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Walsh BM, Kuntz KD, Busk S, Cameron T, Chornay D, Chuchra A, Collier MR, Connor C, Connor HK, Cravens TE, Dobson N, Galeazzi M, Kim H, Kujawski J, Paw U CK, Porter FS, Naldoza V, Nutter R, Qudsi R, Sibeck DG, Sembay S, Shoemaker M, Simms K, Thomas NE, Atz E, Winkert G. The Lunar Environment Heliophysics X-ray Imager (LEXI) Mission. Space Sci Rev 2024; 220:37. [PMID: 38756703 PMCID: PMC11093736 DOI: 10.1007/s11214-024-01063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/26/2024] [Indexed: 05/18/2024]
Abstract
The Lunar Environment heliospheric X-ray Imager (LEXI) is a wide field-of-view soft X-ray telescope developed to study solar wind-magnetosphere coupling. LEXI is part of the Blue Ghost 1 mission comprised of 10 payloads to be deployed on the lunar surface. LEXI monitors the dayside magnetopause position and shape as a function of time by observing soft X-rays (0.1-2 keV) emitted from solar wind charge-exchange between exospheric neutrals and high charge-state solar wind plasma in the dayside magnetosheath. Measurements of the shape and position of the magnetopause are used to test temporal models of meso- and macro-scale magnetic reconnection. To image the boundary, LEXI employs lobster-eye optics to focus X-rays to a microchannel plate detector with a 9.1× ∘ 9.1 ∘ field of view.
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Affiliation(s)
- B. M. Walsh
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - K. D. Kuntz
- The Henry A. Rowland Department of Physics and Astronomy, Johns Hopkins University, Baltimore, 21218 MD USA
| | - S. Busk
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - T. Cameron
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - D. Chornay
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | | | - M. R. Collier
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - C. Connor
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - H. K. Connor
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - T. E. Cravens
- Department of Physics and Astronomy, University of Kansas, Lawrence, 66045 KS USA
| | - N. Dobson
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - M. Galeazzi
- Department of Physics, University of Miami, Miami, 33146 FL USA
| | - H. Kim
- Space Research Institute, Austrian Academy of Sciences, Graz, Austria
| | - J. Kujawski
- Brandywine Photonics, College Station, 77845 TX USA
| | - C. K. Paw U
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - F. S. Porter
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - V. Naldoza
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - R. Nutter
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - R. Qudsi
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - D. G. Sibeck
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - S. Sembay
- School of Physics and Astronomy, University of Leicester, Leicester, UK
| | - M. Shoemaker
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - K. Simms
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
| | - N. E. Thomas
- Marshall Space Flight Center, NASA, Huntsville, 35808 AL USA
| | - E. Atz
- Center for Space Physics, Boston University, Boston, 02215 MA USA
| | - G. Winkert
- NASA, Goddard Space Flight Center, Greenbelt, 20771 MD USA
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Chouliara N, Cameron T, Byrne A, Fisher R. Getting the message across; a realist study of the role of communication and information exchange processes in delivering stroke Early Supported Discharge services in England. PLoS One 2024; 19:e0298140. [PMID: 38457416 PMCID: PMC10923427 DOI: 10.1371/journal.pone.0298140] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/17/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Stroke early supported discharge (ESD) involves the co-ordinated transfer of care from hospital to home. The quality of communication processes between professionals delivering ESD and external stakeholders may have a role to play in streamlining this process. We explored how communication and information exchange were achieved and influenced the hospital-to-home transition and the delivery quality of ESD, from healthcare professionals' perspectives. METHODS Six ESD case study sites in England were purposively selected. Under a realist approach, we conducted interviews and focus groups with 117 staff members, including a cross-section of the multidisciplinary team, service managers and commissioners. RESULTS Great variation was observed between services in the type of communication processes they employed and how organised these efforts were. Effective communication between ESD team members and external stakeholders was identified as a key mechanism driving the development of collaborative and trusting relationships and promoting coordinated care transitions. Cross-boundary working arrangements with inpatient services helped clarify the role and remit of ESD, contributing to timely hospital discharge and response from ESD teams. Staff perceived honest and individualised information provision as key to effectively prepare stroke survivors and families for care transitions and promote rehabilitation engagement. In designing and implementing ESD, early stakeholder involvement ensured the services' fit in the local pathway and laid the foundations for communication and partnership working going forward. CONCLUSIONS Findings highlighted the interdependency between services delivering ESD and local stroke care pathways. Maintaining good communication and engagement with key stakeholders may help achieve a streamlined hospital discharge process and timely delivery of ESD. ESD services should actively manage communication processes with external partners. A shared cross-service communication strategy to guide the provision of information along to continuum of stroke care is required. Findings may inform efforts towards the delivery of better coordinated stroke care pathways.
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Affiliation(s)
- Niki Chouliara
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Applied Research Collaboration (ARC) East Midlands, Nottingham, United Kingdom
| | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Adrian Byrne
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Clinical Policy Unit, NHS England, Nottingham, United Kingdom
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Fisher RJ, Russell L, Riley-Bennett F, Cameron T, Walker M, Sackley C. Barriers and facilitators in providing home-based rehabilitation for stroke survivors with severe disability in the UK: an online focus group study with multidisciplinary rehabilitation teams. BMJ Open 2023; 13:e071217. [PMID: 37532479 PMCID: PMC10401239 DOI: 10.1136/bmjopen-2022-071217] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has focused on establishing consensus regarding the core components of home-based rehabilitation for this under investigated group. This study explores the barriers of providing rehabilitation and identifies strategies to overcome them. DESIGN Three focus group interviews were conducted with n=20. The context coding framework was employed to organise the transcribed data and to facilitate inductive and deductive analysis and synthesis. SETTING Online, MSTeams, UK. PARTICIPANTS A purposive sample of 20 National Health Service clinical staff participants, from 3 multidisciplinary teams providing home-based stroke rehabilitation for this population (n=7, 6 and 7). RESULTS High levels of need were reported across multiple domains for survivors including continence, communication and physical function. Interventions often required multiagency collaboration in order to optimise the available resources and specialist skills. There was lack of clarity regarding who was ultimately responsible for providing components of rehabilitation for stroke survivors with severe disability. Teams provide rehabilitation for this population but are insufficiently commissioned or resourced to fully meet their needs. In-complete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams used a variety of strategies to overcome these barriers and optimise rehabilitation opportunities. These included upskilling a diverse range of partners to capitalise on the skills and resources across health, social care and voluntary sector boundaries employing multiagency collaboration. Teams established and engaged networks of stakeholders in order to advocate on behalf of stroke survivors. CONCLUSIONS Collaboration and partnership working is important in the delivery of rehabilitation for stroke survivors with severe disability. Commissioners need to be aware that cross-agency multidisciplinary expertise is required, if rehabilitation opportunities are to be realised and existing health inequalities addressed.
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Affiliation(s)
| | - Lal Russell
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Cath Sackley
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Chouliara N, Cameron T, Byrne A, Lewis S, Langhorne P, Robinson T, Waring J, Walker M, Fisher R. How do stroke early supported discharge services achieve intensive and responsive service provision? Findings from a realist evaluation study (WISE). BMC Health Serv Res 2023; 23:299. [PMID: 36978068 PMCID: PMC10052830 DOI: 10.1186/s12913-023-09290-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Stroke Early Supported Discharge (ESD) involves provision of responsive and intensive rehabilitation to stroke survivors at home and it is recommended as part of the stroke care pathway. Core components have been identified to guide the delivery of evidence-based ESD, however, service provision in England is of variable quality. The study sought to understand how and in what conditions the adoption of these components drives the delivery of responsive and intensive ESD services in real world settings. METHODS This qualitative study was part of a wider multimethod realist evaluation project (WISE) conducted to inform large-scale ESD implementation. Overarching programme theories and related context-mechanism-outcome configurations were used as a framework to guide data collection and analysis. Six case study sites were purposively selected; interviews and focus groups with ESD staff members were conducted and analysed iteratively. RESULTS We interviewed 117 ESD staff members including clinicians and service managers. Staff highlighted the role of certain core components including eligibility criteria, capacity, team composition and multidisciplinary team (MDT) coordination in achieving responsive and intensive ESD. Regardless of the geographical setting, adhering to evidence-based selection criteria, promoting an interdisciplinary skillset and supporting the role of rehabilitation assistants, allowed teams to manage capacity issues and maximise therapy time. Gaps in the stroke care pathway, however, meant that teams had to problem solve beyond their remit to cater for the complex needs of patients with severe disabilities. Adjusting MDT structures and processes was seen as key in addressing challenges posed by travel times and rural geography. CONCLUSIONS Despite variations in the wider service model of operation and geographical location, the adoption of core components of ESD helped teams manage the pressures and deliver services that met evidence-based standards. Findings point to a well-recognised gap in service provision in England for stroke survivors who do not meet the ESD criteria and emphasise the need for a more integrated and comprehensive stroke service provision. Transferable lessons could be drawn to inform improvement interventions aimed at promoting evidence-based service delivery in different settings. TRIAL REGISTRATION ISRCTN: 15,568,163, registration date: 26 October 2018.
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Affiliation(s)
- Niki Chouliara
- NIHR Applied Research Collaboration (ARC) East Midlands, School of Medicine, University of Nottingham, Nottingham, England.
| | - Trudi Cameron
- School of Medicine, University of Nottingham, Nottingham, England
| | - Adrian Byrne
- School of Medicine, University of Nottingham, Nottingham, England
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, England
| | - Peter Langhorne
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, England
| | - Marion Walker
- School of Medicine, University of Nottingham, Nottingham, England
| | - Rebecca Fisher
- School of Medicine, University of Nottingham, Nottingham, England
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Byrne A, Chouliara N, Cameron T, Geue C, Lewis S, Robinson T, Langhorne P, Walker MF, Fisher RJ. Evaluating stroke early supported discharge using cost-consequence analysis. Disabil Rehabil 2022; 44:7127-7133. [PMID: 34618617 DOI: 10.1080/09638288.2021.1983043] [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] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate different stroke early supported discharge (ESD) services in different geographical settings using cost-consequence analysis (CCA), which presents information about costs and outcomes in the form of a balance sheet. ESD is a multidisciplinary service intervention that facilitates discharge from hospital and includes delivery of stroke specialist rehabilitation at home. MATERIALS AND METHODS Data were collected from six purposively sampled services across the Midlands, East and North of England. All services, rural and urban, provided stroke rehabilitation to patients in their own homes. Cost data included direct and overhead costs of service provision and staff travel. Consequence data included service level adherence to an expert consensus regarding the specification of ESD service provision. RESULTS We observed that the most rural services had the highest service cost per patient. The main costs associated with running each ESD service were staff costs. In terms of the consequences, there was a positive association between service costs per patient and greater adherence to meeting the evidence-based ESD service specification agreed by an expert panel. CONCLUSIONS This study found that rural services were associated with higher costs per patient, which in turn were associated with greater adherence to the expert consensus regarding ESD service specification. We suggest additional resources and costs are required in order for rural services to meet evidence-based criteria.Implications for rehabilitationThe main costs of an early supported discharge (ESD) service for stroke survivors were staff costs and these were positively associated with greater levels of rurality.Greater costs were associated with greater adherence to ESD core components, which has been previously found to enhance the effectiveness of ESD service provision.The cost-consequence analysis provides a descriptive summary for decision-makers about the costs of delivering ESD, suggesting additional resources and costs are required in order for rural services to meet evidence-based criteria.
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Affiliation(s)
- Adrian Byrne
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Niki Chouliara
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Trudi Cameron
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Claudia Geue
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marion F Walker
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Rebecca J Fisher
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
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Fisher RJ, Chouliara N, Byrne A, Cameron T, Lewis S, Langhorne P, Robinson T, Waring J, Geue C, Paley L, Rudd A, Walker MF. Large-scale implementation of stroke early supported discharge: the WISE realist mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In England, the provision of early supported discharge is recommended as part of an evidence-based stroke care pathway.
Objectives
To investigate the effectiveness of early supported discharge services when implemented at scale in practice and to understand how the context within which these services operate influences their implementation and effectiveness.
Design
A mixed-methods study using a realist evaluation approach and two interlinking work packages was undertaken. Three programme theories were tested to investigate the adoption of evidence-based core components, differences in urban and rural settings, and communication processes.
Setting and interventions
Early supported discharge services across a large geographical area of England, covering the West and East Midlands, the East of England and the North of England.
Participants
Work package 1: historical prospective patient data from the Sentinel Stroke National Audit Programme collected by early supported discharge and hospital teams. Work package 2: NHS staff (n = 117) and patients (n = 30) from six purposely selected early supported discharge services.
Data and main outcome
Work package 1: a 17-item early supported discharge consensus score measured the adherence to evidence-based core components defined in an international consensus document. The effectiveness of early supported discharge was measured with process and patient outcomes and costs. Work package 2: semistructured interviews and focus groups with NHS staff and patients were undertaken to investigate the contextual determinants of early supported discharge effectiveness.
Results
A variety of early supported discharge service models had been adopted, as reflected by the variability in the early supported discharge consensus score. A one-unit increase in early supported discharge consensus score was significantly associated with a more responsive early supported discharge service and increased treatment intensity. There was no association with stroke survivor outcome. Patients who received early supported discharge in their stroke care pathway spent, on average, 1 day longer in hospital than those who did not receive early supported discharge. The most rural services had the highest service costs per patient. NHS staff identified core evidence-based components (e.g. eligibility criteria, co-ordinated multidisciplinary team and regular weekly multidisciplinary team meetings) as central to the effectiveness of early supported discharge. Mechanisms thought to streamline discharge and help teams to meet their responsiveness targets included having access to a social worker and the quality of communications and transitions across services. The role of rehabilitation assistants and an interdisciplinary approach were facilitators of delivering an intensive service. The rurality of early supported discharge services, especially when coupled with capacity issues and increased travel times to visit patients, could influence the intensity of rehabilitation provision and teams’ flexibility to adjust to patients’ needs. This required organising multidisciplinary teams and meetings around the local geography. Findings also highlighted the importance of good leadership and communication. Early supported discharge staff highlighted the need for collaborative and trusting relationships with patients and carers and stroke unit staff, as well as across the wider stroke care pathway.
Limitations
Work package 1: possible influence of unobserved variables and we were unable to determine the effect of early supported discharge on patient outcomes. Work package 2: the pragmatic approach led to ‘theoretical nuggets’ rather than an overarching higher-level theory.
Conclusions
The realist evaluation methodology allowed us to address the complexity of early supported discharge delivery in real-world settings. The findings highlighted the importance of context and contextual features and mechanisms that need to be either addressed or capitalised on to improve effectiveness.
Trial registration
Current Controlled Trials ISRCTN15568163.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rebecca J Fisher
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Niki Chouliara
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Adrian Byrne
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Trudi Cameron
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and National Institute for Health Research Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Claudia Geue
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lizz Paley
- Sentinel Stroke National Audit Programme, King’s College London, London, UK
| | - Anthony Rudd
- Sentinel Stroke National Audit Programme, King’s College London, London, UK
| | - Marion F Walker
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
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Concin N, Gonzalez Martin A, Vergote I, Pignata S, Harter P, Patel M, Gunderson C, Wride K, Lepley D, Dusek R, Go J, Hurley S, Cameron T, Hamilton E. 885TiP LIO-1: A phase II study of lucitanib + nivolumab in patients (pts) with gynaecological tumours (CO-3810-101; NCT04042116; ENGOT-GYN3/AGO/LIO). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2091] [Citation(s) in RCA: 1] [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: 10/23/2022] Open
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Hamilton E, Patel M, Gunderson C, Wride K, Lepley D, Dusek R, Liao M, Cameron T. 556P Initial clinical experience of lucitanib + nivolumab in advanced metastatic solid tumours: Data from the phase Ib/II LIO-1 study (CO-3810-101; NCT04042116). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dean A, Oza A, Lorusso D, Aghajanian C, Oaknin A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, O'Malley D, Cameron T, Maloney L, Goble S, Coleman R, Ledermann J. 821P Timing of adverse events during maintenance treatment with rucaparib for recurrent ovarian cancer in the phase III ARIEL3 study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.960] [Citation(s) in RCA: 1] [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: 11/30/2022] Open
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Kristeleit R, Oza A, Oaknin A, Aghajanian C, Tinker A, Tredan O, O’Malley D, Leary A, Konecny G, Lorusso D, Weberpals J, Goble S, Maloney L, Cameron T, Swisher E, McNeish I, Shapira-Frommer R, Ledermann J, Coleman R. Integrated safety analysis of the poly (ADP-ribose) polymerase (PARP) inhibitor rucaparib in patients (pts) with ovarian cancer in the treatment and maintenance settings. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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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Ledermann J, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, O’Malley D, Cameron T, Maloney L, Goble S, Coleman R. Effect of response to last platinum-based chemotherapy in patients (pts) with platinum-sensitive, recurrent ovarian carcinoma in the phase III study ARIEL3 of rucaparib maintenance treatment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Coleman R, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, O'Malley D, Banerjee S, Goble S, Cameron T, Ledermann J. Post hoc exploratory analysis of rucaparib in patients with platinum-sensitive recurrent ovarian carcinoma from the randomized, placebo-controlled phase III study ARIEL3: Effect of a deleterious germline or no germline mutation on efficacy. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ledermann J, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Gancedo MA, Fong P, Goh J, Backes F, Banerjee S, Goble S, Cameron T, Coleman R. The effect of age on efficacy and safety outcomes with rucaparib: A post hoc exploratory analysis of ARIEL3, a phase III, randomized, placebo-controlled maintenance study in patients with recurrent ovarian carcinoma. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alkayyali T, Cameron T, Haltli B, Kerr R, Ahmadi A. Microfluidic and cross-linking methods for encapsulation of living cells and bacteria - A review. Anal Chim Acta 2019; 1053:1-21. [DOI: 10.1016/j.aca.2018.12.056] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/14/2022]
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Lorusso D, Coleman R, Oza A, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, Amenedo Gancedo M, Fong P, Goh J, O’Malley D, Banerjee S, Goble S, Cameron T, Ledermann J. Subgroup analysis of rucaparib in platinum-sensitive recurrent ovarian carcinoma: Effect of prior chemotherapy regimens in ARIEL3. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.155] [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: 11/14/2022] Open
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Cameron T, Moore K, Montgomery R, Stewart EJ. Creative ventures and the personalities that activate them in a post-disaster setting. Creat Innov Manag 2018. [DOI: 10.1111/caim.12270] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Trudi Cameron
- Department of Tourism, Sport and Society, Faculty of Environment, Society and Design; Lincoln University; New Zealand
| | - Kevin Moore
- Department of Tourism, Sport and Society, Faculty of Environment, Society and Design; Lincoln University; New Zealand
| | - Roy Montgomery
- Department of Environmental Management, Faculty of Environment, Society and Design; Lincoln University; New Zealand
| | - Emma J. Stewart
- Department of Tourism, Sport and Society, Faculty of Environment, Society and Design; Lincoln University; New Zealand
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Ledermann J, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, O'Malley D, Cameron T, Maloney L, Goble S, Lin K, Sun J, Giordano H, Coleman R. ARIEL3: A phase 3, randomised, double-blind study of rucaparib vs placebo following response to platinum-based chemotherapy for recurrent ovarian carcinoma (OC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jha A, Al-Jaroudi Z, Mohapatra P, Cameron T. Expedient and Diastereoselective Synthesis of Substituted 6,6a-Dihydroisoindolo[2,1-a]quinolin-11(5H)-ones. SYNTHESIS-STUTTGART 2016. [DOI: 10.1055/s-0035-1562616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - T. Cameron
- Department of Chemistry, Dalhousie University
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Affiliation(s)
- Anil Kumar
- Department of Chemistry, Birla Institute of Technology and Science
| | - Ganesh Shelke
- Department of Chemistry, Birla Institute of Technology and Science
| | - V. Rao
- Department of Chemistry, Birla Institute of Technology and Science
| | - Mukund Jha
- Department of Biology and Chemistry, Nipissing University
| | - T. Cameron
- Department of Chemistry, Dalhousie University
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Chaudhuri A, De-Groot C, Seel M, Jolly M, Cameron T. Successful Treatment of Widespread Cutaneous Metastases from Melanoma using HDR Mould Brachytherapy: Hope Where Previously There Was None. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Crawford S, Thompson A, Uddin M, Thirumalairajan S, Cameron T. Improved Synthetic Route to C-Ring Ester-Functionalized Prodigiosenes. Synlett 2010. [DOI: 10.1055/s-0030-1258769] [Citation(s) in RCA: 4] [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: 10/19/2022]
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Márquez-Chin C, Popovic MR, Cameron T, Lozano AM, Chen R. Control of a neuroprosthesis for grasping using off-line classification of electrocorticographic signals: case study. Spinal Cord 2009; 47:802-8. [PMID: 19381156 DOI: 10.1038/sc.2009.41] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Proof of concept study to control a neuroprosthesis for grasping using identification of arm movements from ECoG signals. OBJECTIVE To test the feasibility of using electrocorticographic (ECoG) signals as a control method for a neuroprosthesis for grasping. SETTING Acute care hospital, Toronto Western Hospital and spinal cord injury (SCI) rehabilitation centre, Toronto Rehabilitation Institute, Lyndhurst Centre. Both hospitals are located in Toronto, Canada. METHODS Two subjects participated in this study. The first subject had subdural electrodes implanted on the motor cortex for the treatment of essential tremor (ET). ECoG signals were recorded while the subject performed specific arm movements. The second subject had a complete SCI at C6 level (ASIA B score) and was fitted with a neuroprosthesis, capable of identifying arm movements from ECoG signals off-line, for grasping. To operate the neuroprosthesis, subject 2 issued a command that would trigger the release of a randomly selected ECoG signal recorded from subject 1, associated with a particular arm movement. The neuroprosthesis identified which arm movement was performed at the time of recording and used that information to trigger the stimulation sequence. A correct ECoG classification resulted in the neuroprosthesis producing the correct hand function (that is grasp and release). RESULTS The neuroprosthesis classified ECoG signals correctly delivering the correct stimulation strategy with 94.5% accuracy. CONCLUSIONS The feasibility of using ECoG signals as a control strategy for a neuroprosthesis for grasping was shown.
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Affiliation(s)
- C Márquez-Chin
- Rehabilitation Engineering Laboratory, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada M4G 3V9
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Abstract
7166 Background: Previous NSCLC trials have suggested female non-smokers with adenocarcinoma are most likely to benefit from treatment with EGFR inhibitors such as erlotinib. Thus, male smokers with squamous-cell carcinoma might be expected to fail treatment with erlotinib monotherapy. Methods: In a double-blind, placebo-controlled study of 731 patients with incurable stage IIIB/IV NSCLC who had failed 1 or 2 prior chemotherapy regimens, patients were randomized in a 2:1 ratio to receive either erlotinib 150 mg or placebo (Shepherd et al NEJM 2005; 353(2):123–132). For a subset of male patients with squamous-cell carcinoma and a history of smoking, median survival was estimated from Kaplan-Meier survival curves. The hazard ratio (HR) for death and corresponding 95% confidence interval (CI) were calculated from a univariate Cox model and statistical significance was described by a log-rank statistic. Results: In the ITT population the adjusted HR for death between the erlotinib and placebo arms was 0.73 (P < 0.001). Among male smokers with squamous-cell carcinoma, overall survival was significantly improved among patients receiving erlotinib (N = 100) compared with patients with similar attributes in the placebo arm (N = 57): HR = 0.66, 95% CI 0.47 to 0.92, P = 0.016. This difference resulted in median survival time of 5.5 months in the erlotinib arm compared with 3.4 months in the placebo arm. Conclusions: Although male smokers with squamous-cell carcinoma have not been considered ideal candidates for treatment with erlotinib, survival benefits were observed in this subset of patients. [Table: see text]
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Affiliation(s)
- G. M. Clark
- OSI Pharmaceuticals Inc., Boulder, CO; OSI Pharmaceuticals UK Limited, Oxford, United Kingdom; Hoffman-La Roche, Basel, Switzerland
| | - T. Cameron
- OSI Pharmaceuticals Inc., Boulder, CO; OSI Pharmaceuticals UK Limited, Oxford, United Kingdom; Hoffman-La Roche, Basel, Switzerland
| | - A. Das Gupta
- OSI Pharmaceuticals Inc., Boulder, CO; OSI Pharmaceuticals UK Limited, Oxford, United Kingdom; Hoffman-La Roche, Basel, Switzerland
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Ranson M, Dobbs T, Modiano M, Nicolson M, Fyfe D, Harper P, Sandler A, Cameron T, Ptaszynski M. P-789 Phase II study of OSI-211 (liposomal lurtotecan) in recurrentsmall-cell lung cancer (SCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Poole CJ, Thomas H, Gore M, Dark G, Vasey P, Bailey N, Cameron T, van Duym C, Ptaszynski M. Randomized phase II parallel evaluation of OSI-211 (liposomal lurtotecan) and topotecan in women with relapsed epithelial ovarian cancer (EOC). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. J. Poole
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - H. Thomas
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - M. Gore
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - G. Dark
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - P. Vasey
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - N. Bailey
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - T. Cameron
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - C. van Duym
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
| | - M. Ptaszynski
- The Univ of Birmingham, Birmingham, United Kingdom; Univ of Surrey, Guildford, United Kingdom; Royal Marsden Hosp, London, United Kingdom; Univ of Newcastle, Newcastle, United Kingdom; Univ of Glasgow, Glasgow, United Kingdom; Torbay District Gen Hosp, Torbay, United Kingdom; OSI Pharmaceuticals, Oxford, United Kingdom; OSI Pharmaceuticals Inc, Boulder, CO
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Arnold D, Mangion D, Frizzle M, Cameron T. The Photochemistry of Acrylonitrile with Methoxylated Naphthalenes: Introducing the Photochemical Electrophile-Olefin Combination, Aromatic Substitution (Photo-EOCAS) Reaction. SYNTHESIS-STUTTGART 2004. [DOI: 10.1055/s-2001-15071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Cameron T. The development of field guides for birding: Gwillim, Wilson, Audubon and Peterson. J Biocommun 2001; 27:6-10. [PMID: 10916743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Gillard DM, Yakovenko S, Cameron T, Prochazka A. Isometric muscle length-tension curves do not predict angle-torque curves of human wrist in continuous active movements. J Biomech 2000; 33:1341-8. [PMID: 10940392 DOI: 10.1016/s0021-9290(00)00127-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study we tested the hypothesis that during steady contractions of human wrist extensors or flexors, the torque-angle relationship during movements imposed about the wrist is predicted by the classical isometric muscle length-tension curve, with ascending, descending and ascending limbs. Angle-torque relationships were measured during steady muscle activation (10% of maximal voluntary contraction: MVC), elicited either by electrical stimulation or voluntary regulation of the electromyogram (EMG). Flexion-extension movements of constant speed (+/-10 degrees /s) were imposed on the subjects' hands with a servo actuator, either through the full physiological range of motion +/-50 degrees, or through +/-10 degrees. During extensor contractions, angle-torque curves in +/-50 degrees movements had ascending, descending and ascending limbs, as in isometric contractions. However, in +/-10 degrees movements, torque always increased with increasing muscle length and decreased with decreasing length, even over angles corresponding to the descending limb of isometric curves. For flexor activation, angle-torque curves had similar properties, though descending limbs were less obvious or absent. During imposed movements, hysteresis was observed in the angle-torque curves. This was attributed to non-linearities of the active muscles. Hysteresis reached a maximum at intermediate wrist angles and declined at maximal muscle length, contradicting the recent hypothesis that sarcomere non-uniformity is responsible for the hysteresis. We conclude that the classical isometric length-tension curve, with its prominent descending limb, does not predict angle-torque curves of human wrist muscles in continuous movements. A more appropriate model is one in which stiffness about the wrist is always positive and hysteresis is a significant factor.
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Affiliation(s)
- D M Gillard
- Division of Neuroscience, University of Alberta, 513 Heritage Medical Research Centre, Edmonton, T6G 2S2, Alberta, Canada
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Abstract
The epidemiology of AIDS has changed greatly in recent years and increasing numbers of poor, minority women with children now contract HIV/AIDS. As infected women succumb to AIDS, many of their children become orphans. The paper explores the ability and appropriateness of the current child welfare system to care for healthy children orphaned by AIDS, and the likelihood of adoption for this population. The study includes a wide-ranging literature review of information about children orphaned by AIDS, and relevant information about the child welfare system, including racial bias. To determine current support for children orphaned by AIDS, the author surveyed social service departments and private agencies in eight major cities about programs available. Based on this information, the author proposes a series of policy initiatives aimed at alleviating the flight of children orphaned because of AIDS.
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Affiliation(s)
- T Cameron
- School of Planning & Landscape Architecture, Arizona State University Tempe 85287, USA
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Gillard DM, Cameron T, Prochazka A, Gauthier MJ. Tremor suppression using functional electrical stimulation: a comparison between digital and analog controllers. IEEE Trans Rehabil Eng 1999; 7:385-8. [PMID: 10498383 DOI: 10.1109/86.788474] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this study, we compared digital and analog versions of a functional electrical stimulator designed to suppress tremor. The device was based on a closed-loop control system designed to attenuate movements in the tremor frequency range, without significantly affecting slower, voluntary movements. Testing of the digital filter was done on three patients with Parkinsonian tremor and the results compared to those of a functional electrical stimulation device based on an analog filter evaluated in a previous study. Additional testing of both the analog and digital filters was done on three subjects with no neurological impairment performing tremor-like movements and slow voluntary movements. We found that the digital controller provided a mean attenuation of 84%, compared to 65% for the analog controller.
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Affiliation(s)
- D M Gillard
- Division of Neuroscience, University of Alberta, Edmonton, Canada
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Cameron T, McDonald K, Anderson L, Prochazka A. The effect of wrist angle on electrically evoked hand opening in patients with spastic hemiplegia. IEEE Trans Rehabil Eng 1999; 7:109-11. [PMID: 10188613 DOI: 10.1109/86.750560] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper studied the effect of wrist angle on the amount of hand opening achieved by electrical stimulation in people with spastic hemiplegia. With their forearm in pronation, subjects were asked to relax while their affected wrist was passively moved in steps of about 15 degrees from full flexion into extension. Trains of stimuli were applied to the long finger extensor muscles through surface electrodes on the forearm. At each wrist position stimulation was turned on for a few seconds until hand opening equilibrated. Wrist angle and fingertip positions were recorded using a three-dimensional (3-D) motion analysis system. Maximal displacements between thumbtip and each fingertip occurred when the wrist was fully flexed. As the wrist was extended, hand aperture achieved by electrical stimulation progressively declined, reaching zero at 40 degrees of wrist extension. We conclude that electrical stimulation can significantly increase the grasp aperture of the hemiplegic hand, but this is strongly dependent on wrist posture and accompanying voluntary effort.
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Affiliation(s)
- T Cameron
- Division of Neuroscience, University of Alberta, Edmonton, Canada
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Cameron T, Richmond FJ, Loeb GE. Effects of regional stimulation using a miniature stimulator implanted in feline posterior biceps femoris. IEEE Trans Biomed Eng 1998; 45:1036-43. [PMID: 9691578 DOI: 10.1109/10.704872] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [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: 11/06/2022]
Abstract
The effects of placement of a miniature implantable stimulator on motor unit recruitment were examined in the posterior head of cat biceps femoris. The implantable stimulator (13-mm long x 2-mm diameter) was injected either proximally near the main nerve branch, or distally near the muscle insertion, through a 12-gauge hypodermic needle. Glycogen-depletion methods were used to map the distribution of fibers activated by electrical stimulation. Muscle fibers were found to be depleted at most or all proximodistal levels of the muscle, but the density of depleted fibers varied transversely according to the stimulus strength and proximity of the device to the nerve-entry site. Thus, muscle cross sections often had a "patchy" appearance produced because different proportions of depleted fibers intermingled with undepleted fibers in different parts of the cross section. In other preparations, the force of muscle contraction was measured when stimuli of varying strengths were delivered by the stimulator positioned at the same proximal or distal sites within the muscle. Devices placed close to the nerve-entry site produced the greatest forces. Those placed more distally produced less force. As stimulus current and/or pulse width increased, muscle force increased, often in steps, until a maximum was reached, which was usually limited by the compliance voltage of the device to less than the force produced by whole nerve stimulation.
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Affiliation(s)
- T Cameron
- Advanced Neuromodulation Systems, Inc., Allen, Texas 75002, USA.
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Cameron T, Liinamaa TL, Loeb GE, Richmond FJ. Long-term biocompatibility of a miniature stimulator implanted in feline hind limb muscles. IEEE Trans Biomed Eng 1998; 45:1024-35. [PMID: 9691577 DOI: 10.1109/10.704871] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic foreign-body responses and muscular changes were examined following the implantation of active miniature stimulators into the hind limb muscles of cats for periods of up to three months. The radio-frequency (RF)-powered stimulators were injected into muscles through a 12-gauge hypodermic needle. The tissue responses around the active stimulators were compared histologically to those provoked by passive devices, broken glass, silicone tubing, polyester suture material coated with polybutylate, and two of the internal components of the stimulator (ferrite, integrated circuit chip). Active and passive stimulators produced similar, benign foreign-body reactions that resulted in an essentially identical fibrous capsule over time. The responses were similar to those produced by the internal components and the suture material, and were more modest than those produced by the broken glass. The capsule did not appear to interfere with the functionality of active devices because thresholds measured during the post-implantation survival period did not change significantly over time. Unexpectedly, the severity of the reaction differed significantly amongst the various target muscles. Medial gastrocnemius exhibited the most severe response, whereas tibialis anterior had the least reaction.
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Affiliation(s)
- T Cameron
- Advanced Neuromodulation Systems, Inc., Allen, Texas 75002, USA.
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Abstract
1. Muscle receptors play an important role in our conscious perception of movement, but there are no published accounts of our ability to detect their signals during different motor tasks. The present experiments introduce a method to test muscular sense when humans move. 2. Muscle receptors were excited by an electrically induced twitch of the right extensor carpi ulnaris muscle. The muscle was stimulated via percutaneously inserted intramuscular electrodes or using surface stimulation through anaesthetized skin. Muscular sense was represented by the ability to detect the twitch and was compared between various tasks and stationary control trials. 3. Three hertz voluntary wrist movements significantly attenuated muscular sense to 37 % of control. This velocity-dependent attenuation was present over a range of twitch amplitudes suggesting it does not simply reflect a masking of low intensity stimuli. Perceptual ratings of twitch amplitude during fast imposed passive movements were reduced by 40 %, though this did not quite reach statistical significance. However, perceptual ratings of twitches evoked up to 2 s after the termination of the passive movements were significantly different from control. 4. Reaching with the stimulated, but not the contralateral, arm also significantly reduced muscular sense (to 40 %). 5. Attenuation to 58 % of control during cyclic stretching of the skin on the dorsum of the hand showed that signals from peripheral receptors may play a role. Attenuation prior to a single wrist flexion movement indicated that central sources can also contribute. 6. The results are consistent with current findings of a general attenuation of sensory feedback during movement and raise questions regarding the role of muscular sense in movement control.
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Affiliation(s)
- D F Collins
- Division of Neuroscience, University of Alberta, Edmonton, Alberta, Canada T6G 2S2.
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Cameron T, Broton JG, Needham-Shropshire B, Klose KJ. An upper body exercise system incorporating resistive exercise and neuromuscular electrical stimulation (NMS). J Spinal Cord Med 1998; 21:1-6. [PMID: 9541880 DOI: 10.1080/10790268.1998.11719503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A device is described which combines arm crank ergometry and neuromuscular electrical stimulation (NMS) delivered at different phases of the crank cycle. Details of the device including circuit schematics are shown. The device was evaluated by non-paralyzed subjects for its operational safety and by tetraplegic subjects for its effectiveness as a muscle-strengthening tool. All subjects showed improvement in one or more of their manual muscle scores. The most dramatic increased motor score occurred in the triceps muscle group. There was an average increase in the manual muscle score of 1.1 +/- 0.2 for the left triceps and 0.7 +/- 0.1 for the right triceps after eight weeks of NMS assisted exercise. No adverse effects were experienced and it appears to meet safety considerations necessary for this group of individuals. Preliminary observations indicate that an eight-week exercise protocol that utilizes this device can be beneficial for this population.
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Affiliation(s)
- T Cameron
- Quest Medical Inc., Allen, TX 75002, USA
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Abstract
A literature search reveals a number of instances where people with AIDS (PWAs) have limits placed on their health care by self-insured firms. Some firms cite the high cost of health care for AIDS as the motivation for their decision. Research demonstrates, however, that AIDS is not the only high-priced disease to treat. Treatment for lung cancer is costly as well. In many cases, unprotected sex leads to HIV/AIDS and lung cancer is strongly linked to tobacco use. Therefore, lung cancer can be studied as a comparison disease for issues relating to health care coverage of PWAs. A literature search also shows that no examples of limitations on health care were found among lung cancer patients. A 1992 Supreme Court decision did not restrict the inequitable access to health care through self-insured plans for AIDS patients. When employees of self-insured firms exhaust their insurance benefits, which can occur quickly, they apply for Medicaid or Medicare benefits. As a result, the government's burden is increased in the care of PWAs. The issue, therefore, should be to ensure that employees of self-insured firms have equal access to health care since there are other serious diseases, such as lung cancer, that are also expensive to treat.
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Cameron T, Loeb GE, Peck RA, Schulman JH, Strojnik P, Troyk PR. Micromodular implants to provide electrical stimulation of paralyzed muscles and limbs. IEEE Trans Biomed Eng 1997; 44:781-90. [PMID: 9282470 DOI: 10.1109/10.623047] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [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: 02/05/2023]
Abstract
We describe the design, fabrication, and output capabilities of a microminiature electrical stimulator that can be injected in or near nerves and muscles. Each single-channel microstimulator consists of a cylindrical glass capsule with hermetically sealed electrodes in either end (2-mm diameter x 13-mm overall length). Power and digital control data can be transmitted to multiple implants (256 unique addresses) via a 2-MHz RF field created by an external AM oscillator and inductive coil. In vitro testing demonstrated accurate control of output pulsewidth (3-258 microseconds in 1-microseconds steps) and current (0-30 mA in two linear ranges of 16 steps each, up to 8.5 V available compliance voltage). Microstimulators were used successfully for chronic stimulation in hindlimb muscles of cats. Design and fabrication issues affecting yield and reliability of the packaging and electronics are discussed.
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Affiliation(s)
- T Cameron
- Queen's University, Biomedical Engineering Unit, Kingston, Ont. Canada.
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Cameron T. Gold color in dental alloys. J Dent Technol 1997; 14:28-33. [PMID: 9524484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article will help the dental laboratory with alloy selection by exploring how the relationship among color, ductility and strength applies to gold and how color can be quantified. Because higher quality materials translate into higher profits, upselling to the dentist and patient is also discussed.
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Affiliation(s)
- T Cameron
- Ney Dental International, Bloomfield, Connecticut 06002, USA.
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Gore ME, Rustin G, Slevin M, Gallagher C, Penson R, Osborne R, Ledermann J, Cameron T, Thompson JM. Single-agent paclitaxel in patients with previously untreated stage IV epithelial ovarian cancer. London Gynaecological Oncology and North Thames Gynaecological Oncology Groups. Br J Cancer 1997; 75:710-4. [PMID: 9043029 PMCID: PMC2063326 DOI: 10.1038/bjc.1997.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to evaluate the efficacy of high-dose paclitaxel in patients with previously untreated stage IV epithelial ovarian cancer. Paclitaxel was administered intravenously over 3 h at a dose of 225 mg m(-2) on a 21-day cycle for six courses. Thirty-six patients were entered into this study; all 36 were assessed for toxicity and 33 patients were evaluable for response. One patient had a complete response and 12 patients had partial responses (overall response rate 39.4%, 95% CI 23-58%). The overall median duration of response was 9 months (range 3.5-23+ months). The response rate to carboplatin following failure of paclitaxel within 1 year of stopping therapy was 57% (four out of seven patients). The median survival of patients was 17.2 months. The main toxicity encountered was neutropenia which was WHO grade 3 in 11 patients (31%) and WHO grade 4 in seven patients (19%). Granulocyte colony-stimulating factor (GCSF) was not given to any patient during the study. Other toxicities were: grade 3/4 infection (11%) and nausea and vomiting (11%); grade 3 bone pain (22%), fatigue (14%), diarrhoea (3%), myalgia/arthralgia (3%) and dry eyes (3%). Transient peripheral neuropathy occurred in 16 patients (44%), and alopecia was encountered in most patients (grade 2/3, 78%). Paclitaxel given at 225 mg m(-2) to patients with stage IV epithelial ovarian cancer is active, well tolerated and does not require GCSF support.
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Affiliation(s)
- M E Gore
- Royal Marsden Hospital, London, UK
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Fitzpatrick TL, Liinamaa TL, Brown IE, Cameron T, Richmond FJ. A novel method to identify migration of small implantable devices. J Long Term Eff Med Implants 1995; 6:157-68. [PMID: 10172964] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A histologic method has been developed to assess the migration of chronically-implanted intramuscular devices. Bullet-shaped glass devices with varying tip configurations and glass-encapsulated microstimulators of a similar size were loaded with the fluorescent tracer Procion Yellow dissolved in molten glucose. Dissolution of the hardened glucose soon after contact with body fluids released the Procion Yellow, which binds irreversibly to local tissues, thereby marking the initial site of implantation with a localized fluorescent spot. After survival times of 2-7 weeks, histologic analysis usually showed a close physical relationship between the fluorescent spot and the connective-tissue capsule from which the device was extracted. In one case, migration of a sharply pointed device from the deep surface of an implanted muscle was recognized by differences in the location of the dye spot and the site of explantation from nearby fascia. Results suggested that this method could measure migratory distances as small as 5-10 mm.
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Affiliation(s)
- T L Fitzpatrick
- Department of Physiology, Queen's University, Kingston, Ontario, Canada
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Cameron T, Calancie B. Mechanical and fatigue properties of wrist flexor muscles during repetitive contractions after cervical spinal cord injury. Arch Phys Med Rehabil 1995; 76:929-33. [PMID: 7487433 DOI: 10.1016/s0003-9993(95)80069-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Force generation and fatigue properties of wrist flexor muscles were examined in subjects with chronic (> 1 year) cervical spinal cord injury (SCI, n = 16), and also in a control group of able-bodied (AB, n = 9) subjects. DESIGN Using surface electrodes, wrist flexor muscles were stimulated with 126 trains of 26 stimuli at a frequency of 40Hz. The offset of each train was followed by a 1.5-second pause, for a total fatigue-test time of approximately 4.2 minutes. Isometric wrist flexion force was measured with a strain gauge. SETTING This study was conducted at a research and rehabilitation center for spinal cord injury. MAIN OUTCOME MEASURES Force profiles were analyzed for the maximum (peak) amplitude, the rise time, and the time constant of relaxation. RESULTS At the outset, the average peak isometric measured in the SCI group was approximately one half that of the AB subjects. Although the relative decline in force with repeated stimulation was comparable between groups, the slowing of relaxation rate was much more pronounced in the SCI group. CONCLUSIONS These findings are consistent with alterations in the metabolic profiles of wrist flexor muscles in the SCI group, probably reflected their altered activation pattern. When designing stimulation protocols for optimizing force and fatigue resistance in muscle left partially-paralyzed after spinal cord injury, particular care must be taken to allow adequate time for complete muscle relaxation, to avoid overdriving of the muscle and a loss of functional capacity.
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Affiliation(s)
- T Cameron
- Miami Project to Cure Paralysis, University of Miami School of Medicine, FL 33136, USA
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Travin MI, Dessouki A, Cameron T, Heller GV. Use of exercise technetium-99m sestamibi SPECT imaging to detect residual ischemia and for risk stratification after acute myocardial infarction. Am J Cardiol 1995; 75:665-9. [PMID: 7900657 DOI: 10.1016/s0002-9149(99)80650-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The clinical presentation, electrocardiographic findings, and technetium-99m sestamibi single-photon emission computed tomography (SPECT) imaging results of 134 consecutive patients who underwent nuclear exercise testing within 14 days of an acute myocardial infarction (AMI) were correlated with cardiac events over a 15 +/- 10-month follow-up. Whereas only 23 patients (17%) had chest pain and 31 (23%) had ischemic ST-segment depression during exercise, 94 (70%) had ischemia on SPECT (p < 0.001). On follow-up, 13 patients experienced a cardiac event: 7 were rehospitalized for unstable angina, 3 had recurrent AMI, and 3 died of cardiac causes. Ischemia on the sestamibi images identified 11 of these patients (85%), whereas chest pain identified only 3 (23%, p = 0.006), and electrocardiographic ischemia identified only 4 (31%, p = 0.017). The presence of either ischemia as seen on SPECT or defects in multiple vascular territories identified 12 patients (92%) with an event, including all who had cardiac death. By Cox regression analysis of clinical, stress, and image parameters, the number of ischemic defects on SPECT was the only significant correlate of a future event (chi-square = 4.62, p = 0.03), and patients with > or = 3 reversible sestamibi defects had an event rate of 38%. The extent of ischemia as seen on nuclear imaging remained a strong correlate (p = 0.008) of an event in the 54 patients (40%) who had received thrombolytic therapy. Thus, exercise technetium-99m sestamibi SPECT after AMI frequently reveals residual ischemia, and is better than clinical data, symptoms, and stress electrocardiographic data in identifying patients who will have a subsequent cardiac event.
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Affiliation(s)
- M I Travin
- Division of Cardiology, Roger Williams Medical Center, Providence, Rhode Island 02908, USA
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Wang D, Mentzer WC, Cameron T, Johnson RM. Purification of band 7.2b, a 31-kDa integral phosphoprotein absent in hereditary stomatocytosis. J Biol Chem 1991; 266:17826-31. [PMID: 1655727] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 31-kDa human erythrocyte integral protein, band 7.2b, has been purified to better than 95% homogeneity. The polypeptide was found to be insoluble in most detergents and was isolated in denatured form by gel filtration in the presence of sodium dodecyl sulfate and preparative electrophoresis. In intact erythrocytes that were equilibrated with 32Pi, band 7.2b was phosphorylated in response to exogenous dibutyryl cAMP. The peptide is also palmitylated, as shown by its incorporation of radioactivity when intact erythrocytes were incubated with [9,10-3H]palmitic acid. Antisera to band 7.2b were raised in rabbits, and these antibodies cross-react with 31-kDa polypeptides in human liver and kidney. Immunoblots of red cells from a number of other species were negative, with the exception of a cross-reacting 23-kDa polypeptide in rat erythrocyte membranes. Band 7.2b was absent in erythrocyte membranes from an individual with overhydrated hereditary stomatocytes.
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Affiliation(s)
- D Wang
- Department of Biochemistry, Wayne Street University, Detroit, Michigan 48201
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Wang D, Mentzer W, Cameron T, Johnson R. Purification of band 7.2b, a 31-kDa integral phosphoprotein absent in hereditary stomatocytosis. J Biol Chem 1991. [DOI: 10.1016/s0021-9258(18)55202-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
Dysphagia is a major problem in patients with neurologic disorders. Aspiration pneumonia and impaired nutritional status are consequences of dysphagia that result in high morbidity and mortality rates. Assessment and treatment of the dysphagic patient by a multidisciplinary team have been advocated but to date the effects of such an approach have not been demonstrated quantitatively. This prospective study was conducted to determine if a dysphagia program would improve patients' caloric intake and body weight, decrease the instances of aspiration pneumonia, or improve patients' feeding ability. Patients were referred from a 26 bed neurology/neurosurgery unit. A time series design was utilized. The control group consisted of 15 patients (mean age = 46.1 years), managed according to the existing ward routine. Subsequently, nursing staff attended a dysphagia training program. Following this, the treated group of 16 patients, (mean age = 49.3 years) was assessed by the dysphagia team, using bedside and videofluoroscopic examinations to determine the specific swallowing disorder. An individualized treatment program was designed for each patient. The groups were compared on the basis of deviation from their baseline weight, deviation from ideal energy intake, and the incidence of aspiration pneumonia. Statistical analysis revealed that the groups were comparable in age, number of days on the study, and Glasgow Coma Scale score; and that a significant weight gain and increase in caloric intake occurred in the treated group. No incidence of aspiration pneumonia was reported in either group. We speculate that this may have been influenced by the meticulousness of the care delivered in an acute unit as well as greater attention to prevention given in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Martens
- Health Sciences Centre, Winnipeg, Manitoba, Canada
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Cameron T, Prado R, Watson BD, Gonzalez-Carvajal M, Holets VR. Photochemically induced cystic lesion in the rat spinal cord. I. Behavioral and morphological analysis. Exp Neurol 1990; 109:214-23. [PMID: 2165913 DOI: 10.1016/0014-4886(90)90076-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study describes the production of a spinal cord lesion which is initiated by vascular occlusion resulting from the interaction between the photosensitizing dye erythrosin B and an argon laser beam. The lesion has characteristics similar to those of the central cavity thought to lead to the production of post-traumatic syringomyelia (PTS) in humans. The present study examines the behavioral and morphological characteristics of this injury over a 28-day period. Histological analysis revealed a cavity extending from the dorsal horns to lamina VIII, with some lateral and ventral pathways being spared. The cavity volume reached a maximum 7 days after lesion induction. Behavioral changes were assessed using six different tests of motor and reflex function (motor function, climbing, waterbath, inclined plane, withdrawal to pain, and withdrawal to extension). Lesioned animals exhibited flaccid paralysis for 3-5 days, which resolved afterward. The photochemically induced cavity should provide a reproducible model for examining the effects of cystic spinal cord injury on locomotor and reflex function.
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Affiliation(s)
- T Cameron
- Department of Biomedical Engineering, University of Miami, Florida
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Saltzstein SL, Harrell JH, Cameron T. Brusings, washings, or biopsy? Obtaining maximum value from flexible fiberoptic bronchoscopy in the diagnosis of cancer. Chest 1977; 71:630-2. [PMID: 852341 DOI: 10.1378/chest.71.5.630] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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