors and Outcomes. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Saxena S, Um J, Dumitru I, Cookman B, Pilmaier S, Ryan T, Yannone S, Moulton M, Lowes B, Raichlin E. Improvement in Severe Kidney Dysfunction after Implantation of Continuous-Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.722] [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: 10/27/2022] Open
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39
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Um J, Ryan T, Moulton M. Contemporary Experience with Percutaneous and Surgical Right Ventricular Assist Devices. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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40
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Masters C, Robert B, Ryan T, Lind M, Li QX, Watt A, Cherny R, Barnham K. 49 Aβ oligomers as diagnostic and therapeutic targets for Alzheimer's disease. Neurobiol Aging 2012. [DOI: 10.1016/j.neurobiolaging.2012.01.067] [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: 10/28/2022]
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Grealy R, White M, O'Dwyer M, Stordeur P, Doherty DG, McManus R, Ryan T. Modelling immune responses in sepsis. Crit Care 2012. [PMCID: PMC3363422 DOI: 10.1186/cc10611] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - M White
- St James's Hospital, Dublin, Ireland
| | - M O'Dwyer
- St James's Hospital, Dublin, Ireland
| | | | | | | | - T Ryan
- St James's Hospital, Dublin, Ireland
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McKenny M, Ryan T, Tate H, Graham B, Young VK, Dowd N. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery. Br J Anaesth 2011; 106:643-9. [PMID: 21414977 DOI: 10.1093/bja/aer029] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study investigated the hypothesis that storage age of transfused red blood cells (RBCs) is associated with adverse outcome after cardiac surgery, and examined association between volume of RBC transfusions and outcome after cardiac surgery. METHODS Adult patients undergoing first time elective/urgent cardiac surgery who had received RBC transfusion perioperatively were included. Three prospective institutional databases were linked. Patients were grouped according to the oldest storage age of any RBCs transfused: those who received only RBCs stored for ≤14 days, only RBCs stored for >14 days, and a mixture of both ages of blood. The effect of RBC age on early mortality, postoperative ventilation ≥72 h, renal failure, pulmonary and infectious complications, length of intensive care stay, and postoperative ventilation time was examined using regression analyses with adjustment for confounding factors, including number of units transfused. RESULTS Data were analysed on 1153 patients who received a total of 5962 RBC units. There was no difference in adjusted odds of any outcome between the ≤14 days group and the group who received RBCs aged >14 days. Multivariate logistic regression analyses disclosed number of RBC units transfused as the most consistent factor associated with major postoperative complications, P<0.0001 in all cases. A trend of increasing complication rate was observed with more units transfused. CONCLUSIONS Storage age of RBC transfusion up to 35 days was not associated with increased postoperative adverse outcome after cardiac surgery. The number of RBC units transfused is consistently associated with adverse outcome.
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Affiliation(s)
- M McKenny
- Department of Anaesthesia, St James's Hospital, James's Street, Dublin, Ireland.
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White M, McManus R, Ryan T. Hospital-acquired pneumonia is associated with deficient γc-cytokine gene expression. Crit Care 2011. [PMCID: PMC3066857 DOI: 10.1186/cc9603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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44
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Cohen DJ, Leichman LP, Love E, Ryan T, Leichman CG, Newman E, Levinson B, Hochster HS. Phase II study of sorafenib with gemcitabine and erlotinib (GES) in first-line advanced pancreatic cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
266 Background: Addition of erlotinib (E) to gemcitabine (G) results in improved OS for patients (pts) with advanced pancreatic cancer. Many pancreatic tumors have constitutively activated ras/raf pathways and overexpress VEGF. Sorafenib (S), a multitargeted tyrosine kinase inhibitor, including VEGR 1-3, PDGFR-α and β and the RAF/MEK/ERK pathway, when combined with G and E may synergize, resulting in a more complete blockade of the signal transduction cascade in pancreatic cancer growth and progression, and improved outcome. Methods: Pts with previously untreated, histologically confirmed, unresectable pancreatic adenocarcinoma, PS 0-1, and adequate organ function were eligible and received G 1,000 mg/m2 over 30 min qw x 3 every 4w. E 150 mg PO daily and S 400 mg PO bid were given continuously. CT scans were performed every 2 cycles (8w). Primary endpoint included PFS at 4 mos and secondary endpoints included safety and tolerability of the novel combination, RR, and OS. Results: 45 pts enrolled, 44 evaluable for toxicity(1 not treated), and 30 evaluable for response. Median age was 64 (45-84), 32 males (71%), 43 (96%) had metastatic disease, PS was 0 in 26 (58%). Median number of cycles was 2 (0-10). Grade (gr) 3 toxicity included: thrombocytopenia 5; diarrhea 4; vomiting 4; HFS, hyperbilirubinemia, hyperglycemia and SOB each 3 pts; 1 bowel perforation and 1 epistaxis. Gr 4 toxicity included 1 each: bowel perforation, GI bleed, transaminitis, hyperglycemia and sepsis with hypotension. 2 patients only required dose reduction of S for HFS. There were 2 PR (7%), 13 SD (43%), overall RR of 7% and DCR of 50%. Median TTP 111 days (95% CI = 53-175) and median OS 195 days (144-290). PFS at 16 weeks was 49%, just reaching statistical significance. Conclusions: The combination of G and E plus S in the treatment of advanced pancreatic cancer is a well tolerated regimen without significant increased toxicity as compared to G alone, except for very manageable cutaneous reactions. While the primary endpoint met our pre-determined criteria (compared with NCIC PA.3), this study does not suggest a major benefit for addition of S to G-E when compared to published data. Supported in part by grants from Bayer Healthcare Pharmaceuticals/Onyx and OSI. No significant financial relationships to disclose.
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Affiliation(s)
- D. J. Cohen
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - L. P. Leichman
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - E. Love
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - T. Ryan
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - C. G. Leichman
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - E. Newman
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - B. Levinson
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
| | - H. S. Hochster
- New York University Cancer Institute, New York, NY; Comprehensive Cancer Center at Desert Regional Medical Center, Palm Springs, CA; New York University Medical Center, New York, NY; Yale Cancer Center, New Haven, CT
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Atanasoff S, Ryan T, Lightfoot R, Johann-Liang R. Shoulder injury related to vaccine administration (SIRVA). Vaccine 2010; 28:8049-52. [PMID: 20955829 DOI: 10.1016/j.vaccine.2010.10.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 10/01/2010] [Accepted: 10/03/2010] [Indexed: 10/18/2022]
Abstract
Shoulder pain is a common transient side-effect of vaccination. Infrequently, patients can develop prolonged shoulder pain and dysfunction following vaccination. A series of 13 cases are described in which persistent shoulder dysfunction and pain developed following immunization. Common clinical characteristics include absence of a history of prior shoulder dysfunction, previous exposure to vaccine administered, rapid onset of pain, and limited range of motion. The proposed mechanism of injury is the unintentional injection of antigenic material into synovial tissues resulting in an immune-mediated inflammatory reaction. Careful consideration should be given to appropriate injection technique when administering intramuscular vaccinations to reduce the risk of shoulder injury.
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Affiliation(s)
- S Atanasoff
- U.S. Department of Health and Human Services, Health Resources and Services Administration, National Vaccine Injury Compensation Program, USA.
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Hanson RB, Shafer D, Ryan T, Pope DH, Lowery HK. Bacterioplankton in antarctic ocean waters during late austral winter: abundance, frequency of dividing cells, and estimates of production. Appl Environ Microbiol 2010; 45:1622-32. [PMID: 16346297 PMCID: PMC242509 DOI: 10.1128/aem.45.5.1622-1632.1983] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacterioplankton productivity in Antarctic waters of the eastern South Pacific Ocean and Drake Passage was estimated by direct counts and frequency of dividing cells (FDC). Total bacterioplankton assemblages were enumerated by epifluorescent microscopy. The experimentally determined relationship between in situ FDC and the potential instantaneous growth rate constant (mu) is best described by the regression equation ln mu = 0.081 FDC - 3.73. In the eastern South Pacific Ocean, bacterioplankton abundance (2 x 10 to 3.5 x 10 cells per ml) and FDC (11%) were highest at the Polar Front (Antarctic Convergence). North of the Subantarctic Front, abundance and FDC were between 1 x 10 to 2 x 10 cells per ml and 3 to 5%, respectively, and were vertically homogeneous to a depth of 600 m. In Drake Passage, abundance (10 x 10 cells per ml) and FDC (16%) were highest in waters south of the Polar Front and near the sea ice. Subantarctic waters in Drake Passage contained 4 x 10 cells per ml with 4 to 5% FDC. Instantaneous growth rate constants ranged between 0.029 and 0.088 h. Using estimates of potential mu and measured standing stocks, we estimated productivity to range from 0.62 mug of C per liter . day in the eastern South Pacific Ocean to 17.1 mug of C per liter . day in the Drake Passage near the sea ice.
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Affiliation(s)
- R B Hanson
- Skidaway Institute of Oceanography, Savannah, Georgia 31406, and Department of Biology & Freshwater Institute, Rensselaer Polytechnic Institute, Troy, New York 12181
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Ryan T, Smith I, Hancock J, Dovaston G, Smith M, Ryan T, Smith I, Hancock J, Dovaston G, Smith M. Applying aspects of the community reinforcement approach to alcohol and drug services. Journal of Substance Use 2009. [DOI: 10.3109/14659899909053016] [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]
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Richmond DH, Macdonald JH, Ryan T. Epidural analgesia implies a high forceps rate—can this be reduced? J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618809151335] [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]
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