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Knott L, Litchfield D, Donovan T, Marsh JE. False memory-guided eye movements: insights from a DRM-Saccade paradigm. Memory 2024; 32:223-236. [PMID: 38285521 DOI: 10.1080/09658211.2024.2307921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024]
Abstract
The Deese-Roediger and McDermott (DRM) paradigm and visually guided saccade tasks are both prominent research tools in their own right. This study introduces a novel DRM-Saccade paradigm, merging both methodologies. We used rule-based saccadic eye movements whereby participants were presented with items at test and were asked to make a saccade to the left or right of the item to denote a recognition or non-recognition decision. We measured old/new recognition decisions and saccadic latencies. Experiment 1 used a pro/anti saccade task to a single target. We found slower saccadic latencies for correct rejection of critical lures, but no latency difference between correct recognition of studied items and false recognition of critical lures. Experiment 2 used a two-target saccade task and also measured corrective saccades. Findings corroborated those from Experiment 1. Participants adjusted their initial decisions to increase accurate recognition of studied items and rejection of unrelated lures but there were no such corrections for critical lures. We argue that rapid saccades indicate cognitive processing driven by familiarity thresholds. These occur before slower source-monitoring is able to process any conflict. The DRM-Saccade task could effectively track real-time cognitive resource use during recognition decisions.
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Affiliation(s)
- Lauren Knott
- Department of Psychology, City, University of London, London, UK
| | | | - Tim Donovan
- Institute of Health, University of Cumbria, Lancaster, UK
| | - John E Marsh
- School of Psychology and Humanities, University of Central Lancashire, Preston, UK
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, Luleå, Sweden
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Kim E, Nguyen KH, Donovan T, Edirippulige S, Armfield NR. A cost-minimisation analysis comparing alternative telemedicine screening approaches for retinopathy of prematurity. J Telemed Telecare 2023; 29:196-202. [PMID: 33412992 DOI: 10.1177/1357633x20976028] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening for retinopathy of prematurity (ROP) is an important procedure in the prevention of blindness in high-risk preterm infants. In the regionalised healthcare system of Queensland (Australia), outside of the major centres, some preterm infants are cared for in special care nurseries (SCNs). When necessary, infants in these nurseries who are at risk of ROP are transferred to a tertiary hospital for screening by paediatric ophthalmologists. The transport of preterm infants for eye examinations adds risk and incurs significant costs to the health system. Using a cost-minimisation approach, we aimed to compare the costs of the current ROP screening practice with two alternative telemedicine approaches. METHODS We constructed a decision analytic model to estimate costs from a health service perspective with a five-year analysis horizon; activity data from a tertiary ROP screening service were used to inform the models. The three models assessed were: (a) a digital retinal photography (DRP)-equipped travelling nurse, (b) equipping SCNs with DRP, and providing training to local nurses, and (c) current practice of infant transfer. In all cases, the tertiary centre provides specialist ophthalmologic review. RESULTS Of the three models, we estimated the most expensive option to be equipping SCNs with DRP and providing training to local nurses (AUD$4114/infant). We found that the current practice of transferring infants was the second most expensive (AUD$1021/infant). The most economical model was the specialist nurse travelling to each SCN with a portable DRP (AUD$363/infant). A sensitivity analysis, which assessed uncertainty and variability around the cost estimates, found that the ranking for the expected costs of the alternative models of care did not change. DISCUSSION This is the first economic and cost-minimisation analysis in Australia to compare the costs of the current screening programme with two alternative telemedicine approaches for screening ROP. Telemedicine programmes that facilitate non-physician screening may improve the cost efficiency of the health system while maintaining the health outcomes for children, and reducing the risk associated with infant transport.
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Affiliation(s)
- Emmanuel Kim
- Centre for Online Health, The University of Queensland, Australia
| | - Kim-Huong Nguyen
- Centre for Online Health, The University of Queensland, Australia
| | - Tim Donovan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Australia.,Faculty of Medicine, The University of Queensland, Australia
| | | | - Nigel R Armfield
- Centre for Online Health, The University of Queensland, Australia.,Division of Neonatology, Royal Brisbane and Women's Hospital, Australia
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Lunney A, Donovan T. 'Current trends in lower limb Doppler scanning in Ireland'. Radiography (Lond) 2023; 29:50-55. [PMID: 36308847 DOI: 10.1016/j.radi.2022.10.006] [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: 06/23/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The clinical need to diagnose and treat above knee deep vein thrombosis (AKDVT) has long been established in literature and in practice. On the other hand, the need to diagnose and treat below knee deep vein thrombosis (BKDVT) continues to be debated in literature. This has resulted in variation in clinical guidelines and protocols nationwide. This research aims to establish if there is a standard practice in Irish ultrasound departments and if so, what that practice is and where sonographers are getting information to inform this. METHODS A questionnaire was designed using SurveyMonkey and distributed using online platforms. The questionnaire aimed to establish the experience of the sonographer, the types of exams performed, protocols/guidelines used as well as scenarios where the sonographer might deviate from protocol. RESULTS The study yielded 90 responses. The research found 49% of sites perform whole leg ultrasound routinely and 46% perform proximal ultrasound only. 41% of respondents said their protocols were based on clinical guidelines however, 22% of participants didn't know what these guidelines were. 49% of respondents were unaware of what treatment a patient would receive in cases where there is a high clinical suspicion of DVT, but the ultrasound is negative for DVT. CONCLUSION The research has established a lack of consistency amongst sonographers and scanning practices with a fairly even split (49% of respondents perform whole leg ultrasound and 46% perform proximal only). Not only has the research identified a lack of standardised scanning approach nationwide, but inconsistencies are also seen in the guidelines that inform our department's protocols as well as inconspicuous terms used in radiology reporting and jargon in literature in relation to DVT. IMPLICATIONS FOR PRACTICE 1. An inconsistency in practice has been established. Discussions are now needed to decide what guidelines should be implemented into Irish Ultrasound DVT protocols. 2. A national protocol for BKDVT would result in all patients in Ireland having access to the same standard of care. 3. Call for consensus on appropriate training for sonographers undertaking LLDs.
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Affiliation(s)
- A Lunney
- University of Cumbria, Lancaster, United Kingdom; University College Dublin, Ireland.
| | - T Donovan
- University of Cumbria, Lancaster, United Kingdom.
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Abstract
BACKGROUND Bronchiectasis is a common but under-diagnosed chronic disorder characterised by permanent dilation of the airways arising from a cycle of recurrent infection and inflammation. Symptoms including chronic, persistent cough and productive phlegm are a significant burden for people with bronchiectasis, and the main aim of treatment is to reduce exacerbation frequency and improve quality of life. Prophylactic antibiotic therapy aims to break this infection cycle and is recommended by clinical guidelines for adults with three or more exacerbations a year, based on limited evidence. It is important to weigh the evidence for bacterial suppression against the prevention of antibiotic resistance and further evidence is required on the safety and efficacy of different regimens of intermittently administered antibiotic treatments for people with bronchiectasis. OBJECTIVES To evaluate the safety and efficacy of intermittent prophylactic antibiotics in the treatment of adults and children with bronchiectasis. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted searches on 6 September 2021, with no restriction on language of publication. SELECTION CRITERIA We included randomised controlled trials (RCTs) of at least three months' duration comparing an intermittent regime of prophylactic antibiotics with placebo, usual care or an alternate intermittent regimen. Intermittent prophylactic administration was defined as repeated courses of antibiotics with on-treatment and off-treatment intervals of at least 14 days' duration. We included adults and children with a clinical diagnosis of bronchiectasis confirmed by high resolution computed tomography (HRCT), plain film chest radiograph, or bronchography and a documented history of recurrent chest infections. We excluded studies where participants received high dose antibiotics immediately prior to enrolment or those with a diagnosis of cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), primary ciliary dyskinesia, hypogammaglobulinaemia, sarcoidosis, or a primary diagnosis of COPD. Our primary outcomes were exacerbation frequency and serious adverse events. We did not exclude studies on the basis of review outcomes. DATA COLLECTION AND ANALYSIS We analysed dichotomous data as odds ratios (ORs) or relative risk (RRs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures expected by Cochrane. We conducted GRADE assessments for the following primary outcomes: exacerbation frequency; serious adverse events and secondary outcomes: antibiotic resistance; hospital admissions; health-related quality of life. MAIN RESULTS We included eight RCTs, with interventions ranging from 16 to 48 weeks, involving 2180 adults. All evaluated one of three types of antibiotics over two to six cycles of 28 days on/off treatment: aminoglycosides, ß-lactams or fluoroquinolones. Two studies also included 12 cycles of 14 days on/off treatment with fluoroquinolones. Participants had a mean age of 63.6 years, 65% were women and approximately 85% Caucasian. Baseline FEV1 ranged from 55.5% to 62.6% predicted. None of the studies included children. Generally, there was a low risk of bias in the included studies. Antibiotic versus placebo: cycle of 14 days on/off. Ciprofloxacin reduced the frequency of exacerbations compared to placebo (RR 0.75, 95% CI 0.61 to 0.93; I2 = 65%; 2 studies, 469 participants; moderate-certainty evidence), with eight people (95% CI 6 to 28) needed to treat for an additional beneficial outcome. The intervention increased the risk of antibiotic resistance more than twofold (OR 2.14, 95% CI 1.36 to 3.35; I2 = 0%; 2 studies, 624 participants; high-certainty evidence). Serious adverse events, lung function (FEV1), health-related quality of life, and adverse effects did not differ between groups. Antibiotic versus placebo: cycle of 28 days on/off. Antibiotics did not reduce overall exacerbation frequency (RR 0.92, 95% CI 0.82 to 1.02; I2 = 0%; 8 studies, 1695 participants; high-certainty evidence) but there were fewer severe exacerbations (OR 0.59, 95% CI 0.37 to 0.93; I2 = 54%; 3 studies, 624 participants), though this should be interpreted with caution due to low event rates. The risk of antibiotic resistance was more than twofold higher based on a pooled analysis (OR 2.20, 95% CI 1.42 to 3.42; I2 = 0%; 3 studies, 685 participants; high-certainty evidence) and consistent with unpooled data from four further studies. Serious adverse events, time to first exacerbation, duration of exacerbation, respiratory-related hospital admissions, lung function, health-related quality of life and adverse effects did not differ between study groups. Antibiotic versus usual care. We did not find any studies that compared intermittent antibiotic regimens with usual care. Cycle of 14 days on/off versus cycle of 28 days on/off. Exacerbation frequency did not differ between the two treatment regimens (RR 1.02, 95% CI 0.84 to 1.24; I2 = 71%; 2 studies, 625 participants; moderate-certainty evidence) However, inconsistencies in the results from the two trials in this comparison indicate that the apparent aggregated similarities may not be reliable. There was no evidence of a difference in antibiotic resistance between groups (OR 1.00, 95% CI 0.68 to 1.48; I2 = 60%; 2 studies, 624 participants; moderate-certainty evidence). Serious adverse events, adverse effects, lung function and health-related quality of life did not differ between the two antibiotic regimens. AUTHORS' CONCLUSIONS Overall, in adults who have frequent chest infections, long-term antibiotics given at 14-day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. Intermittent antibiotic regimens result in little to no difference in serious adverse events. The impact of intermittent antibiotic therapy on children with bronchiectasis is unknown due to an absence of evidence, and further research is needed to establish the potential risks and benefits.
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Affiliation(s)
- Sally Spencer
- Health Research Institute, Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Tim Donovan
- Medical Sciences, Institute of Health, University of Cumbria, Lancaster, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Melissa J McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Anthony Tsang
- Edge Hill University, Ormskirk, UK
- Department of Nursing, Faculty of Health, Social and Psychology, Manchester Metropolitan University, Manchester, UK
| | - Peter Leadbetter
- Medical School, Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Donovan T, Milan SJ, Adatia A, Solkar Z, Stovold E, Dwan K, Hinks TSC, Crossingham I. Subcutaneous omalizumab for people with asthma. Hippokratia 2021. [DOI: 10.1002/14651858.cd014975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tim Donovan
- Medical Sciences, Institute of Health; University of Cumbria; Lancaster UK
| | - Stephen J Milan
- Health Innovation Campus and Centre for Health Futures; Lancaster University; Lancaster UK
| | - Adil Adatia
- Department of Medicine; McMaster University; Hamilton Canada
| | | | - Elizabeth Stovold
- Cochrane Airways, Population Health Research Institute; St George's, University of London; London UK
| | - Kerry Dwan
- Review Production and Quality Unit, Editorial & Methods Department; Cochrane Central Executive; London UK
| | - Timothy SC Hinks
- Respiratory Medicine Unit, Nuffield Department of Medicine; University of Oxford; Oxford UK
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Lunn J, Wilcockson T, Donovan T, Dondelinger F, Perez Algorta G, Monaghan P. The role of chronotype and reward processing in understanding social hierarchies in adolescence. Brain Behav 2021; 11:e02090. [PMID: 33645918 PMCID: PMC8119846 DOI: 10.1002/brb3.2090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Circadian rhythms shift toward an evening preference during adolescence, a developmental period marked by greater focus on the social domain and salience of social hierarchies. The circadian system influences maturation of cognitive architecture responsible for motivation and reward, and observation of responses to reward cues has provided insights into neurocognitive processes that underpin adolescent social development. The objective was to investigate whether circadian phase of entrainment (chronotype) predicted both reward-related response inhibition and social status, and to explore whether mediator and moderator relationships existed between chronotype, reward processing, and social status outcomes. METHODS Participants were 75 adolescents aged 13-14 years old (41 females) who completed an eye tracking paradigm that involved an inhibitory control task (antisaccade task) within a nonsocial reward (Card Guessing Game) and a social reward (Cyberball Game) context. Chronotype was calculated from weekend midsleep and grouped into early, intermediate, and later terciles. Participants indicated subjective social status compared with peers in seven domains. RESULTS An intermediate and later chronotype predicted improved inhibitory control in the social versus nonsocial reward context. Chronotype also predicted higher perceived social status in two domains (powerful, troublemaker). Intermediate chronotypes reported higher "Powerful" status whereas later chronotypes were higher on "Troublemaker." Improved social reward-related performance predicted only the higher powerful scores and chronotype moderated this relationship. Improved inhibitory control to social reward predicted higher subjective social status in the intermediate and later chronotype group, an effect that was absent in the early group. CONCLUSION This behavioral study found evidence that changes toward a later phase of entrainment predicts social facilitation effects on inhibitory control and higher perceived power among peers. It is proposed here that circadian delayed phase in adolescence is linked to approach-related motivation, and the social facilitation effects could reflect a social cognitive capacity involved in the drive to achieve social rank.
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Affiliation(s)
- Judith Lunn
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Thomas Wilcockson
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Tim Donovan
- Centre for Medical Imaging, University of Cumbria, Carlisle, UK
| | | | - Guillermo Perez Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Abstract
BACKGROUND Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of hospital admissions, disease-related morbidity and mortality. COPD is a heterogeneous disease with distinct inflammatory phenotypes, including eosinophilia, which may drive acute exacerbations in a subgroup of patients. Monoclonal antibodies targeting interleukin 5 (IL-5) or its receptor (IL-5R) have a role in the care of people with severe eosinophilic asthma, and may similarly provide therapeutic benefit for people with COPD of eosinophilic phenotype. OBJECTIVES To assess the efficacy and safety of monoclonal antibody therapies targeting IL-5 signalling (anti-IL-5 or anti-IL-5Rα) compared with placebo in the treatment of adults with COPD. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, clinical trials registries, manufacturers' websites, and reference lists of included studies. Our most recent search was 23 September 2020. SELECTION CRITERIA We included randomised controlled trials comparing anti-IL-5 therapy with placebo in adults with COPD. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and analysed outcomes using a random-effects model.The primary outcomes were exacerbations requiring antibiotics or oral steroids, hospitalisations due to exacerbation of COPD, serious adverse events, and quality of life. We used standard methods expected by Cochrane. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS Six studies involving a total of 5542 participants met our inclusion criteria. Three studies used mepolizumab (1530 participants), and three used benralizumab (4012 participants). The studies were on people with COPD, which was similarly defined with a documented history of COPD for at least one year. We deemed the risk of bias to be generally low, with all studies contributing data of robust methodology. Mepolizumab 100 mg reduces the rate of moderate or severe exacerbations by 19% in those with an eosinophil count of at least 150/μL (rate ratio (RR) 0.81, 95% confidence interval (CI) 0.71 to 0.93; participants = 911; studies = 2, high-certainty evidence). When participants with lower eosinophils are included, mepolizumab 100 mg probably reduces the exacerbation rate by 8% (RR 0.92, 95% CI 0.82 to 1.03; participants = 1285; studies = 2, moderate-certainty evidence). Mepolizumab 300 mg probably reduces the rate of exacerbations by 14% in participants all of whom had raised eosinophils (RR 0.86, 95% CI 0.70 to 1.06; participants = 451; studies = 1, moderate-certainty evidence); the evidence was uncertain for a single small study of mepolizumab 750 mg. In participants with high eosinophils, mepolizumab probably reduces the rate of hospitalisation by 10% (100 mg, RR 0.90, 95% CI 0.65 to 1.24; participants = 911; studies = 2, moderate-certainty evidence) and 17% (300 mg, RR 0.83, 95% CI 0.51 to 1.35; participants = 451; studies = 1, moderate-certainty evidence). Mepolizumab 100 mg increases the time to first moderate or severe exacerbation compared to the placebo group, in people with the eosinophilic phenotype (hazard ratio (HR) 0.78, 95% CI 0.66 to 0.92; participants = 981; studies 2, high-certainty evidence). When participants with lower eosinophils were included this difference was smaller and less certain (HR 0.87, 95% CI 0.75 to 1.0; participants = 1285; studies 2, moderate-certainty evidence). Mepolizumab 300 mg probably increases the time to first moderate or severe exacerbation in participants who all had eosinophilic phenotype (HR 0.77, 95% CI 0.60 to 0.99; participants = 451; studies = 1, moderate-certainty evidence). Benralizumab 100 mg reduces the rate of severe exacerbations requiring hospitalisation in those with an eosinophil count of at least 220/μL (RR 0.63, 95% CI 0.49 to 0.81; participants = 1512; studies = 2, high-certainty evidence). Benralizumab 10 mg probably reduces the rate of severe exacerbations requiring hospitalisation in those with an eosinophil count of at least 220/μL (RR 0.68, 95% CI 0.49 to 0.94; participants = 765; studies = 1, moderate-certainty evidence). There was probably little or no difference between the intervention and placebo for quality of life measures. Where there were differences the mean difference fell below the pre-specified minimum clinically significant difference. Treatment with mepolizumab and benralizumab appeared to be safe. All pooled analyses showed that there was probably little or no difference in serious adverse events, adverse events, or side effects between the use of a monoclonal antibody therapy compared to placebo. AUTHORS' CONCLUSIONS We found that mepolizumab and benralizumab probably reduce the rate of moderate and severe exacerbations in the highly selected group of people who have both COPD and higher levels of blood eosinophils. This highlights the importance of disease phenotyping in COPD, and may play a role in the personalised treatment strategy in disease management. Further research is needed to elucidate the role of monoclonal antibodies in the management of COPD in clinical practice. In particular, it is not clear whether there is a threshold blood eosinophil level above which these drugs may be effective. Studies including cost effectiveness analysis may be beneficial given the high cost of these therapies, to support use if appropriate.
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Affiliation(s)
- Tim Donovan
- Medical and Sport Sciences, University of Cumbria, Lancaster, UK
| | | | - Ran Wang
- Department of Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Patrick Bradley
- Department of Respiratory Medicine, North West Lung Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Abstract
INTRODUCTION In 2D ultrasound, the lens of the fetal eye can be distinguished as white circles within the hypoechoic eyeball, and eye movements can be visualized from about 15 weeks' gestation. It has been shown that from 31 weeks gestational age the fetal sensory system is capable of directed vision if enough light is available. METHODS We have developed a light source for delivering visual stimuli to be seen by the fetal eye, using laser dot diodes emitting at 650 nm. The 2D component of 94 fetal ultrasound scans (mean gestational age 240 days), where the light stimulus was presented, was coded to determine whether the eyes moved in response to the stimuli independent of any head movement. RESULTS The light stimulus significantly provoked head and eye movements, but after the light was withdrawn the head stopped moving, yet the eyes continued to move. CONCLUSION This provides evidence for visual attention mechanisms that can be controlled through eye movements that are independent of head movements prior to birth.
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Affiliation(s)
- Tim Donovan
- Medical Sciences, University of Cumbria, Lancaster, UK
| | - Kirsty Dunn
- Department of Psychology, Lancaster University, Lancaster, UK
| | - Amy Penman
- Department of Psychology, Lancaster University, Lancaster, UK
| | - Robert J Young
- Department of Physics, Lancaster University, Lancaster, UK
| | - Vincent M Reid
- Department of Psychology, Lancaster University, Lancaster, UK
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Affiliation(s)
- Tim Donovan
- University of Cumbria; Medical and Sport Sciences; Lancaster UK
| | | | | | - Ran Wang
- Manchester University NHS Foundation Trust; Department of Respiratory Medicine; Manchester UK
| | - Patrick Bradley
- East Lancashire Hospitals NHS Trust; Blackburn Lancashire UK
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Spencer S, Donovan T, Chalmers JD, Mathioudakis AG, McDonnell MJ, Tsang A, Pilkington G. Intermittent prophylactic antibiotics for bronchiectasis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sally Spencer
- Edge Hill University; Postgraduate Medical Institute; St Helens Road Ormskirk Lancashire UK L39 4QP
| | - Tim Donovan
- University of Cumbria; Medical and Sport Sciences; Lancaster UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School; Dundee UK
| | - Alexander G Mathioudakis
- The University of Manchester, Manchester Academic Health Science Centre; Division of Infection, Immunity and Respiratory Medicine; Manchester UK
| | - Melissa J McDonnell
- Galway University Hospital; Department of Respiratory Medicine; Galway Ireland
| | | | - Gerlinde Pilkington
- Edge Hill University; Postgraduate Medical Institute; St Helens Road Ormskirk Lancashire UK L39 4QP
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Litchfield D, Donovan T. Expecting the initial glimpse: prior target knowledge activation or repeated search does not eliminate scene preview search benefits. Journal of Cognitive Psychology 2019. [DOI: 10.1080/20445911.2018.1555163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Tim Donovan
- Medical & Sport Sciences, University of Cumbria, Carlisle, UK
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Eley VA, Chin A, Sekar R, Donovan T, Krepska A, Lawrence M, Bell S, Ralfe K, McGrath S, Webb L, Robinson A, van Zundert A, Marquart L. Increasing body mass index and abdominal subcutaneous fat thickness are associated with increased skin-to-epidural space distance in pregnant women. Int J Obstet Anesth 2018; 38:59-65. [PMID: 30477996 DOI: 10.1016/j.ijoa.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/24/2018] [Revised: 09/03/2018] [Accepted: 10/13/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Body mass index does not indicate the distribution of adipose tissue. Central adiposity may be measured using ultrasound measurement of subcutaneous fat thickness. This study determined if the abdominal subcutaneous fat thickness measured correlated with skin-to-epidural space distance at delivery, and compared this with the booking body mass index. METHODS We analysed a sub-set of participants from a single-centre, prospective cohort study that assessed the relationship between subcutaneous fat thickness and maternity outcomes. Abdominal subcutaneous fat thickness measurements were obtained during the routine fetal anomaly scan. The skin-to-epidural space distance was obtained in those having epidural or combined spinal-epidural analgesia. Linear regression was used to test for strength of association and adjusted R2 values calculated to determine if subcutaneous fat thickness or body mass index was more strongly associated with skin-to-epidural space distance. RESULTS The 463 women had a median (IQR) booking body mass index of 25.0 kg/m2 (21.8-29.3) and subcutaneous fat thickness of 16.2 mm (13.0-21.0). The median (IQR) skin-to-epidural space distance was 5.0 cm (4.5-6.0). Both parameters significantly correlated with skin-to-epidural space distance (r=0.53 and 0.68 respectively, P <0.001). Adjusted linear regression coefficient (95% CI) for subcutaneous fat thickness was 0.09 (0.08 to 0.11), R2=0.30 and for body mass index 0.12 (0.11 to 0.13), R2=0.47. CONCLUSIONS Booking body mass index had a stronger relationship with skin-to- epidural space distance at delivery than subcutaneous fat thickness, explaining 47% of the variation in the skin-to-epidural distance.
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Affiliation(s)
- V A Eley
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia.
| | - A Chin
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia
| | - R Sekar
- The University of Queensland, St Lucia, Queensland, Australia; Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - T Donovan
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Grantley Stable Neonatal Unit, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - A Krepska
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia
| | - M Lawrence
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia
| | - S Bell
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia
| | - K Ralfe
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia
| | - S McGrath
- The University of Queensland, St Lucia, Queensland, Australia; Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - L Webb
- Statistics Unit, Queensland Institute of Medical Research Berghofer, Herston, Queensland, Australia
| | - A Robinson
- The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - A van Zundert
- Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; The University of Queensland, St Lucia, Queensland, Australia
| | - L Marquart
- Statistics Unit, Queensland Institute of Medical Research Berghofer, Herston, Queensland, Australia
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Thomas NM, Donovan T, Dewhurst S, Bampouras TM. Visually fixating or tracking another person decreases balance control in young and older females walking in a real-world scenario. Neurosci Lett 2018; 677:78-83. [PMID: 29689345 DOI: 10.1016/j.neulet.2018.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/16/2018] [Accepted: 04/19/2018] [Indexed: 11/26/2022]
Abstract
Balance control during overground walking was assessed in 10 young (23.6 ± 3.4) and 10 older (71.0 ± 5.5 years) healthy females during free gaze, and when fixating or tracking another person in an everyday use waiting room. Balance control was characterised by medial/lateral sacrum acceleration dispersion, and gaze fixations were simultaneously assessed with eye tracking equipment. The results showed decreased balance control when fixating a stationary (p = 0.003, gav = 0.19) and tracking a walking (p = 0.027, gav = 0.16) person compared to free gaze. The older adults exhibited reduced baseline stability throughout, but the decrease caused by the visual tasks was not more profound than the younger adults. The decreased balance control when fixating on or tracking the observed person was likely due to more challenging conditions for interpreting retinal flow, which facilitated less reliable estimates of self-motion through vision. The older adults either processed retinal flow during the tasks as effectively as the young adults, or they adopted a more rigid posture to facilitate visual stability, which masked any ageing effect of the visual tasks. The decrease in balance control, the first to be shown in this context, may warrant further investigation in those with ocular or vestibular dysfunction.
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Affiliation(s)
- Neil M Thomas
- Department of Medical and Sport Sciences, Active Ageing Research Group, University of Cumbria, Lancaster, LA1 4DH, UK; Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| | - Tim Donovan
- Department of Medical and Sport Sciences, Active Ageing Research Group, University of Cumbria, Lancaster, LA1 4DH, UK
| | - Susan Dewhurst
- Department of Sport and Physical Activity, Bournemouth University, Dorset, BH12 5BB, UK
| | - Theodoros M Bampouras
- Department of Medical and Sport Sciences, Active Ageing Research Group, University of Cumbria, Lancaster, LA1 4DH, UK
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Abstract
BACKGROUND Bronchiectasis is a chronic airway disease characterised by a destructive cycle of recurrent airway infection, inflammation and tissue damage. Antibiotics are a main treatment for bronchiectasis. The aim of continuous therapy with prophylactic antibiotics is to suppress bacterial load, but bacteria may become resistant to the antibiotic, leading to a loss of effectiveness. On the other hand, intermittent prophylactic antibiotics, given over a predefined duration and interval, may reduce antibiotic selection pressure and reduce or prevent the development of resistance. This systematic review aimed to evaluate the current evidence for studies comparing continuous versus intermittent administration of antibiotic treatment in bronchiectasis in terms of clinical efficacy, the emergence of resistance and serious adverse events. OBJECTIVES To evaluate the effectiveness of continuous versus intermittent antibiotics in the treatment of adults and children with bronchiectasis, using the primary outcomes of exacerbations, antibiotic resistance and serious adverse events. SEARCH METHODS On 1 August 2017 and 4 May 2018 we searched the Cochrane Airways Review Group Specialised Register (CAGR), CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and AMED. On 25 September 2017 and 4 May 2018 we also searched www.clinicaltrials.gov, the World Health Organization (WHO) trials portal, conference proceedings and the reference lists of existing systematic reviews. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) of adults or children with bronchiectasis that compared continuous versus intermittent administration of long-term prophylactic antibiotics of at least three months' duration. We considered eligible studies reported as full-text articles, as abstracts only and unpublished data. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results and full-text reports. MAIN RESULTS We identified 268 unique records. Of these we retrieved and examined 126 full-text reports, representing 114 studies, but none of these studies met our inclusion criteria. AUTHORS' CONCLUSIONS No randomised controlled trials have compared the effectiveness and risks of continuous antibiotic therapy versus intermittent antibiotic therapy for bronchiectasis. High-quality clinical trials are needed to establish which of these interventions is more effective for reducing the frequency and duration of exacerbations, antibiotic resistance and the occurrence of serious adverse events.
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Affiliation(s)
- Tim Donovan
- University of CumbriaMedical and Sport SciencesLancasterUK
| | - Lambert M Felix
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)OxfordUK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical SchoolDundeeUK
| | | | | | - Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
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Abstract
BACKGROUND Bronchiectasis is a chronic inflammatory disease characterised by a recurrent cycle of respiratory bacterial infections associated with cough, sputum production and impaired quality of life. Antibiotics are the main therapeutic option for managing bronchiectasis exacerbations. Evidence suggests that inhaled antibiotics may be associated with more effective eradication of infective organisms and a lower risk of developing antibiotic resistance when compared with orally administered antibiotics. However, it is currently unclear whether antibiotics are more effective when administered orally or by inhalation. OBJECTIVES To determine the comparative efficacy and safety of oral versus inhaled antibiotics in the treatment of adults and children with bronchiectasis. SEARCH METHODS We identified studies through searches of the Cochrane Airways Group's Specialised Register (CAGR), which is maintained by the Information Specialist for the group. The Register contains trial reports identified through systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, and PsycINFO, and handsearching of respiratory journals and meeting abstracts. We also searched ClinicalTrials.gov and the WHO trials portal. We searched all databases in March 2018 and imposed no restrictions on language of publication. SELECTION CRITERIA We planned to include studies which compared oral antibiotics with inhaled antibiotics. We would have considered short-term use (less than four weeks) for treating acute exacerbations separately from longer-term use as a prophylactic (4 weeks or more). We would have considered both intraclass and interclass comparisons. We planned to exclude studies if the participants received continuous or high-dose antibiotics immediately before the start of the trial, or if they have received a diagnosis of cystic fibrosis (CF), sarcoidosis, active allergic bronchopulmonary aspergillosis or active non-tuberculous Mycobacterial infection. DATA COLLECTION AND ANALYSIS Two review authors independently applied study inclusion criteria to the searches and we planned for two authors to independently extract data, assess risk of bias and assess overall quality of the evidence using GRADE criteria. We also planned to obtain missing data from the authors where possible and to report results with 95% confidence intervals (CIs). MAIN RESULTS We identified 313 unique records through database searches and a further 21 records from trial registers. We excluded 307 on the basis of title and abstract alone and a further 27 after examining full-text reports. No studies were identified for inclusion in the review. AUTHORS' CONCLUSIONS There is currently no evidence indicating whether orally administered antibiotics are more beneficial compared to inhaled antibiotics. The recent ERS bronchiectasis guidelines provide a practical approach to the use of long-term antibiotics. New research is needed comparing inhaled versus oral antibiotic therapies for bronchiectasis patients with a history of frequent exacerbations, to establish which approach is the most effective in terms of exacerbation prevention, quality of life, treatment burden, and antibiotic resistance.
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Affiliation(s)
- Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Lambert M Felix
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)OxfordUK
| | | | - Rebecca Normansell
- St George's, University of LondonCochrane Airways, Population Health Research InstituteLondonUKSW17 0RE
| | | | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical SchoolDundeeUK
| | - Tim Donovan
- University of CumbriaMedical and Sport SciencesLancasterUK
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Yu TY, Donovan T, Armfield N, Gole GA. Retinopathy of prematurity: the high cost of screening regional and remote infants. Clin Exp Ophthalmol 2018; 46:645-651. [DOI: 10.1111/ceo.13160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tzu-Ying Yu
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Tim Donovan
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Division of Neonatology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Nigel Armfield
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Glen A Gole
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Ophthalmology; Lady Cilento Children's Hospital; Brisbane Queensland Australia
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Donovan T, Friedrich I, Sino S, Greber N. Sternal Application of Vancomycin Greatly Reduces the Incidence of Sternal Wound Complications in Patients undergoing Cardiosurgical Procedures. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T. Donovan
- Klinik für Herz- und Thoraxchirurgie, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - I. Friedrich
- Klinik für Herz- und Thoraxchirurgie, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - S. Sino
- Klinik für Herz- und Thoraxchirurgie, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - N. Greber
- Klinik für Herz- und Thoraxchirurgie, Krankenhaus der Barmherzigen Brüder, Trier, Germany
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Donovan T, Friedrich I. Postoperative Wound Complications in Cardiac Surgery: What Exactly Are We Reporting (or Not Reporting)? Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T. Donovan
- Krankenhaus der Barmherzigen Brüder, Klinik für Herz- und Thoraxchirurgie, Trier, Germany
| | - I. Friedrich
- Krankenhaus der Barmherzigen Brüder, Klinik für Herz- und Thoraxchirurgie, Trier, Germany
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Donovan T, Litchfield D, Crawford TJ. Editorial: Medical Image Perception: How Much Do We Understand It? Front Psychol 2017; 8:2072. [PMID: 29234298 PMCID: PMC5712305 DOI: 10.3389/fpsyg.2017.02072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tim Donovan
- Medical and Sport Sciences, University of Cumbria, Lancaster, United Kingdom
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Damien Litchfield
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Trevor J Crawford
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
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Affiliation(s)
- Isla S Mackenzie
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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Donovan T, Felix LM, Chalmers JD, Milan SJ, Mathioudakis AG, Spencer S. Continuous versus intermittent antibiotics for non-cystic fibrosis bronchiectasis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012733] [Citation(s) in RCA: 2] [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: 11/09/2022]
Affiliation(s)
- Tim Donovan
- University of Cumbria; Medical and Sport Sciences; Lancaster UK
| | - Lambert M Felix
- Edge Hill University; Postgraduate Medical Institute; St Helens Road Ormskirk Lancashire UK L39 4QP
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School; Dundee UK
| | | | - Alexander G Mathioudakis
- University of Manchester; Division of Infection, Immunity and Respiratory Medicine; Manchester UK
| | - Sally Spencer
- Edge Hill University; Postgraduate Medical Institute; St Helens Road Ormskirk Lancashire UK L39 4QP
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23
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Abstract
BACKGROUND Teachers and school staff should be competent in managing asthma in schools. Demonstrated low levels of asthma knowledge mean that staff may not know how best to protect a child with asthma in their care, or may fail to take appropriate action in the event of a serious attack. Education about asthma could help to improve this knowledge and lead to better asthma outcomes for children. OBJECTIVES To assess the effectiveness and safety of asthma education programmes for school staff, and to identify content and attributes underpinning them. SEARCH METHODS We conducted the most recent searches on 29 November 2016. SELECTION CRITERIA We included randomised controlled trials comparing an intervention to educate school staff about asthma versus a control group. We included studies reported as full text, those published as abstract only and unpublished data. DATA COLLECTION AND ANALYSIS At least two review authors screened the searches, extracted outcome data and intervention characteristics from included studies and assessed risk of bias. Primary outcomes for the quantitative synthesis were emergency department (ED) or hospital visits, mortality and asthma control; we graded the main results and presented evidence in a 'Summary of findings' table. We planned a qualitative synthesis of intervention characteristics, but study authors were unable to provide the necessary information.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all with a random-effects model. We assessed clinical, methodological and statistical heterogeneity when performing meta-analyses, and we narratively described skewed data. MAIN RESULTS Five cluster-RCTs of 111 schools met the review eligibility criteria. Investigators measured outcomes in participating staff and often in children or parents, most often at between 1 and 12 months.All interventions were educational programmes but duration, content and delivery varied; some involved elements of training for pupils or primary care providers. We noted risk of selection, performance, detection and attrition biases, although to a differing extent across studies and outcomes.Quanitative and qualitative analyses were limited. Only one study reported visits to the ED or hospital and provided data that were too skewed for analysis. No studies reported any deaths or adverse events. Studies did not report asthma control consistently, but results showed no difference between groups on the paediatric asthma quality of life questionnaire (mean difference (MD) 0.14, 95% confidence interval (CI) -0.03 to 0.31; 1005 participants; we downgraded the quality of evidence to low for risk of bias and indirectness). Data for symptom days, night-time awakenings, restricted activities of daily living and school absences were skewed or could not be analysed; some mean scores were better in the trained group, but most differences between groups were small and did not persist to 24 months.Schools that received asthma education were more adherent to asthma policies, and staff were better prepared; more schools that had received staff asthma training had written asthma policies compared with control schools, more intervention schools showed improvement in measures taken to prevent or manage exercise-induced asthma attacks and more staff at intervention schools reported that they felt able to administer salbutamol via a spacer. However, the quality of the evidence was low; results show imbalances at baseline, and confidence in the evidence was limited by risk of bias and imprecision. Staff knowledge was higher in groups that had received asthma education, although results were inconsistent and difficult to interpret owing to differences between scales (low quality).Available information about the interventions was insufficient for review authors to conduct a meaningful qualitative synthesis of the content that led to a successful intervention, or of the resources required to replicate results accurately. AUTHORS' CONCLUSIONS Asthma education for school staff increases asthma knowledge and preparedness, but studies vary and all available evidence is of low quality. Studies have not yet captured whether this improvement in knowledge has led to appreciable benefits over the short term or the longer term for the safety and health of children with asthma in school. Randomised evidence does not contribute to our knowledge of content or attributes of interventions that lead to the best outcomes, or of resources required for successful implementation.Complete reporting of the content and resources of educational interventions is essential for assessment of their effectiveness and feasibility for implementation. This applies to both randomised and non-randomised studies, although the latter may be better placed to observe important clinical outcomes such as exacerbations and mortality in the longer term.
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Affiliation(s)
- Kayleigh M Kew
- BMJ Knowledge CentreBritish Medical Journal Technology Assessment Group (BMJ‐TAG)BMA HouseTavistock SquareLondonUKWC1H 9JR
| | - Robin Carr
- 28 Beaumont Street Medical PracticeOxfordUK
| | - Tim Donovan
- University of CumbriaMedical and Sport SciencesLancasterUK
| | - Morris Gordon
- University of Central LancashireSchool of MedicinePrestonUK
- Blackpool Victoria HospitalFamilies DivisionBlackpoolUK
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Abstract
We assessed the efficacy of a system for teleconsultation in the care of newborns via real-time video (NEMO, Neonatal Examination and Management Online). The study was conducted in the controlled environment of a tertiary neonatal intensive care unit (NICU) before deployment for trial in remote hospitals. Eight ventilated infants were studied (their parents providing consent). A range of clinical tasks were completed by 14 medical staff. These included visual assessment of respiratory rate and perfusion, gathering of data from cot-side equipment, and the capture and interpretation of an X-ray image from an LCD screen. In total, 854 tests were completed using the system. In the visual infant assessment phase, 100% of participants read the endotracheal tube taped distance accurately within 1 cm, while agreement between participants and control on respiration rate (within 5 breaths/min) was 93%. When reviewing an X-ray image captured from an LCD screen, 85% of participants agreed with the control regarding endotracheal tube placement (high, normal or low). The results show that the NEMO system provides an efficacious means of presenting tertiary neonatal specialists with timely information beyond that currently available by ordinary telephone.
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Affiliation(s)
| | - Mark Bensink
- Centre for Online Health, University of Queensland
| | - Tim Donovan
- Department of Neonatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Affiliation(s)
| | - Mark Bensink
- Centre for Online Health, University of Queensland
| | - Tim Donovan
- Department of Neonatology, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Thomas NM, Bampouras TM, Donovan T, Dewhurst S. Eye Movements Affect Postural Control in Young and Older Females. Front Aging Neurosci 2016; 8:216. [PMID: 27695412 PMCID: PMC5025428 DOI: 10.3389/fnagi.2016.00216] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 02/02/2016] [Accepted: 09/01/2016] [Indexed: 11/13/2022] Open
Abstract
Visual information is used for postural stabilization in humans. However, little is known about how eye movements prevalent in everyday life interact with the postural control system in older individuals. Therefore, the present study assessed the effects of stationary gaze fixations, smooth pursuits, and saccadic eye movements, with combinations of absent, fixed and oscillating large-field visual backgrounds to generate different forms of retinal flow, on postural control in healthy young and older females. Participants were presented with computer generated visual stimuli, whilst postural sway and gaze fixations were simultaneously assessed with a force platform and eye tracking equipment, respectively. The results showed that fixed backgrounds and stationary gaze fixations attenuated postural sway. In contrast, oscillating backgrounds and smooth pursuits increased postural sway. There were no differences regarding saccades. There were also no differences in postural sway or gaze errors between age groups in any visual condition. The stabilizing effect of the fixed visual stimuli show how retinal flow and extraocular factors guide postural adjustments. The destabilizing effect of oscillating visual backgrounds and smooth pursuits may be related to more challenging conditions for determining body shifts from retinal flow, and more complex extraocular signals, respectively. Because the older participants matched the young group's performance in all conditions, decreases of posture and gaze control during stance may not be a direct consequence of healthy aging. Further research examining extraocular and retinal mechanisms of balance control and the effects of eye movements, during locomotion, is needed to better inform fall prevention interventions.
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Affiliation(s)
- Neil M Thomas
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
| | - Theodoros M Bampouras
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
| | - Tim Donovan
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
| | - Susan Dewhurst
- Active Ageing Research Group, Department of Medical and Sport Sciences, University of Cumbria Lancaster, UK
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27
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Lunn J, Donovan T, Litchfield D, Lewis C, Davies R, Crawford T. Saccadic Eye Movement Abnormalities in Children with Epilepsy. PLoS One 2016; 11:e0160508. [PMID: 27483011 PMCID: PMC4970731 DOI: 10.1371/journal.pone.0160508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022] Open
Abstract
Childhood onset epilepsy is associated with disrupted developmental integration of sensorimotor and cognitive functions that contribute to persistent neurobehavioural comorbidities. The role of epilepsy and its treatment on the development of functional integration of motor and cognitive domains is unclear. Oculomotor tasks can probe neurophysiological and neurocognitive mechanisms vulnerable to developmental disruptions by epilepsy-related factors. The study involved 26 patients and 48 typically developing children aged 8–18 years old who performed a prosaccade and an antisaccade task. Analyses compared medicated chronic epilepsy patients and unmedicated controlled epilepsy patients to healthy control children on saccade latency, accuracy and dynamics, errors and correction rate, and express saccades. Patients with medicated chronic epilepsy had impaired and more variable processing speed, reduced accuracy, increased peak velocity and a greater number of inhibitory errors, younger unmedicated patients also showed deficits in error monitoring. Deficits were related to reported behavioural problems in patients. Epilepsy factors were significant predictors of oculomotor functions. An earlier age at onset predicted reduced latency of prosaccades and increased express saccades, and the typical relationship between express saccades and inhibitory errors was absent in chronic patients, indicating a persistent reduction in tonic cortical inhibition and aberrant cortical connectivity. In contrast, onset in later childhood predicted altered antisaccade dynamics indicating disrupted neurotransmission in frontoparietal and oculomotor networks with greater demand on inhibitory control. The observed saccadic abnormalities are consistent with a dysmaturation of subcortical-cortical functional connectivity and aberrant neurotransmission. Eye movements could be used to monitor the impact of epilepsy on neurocognitive development and help assess the risk for poor neurobehavioural outcomes.
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Affiliation(s)
- Judith Lunn
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
- * E-mail:
| | - Tim Donovan
- Centre for Medical Imaging, University of Cumbria, Lancaster, United Kingdom
| | - Damien Litchfield
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Charlie Lewis
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Robert Davies
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Trevor Crawford
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
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Danon Y, Daskalakis A, McDermott B, Thompson N, Youmans A, Block R, Barry D, Epping B, Leinweber G, Rapp M, Donovan T. Recent Developments in Nuclear Data Measurement capabilities at the Gaerttner LINAC Center at RPI. EPJ Web of Conferences 2016. [DOI: 10.1051/epjconf/201611102001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Donovan T, DeFoe A, Heckman A, Walker S, McBride J, Vargo C. Retrospective review of outcomes following mesenteric angiography for gastrointestinal hemorrhage. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.547] [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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Heckman A, DeFoe A, Donovan T, Vargo C. Does size matter? A comparison of 70-150 μm (M1) versus 100-300 μm drug-eluting beads in transarterial chemoembolization for hepatic malignancy. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Litchfield D, Donovan T. Worth a quick look? Initial scene previews can guide eye movements as a function of domain-specific expertise but can also have unforeseen costs. J Exp Psychol Hum Percept Perform 2016; 42:982-94. [PMID: 26784003 DOI: 10.1037/xhp0000202] [Citation(s) in RCA: 13] [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: 11/08/2022]
Abstract
Rapid scene recognition is a global visual process we can all exploit to guide search. This ability is thought to underpin expertise in medical image perception yet there is no direct evidence that isolates the expertise-specific contribution of processing scene previews on subsequent eye movement performance. We used the flash-preview moving window paradigm (Castelhano & Henderson, 2007) to investigate this issue. Expert radiologists and novice observers underwent 2 experiments whereby participants viewed a 250-ms scene preview or a mask before searching for a target. Observers looked for everyday objects from real-world scenes (Experiment 1), and searched for lung nodules from medical images (Experiment 2). Both expertise groups exploited the brief preview of the upcoming scene to more efficiently guide windowed search in Experiment 1, but there was only a weak effect of domain-specific expertise in Experiment 2, with experts showing small improvements in search metrics with scene previews. Expert diagnostic performance was better than novices in all conditions but was not contingent on seeing the scene preview, and scene preview actually impaired novice diagnostic performance. Experiment 3 required novice and experienced observers to search for a variety of abnormalities from different medical images. Rather than maximizing the expertise-specific advantage of processing scene previews, both novices and experienced radiographers were worse at detecting abnormalities with scene previews. We discuss how restricting access to the initial glimpse can be compensated for by subsequent search and discovery processing, but there can still be costs in integrating a fleeting glimpse of a medical scene. (PsycINFO Database Record
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Affiliation(s)
| | - Tim Donovan
- Department of Medical and Sport Sciences, University of Cumbria
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Nunley J, Sutton J, Culp W, Wilson D, Coleman K, Demianiuk R, Schechter A, Moore G, Donovan T, Schwartz P. Primary pulmonary neoplasia in cats: assessment of computed tomography findings and survival. J Small Anim Pract 2015; 56:651-6. [DOI: 10.1111/jsap.12401] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 12/11/2022]
Affiliation(s)
- J. Nunley
- Animal Medical Center; New York NY 10065 USA
| | - J. Sutton
- University of California-Davis; Davis CA 95616 USA
| | - W. Culp
- University of California-Davis; Davis CA 95616 USA
| | - D. Wilson
- University of California-Davis; Davis CA 95616 USA
| | - K. Coleman
- Colorado State University; Fort Collins CO 80523 USA
| | - R. Demianiuk
- Michigan State University; East Lansing MI 48824 USA
| | - A. Schechter
- Michigan State University; East Lansing MI 48824 USA
| | - G. Moore
- Purdue University; West Lafayette IN 47907 USA
| | - T. Donovan
- Animal Medical Center; New York NY 10065 USA
| | - P. Schwartz
- Animal Medical Center; New York NY 10065 USA
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Steinhaus J, Berent A, Weisse C, Eatroff A, Donovan T, Haddad J, Bagley D. Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction. J Vet Intern Med 2015; 29:63-70. [PMID: 25270055 PMCID: PMC4858092 DOI: 10.1111/jvim.12465] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/24/2014] [Accepted: 08/25/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture. OBJECTIVES To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s). ANIMALS 193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3). METHODS Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013. INCLUSION CRITERIA surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings. RESULTS Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was present.
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Affiliation(s)
- J. Steinhaus
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A.C. Berent
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - C. Weisse
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A. Eatroff
- Department of Internal MedicineBluePearl Veterinary PartnersNew YorkNY
| | - T. Donovan
- Department of Anatomic PathologyThe AMCNew YorkNY
| | - J. Haddad
- Department of Anatomic and Clinical PathologyIdexx LaboratoriesNew YorkNY
| | - D. Bagley
- Thomas Jefferson UniversityPhiladelphiaPA
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Davis AE, Lewandowski AJ, Holloway CJ, Ntusi NAB, Banerjee R, Nethononda R, Pitcher A, Francis JM, Myerson SG, Leeson P, Donovan T, Neubauer S, Rider OJ. Observational study of regional aortic size referenced to body size: production of a cardiovascular magnetic resonance nomogram. J Cardiovasc Magn Reson 2014; 16:9. [PMID: 24447690 PMCID: PMC3899403 DOI: 10.1186/1532-429x-16-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 01/14/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is regarded as the gold standard for clinical assessment of the aorta, but normal dimensions are usually referenced to echocardiographic and computed tomography data and no large CMR normal reference range exists. As a result we aimed to 1) produce a normal CMR reference range of aortic diameters and 2) investigate the relationship between regional aortic size and body surface area (BSA) in a large group of healthy subjects with no vascular risk factors. METHODS 447 subjects (208 male, aged 19-70 years) without identifiable cardiac risk factors (BMI range 15.7-52.6 kg/m2) underwent CMR at 1.5 T to determine aortic diameter at three levels: the ascending aorta (Ao) and proximal descending aorta (PDA) at the level of the pulmonary artery, and the abdominal aorta (DDA), at a level 12 cm distal to the PDA. In addition, 201 of these subjects had aortic root imaging, allowing for measurements at the level of the aortic valve annulus (AV), aortic sinuses and sinotubular junction (STJ). RESULTS Normal diameters (mean ±2 SD) were; AV annulus male(♂) 24.4 ± 5.4, female (♀) 21.0 ± 3.6 mm, aortic sinus♂ 32.4 ± 7.7, ♀27.6 ± 5.8 mm, ST-junction ♂25.0 ± 7.4, ♀21.8 ± 5.4 mm, Ao ♂26.7 ± 7.7, ♀25.5 ± 7.4 mm, PDA ♂20.6 ± 5.6, +18.9 ± 4.0 mm, DDA ♂17.6 ± 5.1, ♀16.4 ± 4.0 mm. Aortic root and thoracic aortic diameters increased at all levels measured with BSA. No gender difference was seen in the degree of dilatation with increasing BSA (p>0.5 for all analyses). CONCLUSION Across both genders, increasing body size is characterized by a modest degree of aortic dilatation, even in the absence of traditional cardiovascular risk factors.
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Affiliation(s)
- Anne E Davis
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Adam J Lewandowski
- Oxford Clinical Cardiovascular Research Facility, University of Oxford, Oxford, UK
| | - Cameron J Holloway
- St. Vincent’s Hospital and the Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Ntobeko AB Ntusi
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Rajarshi Banerjee
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Richard Nethononda
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Alex Pitcher
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Jane M Francis
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Saul G Myerson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Paul Leeson
- Oxford Clinical Cardiovascular Research Facility, University of Oxford, Oxford, UK
| | - Tim Donovan
- University of Cumbria Health and Medical Sciences, Lancaster, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Oliver J Rider
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Armfield NR, Donovan T, Bensink ME, Smith AC. The costs and potential savings of telemedicine for acute care neonatal consultation: preliminary findings. J Telemed Telecare 2012; 18:429-33. [DOI: 10.1258/jtt.2012.gth101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Telemedicine was used as a substitute for the telephone (usual care) for some acute care consultations from nurseries at four peripheral hospitals in Queensland. Over a 12-month study period, there were 19 cases of neonatal teleconsultation. Five (26%) cases of avoided infant transport were confirmed by independent assessment, four of which were avoided helicopter retrievals. We conducted two analyses. In the first, the actual costs of providing telemedicine at the study sites were compared with the actual savings associated with confirmed avoided infant transport and nursery costs. There was a net saving to the health system of 54,400 Australian Dollars (AUD) associated with the use of telemedicine over the 12-month period. In the second analysis, we estimated the potential savings that might have been achieved if telemedicine had been used for all retrieval consultations from the study sites. The total projected costs were AUD 64,969 while the projected savings were AUD 271,042, i.e. a projected net saving to the health system of AUD 206,073 through the use of telemedicine. A sensitivity analysis suggested that the threshold proportion of retrievals needed to generate telemedicine-related savings under the study conditions was 5%. The findings suggest that from the health-service perspective, the use of telemedicine for acute care neonatal consultation has substantial economic benefits.
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Affiliation(s)
- Nigel R Armfield
- Centre for Online Health, University of Queensland, Brisbane, Australia
- Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Tim Donovan
- Division of Neonatology, Royal Brisbane and Women's Hospital, Australia
| | | | - Anthony C Smith
- Centre for Online Health, University of Queensland, Brisbane, Australia
- Queensland Children's Medical Research Institute, Brisbane, Australia
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Cobley JN, Bartlett JD, Kayani A, Murray SW, Louhelainen J, Donovan T, Waldron S, Gregson W, Burniston JG, Morton JP, Close GL. PGC-1α transcriptional response and mitochondrial adaptation to acute exercise is maintained in skeletal muscle of sedentary elderly males. Biogerontology 2012. [PMID: 23187721 DOI: 10.1007/s10522-012-9408-1] [Citation(s) in RCA: 39] [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: 01/30/2023]
Abstract
The aim of the present study was to examine the effects of ageing and training status on (1) markers of skeletal muscle mitochondrial content and (2) the ability to activate the acute signalling pathways associated with regulating exercise-induced mitochondrial biogenesis. Muscle biopsies were obtained from the vastus lateralis muscle of young untrained (24 ± 4 years, n = 6; YU), young trained (22 ± 3 years, n = 6; YT), old untrained (65 ± 6 years, n = 6; OU) and old trained (64 ± 3 years, n = 6; OT) healthy males before and after (3 h and 3 days post-exercise) completion of high-intensity interval cycling exercise. In resting muscle, lifelong training preserved mtDNA, PGC-1α and COXIV protein content such that muscles from OT individuals were comparable to muscles from both YU and YT individuals, whereas lifelong sedentary behaviour reduced such markers of mitochondrial content. Regardless of age or training status, acute exercise induced comparable increases in p38MAPK phosphorylation immediately post-exercise, PGC-1α and COXIV mRNA expression at 3 h post-exercise and COXIV protein at 3 days post-exercise. Data demonstrate that lifelong endurance training preserves skeletal muscle PGC-1α content and that despite the mitochondrial dysfunction typically observed with sedentary ageing, muscles from sedentary elderly individuals retain the capacity to activate the acute signalling pathways associated with regulating the early processes of mitochondrial biogenesis. We consider our data to have immediate translational potential as they highlight the potential therapeutic effects of exercise to induce skeletal muscle mitochondrial biogenesis persist late in adulthood, even after a lifetime of physical inactivity.
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Affiliation(s)
- J N Cobley
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool L3 3AF, UK
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Donovan T, Crawford TJ, Litchfield D. Negative priming for target selection with saccadic eye movements. Exp Brain Res 2012; 222:483-94. [DOI: 10.1007/s00221-012-3234-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 08/15/2012] [Indexed: 10/28/2022]
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Choi WW, McBride CA, Bourke C, Borzi P, Choo K, Walker R, Nguyen T, Davies M, Donovan T, Cartwright D, Kimble RM. Long-term review of sutureless ward reduction in neonates with gastroschisis in the neonatal unit. J Pediatr Surg 2012; 47:1516-20. [PMID: 22901910 DOI: 10.1016/j.jpedsurg.2012.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/22/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A sutureless ward reduction (SWR) protocol was implemented in the neonatal intensive care unit of a tertiary level hospital in 1999. Although the short-term outcomes associated with SWR have been documented, the long-term outcomes are unknown. METHODS Retrospective data were collected from the medical records of all neonates with gastroschisis from September 1999 to December 2010. Data on their growth and development and the prevalence of any health problems were collected. RESULTS Eighty-eight patients with gastroschisis were managed over an 11 year period. Forty-four of these patients received SWR, with 2 deaths in the neonatal period. In the 42 survivors, 35 patients were reviewed at a median age of 7 years and 10 months (range, 6-134 months; interquartile range, 37-124 months). One patient experienced failure to thrive and developmental delay, and later died of a medical complication. Thirty-two patients (91.4%) developed an umbilical hernia, only 2 of whom required umbilical herniotomy. Four patients (11.4%) developed small bowel obstruction, all within the first year. CONCLUSION Most patients with SWR exhibited normal growth with minimal bowel complications. Despite the high incidence of umbilical hernia, the majority resolved spontaneously and did not require subsequent herniotomy.
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Affiliation(s)
- Wilson W Choi
- School of Medicine, University of Queensland, Herston, Queensland 4006, Australia.
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Daniels C, Dancy M, Donovan T, Alimo A, Smith D, Berry L. Development of an integrated model for earlier identification and provision of palliative care for patients of all diagnoses. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.133] [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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Litchfield D, Ball LJ, Donovan T, Manning DJ, Crawford T. Viewing another person's eye movements improves identification of pulmonary nodules in chest x-ray inspection. J Exp Psychol Appl 2011; 16:251-62. [PMID: 20853985 DOI: 10.1037/a0020082] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Double reading of chest x-rays is often used to ensure that fewer abnormalities are missed, but very little is known about how the search behavior of others affects observer performance. A series of experiments investigated whether radiographers benefit from knowing where another person looked for pulmonary nodules, and whether the expertise of the model providing the search behavior was a contributing factor. Experiment 1 compared the diagnostic performance of novice and experienced radiographers examining chest x-rays and found that both groups performed better when shown the search behavior of either a novice radiographer or an expert radiologist. Experiment 2 established that benefits in performance only arose when the eye movements shown were related to the search for nodules; however, only the novices' diagnostic performance consistently improved when shown the expert's search behavior. Experiment 3 reexamined the contribution of task, image, and the expertise of the model underlying this benefit. Consistent with Experiment 1, novice radiographers were better at identifying nodules when shown either a naïve's search behavior or an expert radiologist's search behavior, but they demonstrated no improvement when shown a naïve model not searching for nodules. Our results suggest that although the benefits of this form of attentional guidance may be short-lived, novices can scaffold their decisions based on the search behavior of others.
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Buckenmeyer PJ, Bauer J, Hendrick J, Leary J, Donovan T. Relationship Of Sport Participation And Sport/Energy Drink Consumption To BMI In K-6 Children. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385863.90385.30] [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: 11/21/2022]
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Abstract
BACKGROUND Pregnancies with a macrosomic fetus comprise a subgroup of high-risk pregnancies. There is uncertainty in the clinical management and outcomes of such pregnancies. AIM We sought to examine clinical management and maternal and fetal outcomes in pregnancies with macrosomic infants at Royal Brisbane and Women's Hospital (RBWH). METHODS Data from 276 macrosomic births (weighing > or = 4500 g) and 294 controls (weighing 3250-3750 g) delivered during 2002-2004 at RBWH were collected from the hospital database. Univariate and logistic regression analyses were performed for maternal risk factors and maternal and neonatal outcomes that were associated with fetal macrosomia. RESULTS Macrosomia was more than two times likely in women with body mass index (BMI) of > 30 kg/m(2) (odds ratio (OR) 2.41, 95% confidence interval (CI) 1.26-4.61) and in male infant sex (OR 2.05, 95% CI 1.35-3.12), and four times more likely in gestation of > 40 weeks (OR 3.93, 95% CI 1.99-7.74). Maternal smoking reduced the risk of fetal macrosomia (OR 0.27, 95% CI 0.14-0.51). Macrosomia was associated with nearly two times higher risk of emergency caesarean section (OR 1.75, 95% CI 1.02-2.97) and maternal hospital stay of > 3 days (OR 1.66, 95% CI 1.11-2.50), and four times higher risk of shoulder dystocia (OR 4.08, 95% CI 1.62-10.29). Macrosomic infants were twice as likely to have resuscitation (OR 2.21, 95% CI 1.46-3.34) and intensive care nursery admission (OR 1.89, 95% CI 1.03-3.46). CONCLUSION Macrosomia was associated with an increased risk of adverse maternal and neonatal health outcomes. Optimal management strategies of macrosomic pregnancies need evaluation.
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Affiliation(s)
- Hong Ju
- Adelaide Health Technology Assessment, Discipline of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia.
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Armfield NR, Donovan T, Smith AC. Clinicians' perceptions of telemedicine for remote neonatal consultation. Stud Health Technol Inform 2010; 161:1-9. [PMID: 21191153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Telemedicine may have a useful role in neonatal care, particularly in regionalised health care systems where there may be impediments to access. Following the development of a system for neonatal teleconsultation, we assessed its efficacy, usability and preliminary effectiveness. While results were positive, uptake in routine clinical use was less than expected. The study described in this paper examined aspects of clinicians' perceptions of telemedicine in neonatal care. Overall, clinicians had positive perceptions of telemedicine. Further work is required to understand the negative perceived usefulness of telemedicine held by some clinicians and to determine whether this may be overcome.
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Affiliation(s)
- Nigel R Armfield
- Centre for Online Health, The University of Queensland, Royal Children's Hospital, Herston, Queensland, Australia.
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Abstract
AIM This study aimed to document the growth patterns of a contemporary cohort of preterm infants born appropriate for gestational age (AGA). It was hypothesised that preterm AGA (PT-AGA) infants would display poorer growth than full-term AGA (FT-AGA) infants. METHODS Sixty-four PT-AGA infants and 64 FT-AGA infants were assessed at 0, 4, 8 and 12 months of corrected age (CA). Measurements of weight and length were recorded at each of the specified ages. Centers for Disease Control and Prevention growth data were used to calculate Z-scores for weight and length based on CA. RESULTS The mean length and weight Z-scores of PT-AGA infants were found to be significantly less than those of FT-AGA infants at term, 4, 8 and 12 months of CA (P < 0.001). The mean weight Z-score of PT-AGA infants was found to be less than their mean length Z-score at each time point, though the differences were not significant. CONCLUSIONS The results of this study suggest that PT-AGA infants are likely to display poorer growth than FT-AGA infants until at least 1 year of CA. Long-term growth monitoring in this population is recommended.
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Affiliation(s)
- Pamela Dodrill
- Children's Nutrition Research Centre, Royal Children's Hospital, Brisbane, Queensland, Australia.
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Abstract
The use of a Bayesian framework to understand how radiologists search images for pathology is important as it formalizes, mathematically, how visual and cognitive processes control eye movements by modelling the ideal searcher against which human performance can be compared. It is important that the interpretation of medical images is understood so that new developments in the ways images are presented and the use of image processing software are matched to human abilities and limitations.
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Affiliation(s)
- T Donovan
- School of Medical Imaging Sciences, St Martin's College, Bowerham Road, Lancaster LA1 3JD, UK.
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Abstract
The work was carried out to investigate differences in visual search characteristics between groups of observers with different levels of experience in the task of pulmonary nodule detection in chest radiology and we report here on these differences in respect of time related decisions. Volunteer observers were divided into three groups depending on their level of expertise. There were eight radiologists, eight radiographers and eight novices. Their task was to detect pulmonary nodules in a test bank of 120 digitized posteroanterior (PA) chest radiographs. Five of the eight radiographers were tested twice: once before and once after a 6-month training programme in interpretation of the adult chest radiograph. During each test session the observers' eye movements were tracked. Data on the observers' decisions through Alternate Free Response Operating Characteristic (AFROC) methodology were correlated to their eye-movement and fixation patterns. True negative decisions from all observers were associated with shorter fixation times than false negative decisions. No correct negative decisions were made after fixations exceeding 3 s.
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Affiliation(s)
- D Manning
- School of Medical Imaging Sciences, St Martin's College, Lancaster LA1 3JD, UK
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Arthurs OJ, Donovan T, Spiegelhalter DJ, Pickard JD, Boniface SJ. Intracortically distributed neurovascular coupling relationships within and between human somatosensory cortices. Cereb Cortex 2006; 17:661-8. [PMID: 16648455 DOI: 10.1093/cercor/bhk014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The coupling of neuronal cellular activity to its blood supply is of critical importance to the physiology of the human brain and has been under discussion for more than a century. Linearity in this relationship has been demonstrated in some animal studies, but evidence is lacking in humans. In this study, we compared scalp evoked potentials and the functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal from healthy human volunteers with changes in the intensity of a somatosensory stimulus. By weighting the fMRI images according to the evoked potential amplitude at corresponding intensities, we tested for positive and negative covariation between these 2 data sets and the extent to which these were linear. Hemodynamic changes in primary somatosensory cortex covaried positively with neuronal activity in a predominantly linear manner, with a small quadratic contribution. Simultaneously, other cortical areas corresponding to the nonstimulated limbs were found to covary negatively and linearly in the hemispheres ipsilateral and contralateral to the stimulus. These concurrent and bilateral cortical dynamics, as well as the intraregional features of this neurovascular coupling, are both more complex than had been considered to date, with considerable implications.
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Affiliation(s)
- O J Arthurs
- Wolfson Brain Imaging Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
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Affiliation(s)
- Isla S Mackenzie
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
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