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Abe TA, Olanipekun T, Yan F, Effoe V, Udongwo N, Oshunbade A, Thomas V, Onuorah I, Terry JG, Yimer WK, Ghali JK, Correa A, Onwuanyi A, Michos ED, Benjamin EJ, Echols M. Carotid Intima-Media Thickness and Improved Stroke Risk Assessment in Hypertensive Black Adults. Am J Hypertens 2024; 37:290-297. [PMID: 38236147 PMCID: PMC10941087 DOI: 10.1093/ajh/hpae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND We aim to determine the added value of carotid intima-media thickness (cIMT) in stroke risk assessment for hypertensive Black adults. METHODS We examined 1,647 participants with hypertension without a history of cardiovascular (CV) disease, from the Jackson Heart Study. Cox regression analysis estimated hazard ratios (HRs) for incident stroke per standard deviation increase in cIMT and quartiles while adjusting for baseline variables. We then evaluated the predictive capacity of cIMT when added to the pool cohort equations (PCEs). RESULTS The mean age at baseline was 57 ± 10 years. Each standard deviation increase in cIMT (0.17 mm) was associated with approximately 30% higher risk of stroke (HR 1.27, 95% confidence interval: 1.08-1.49). Notably, cIMT proved valuable in identifying residual stroke risk among participants with well-controlled blood pressure, showing up to a 56% increase in the odds of stroke for each 0.17 mm increase in cIMT among those with systolic blood pressure <120 mm Hg. Additionally, the addition of cIMT to the PCE resulted in the reclassification of 58% of low to borderline risk participants with stroke to a higher-risk category and 28% without stroke to a lower-risk category, leading to a significant net reclassification improvement of 0.22 (0.10-0.30). CONCLUSIONS In this community-based cohort of middle-aged Black adults with hypertension and no history of CV disease at baseline, cIMT is significantly associated with incident stroke and enhances stroke risk stratification.
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Affiliation(s)
- Temidayo A Abe
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Titilope Olanipekun
- Division of Internal Medicine, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Fengxia Yan
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Valery Effoe
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ndausung Udongwo
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Victoria Thomas
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ifeoma Onuorah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James G Terry
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wondwosen K Yimer
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jalal K Ghali
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anekwe Onwuanyi
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Medicine, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Melvin Echols
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
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Gutierrez-Colina AM, Aichele S, Lavender JM, Sanchez N, Thorstad I, Gulley LD, Emerick JE, Schrag R, Thomas V, Spinner H, Arnold T, Heroy A, Haigney MC, Tanofsky-Kraff M, Shomaker LB. Associations of social and cognitive-behavioral variables with disinhibited eating and anxiety: An ecological momentary assessment study. Int J Eat Disord 2024. [PMID: 38415929 DOI: 10.1002/eat.24177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Among adolescents, disinhibited eating and anxiety commonly co-occur. Precision intervention approaches targeting unique mechanistic vulnerabilities that contribute to disinhibited eating and anxiety may therefore be helpful. However, the effectiveness of such interventions hinges on knowledge of between- and within-person associations related to disinhibited eating, anxiety, and related processes. METHOD A sample of 39 adolescent females (12-17 years) with elevated anxiety and above-average weight (BMI %ile ≥ 75th) completed measures of theoretically driven social and cognitive-behavioral variables, disinhibited eating, and anxiety via ecological momentary assessment over 7 days. Data were analyzed using mixed-effects models. RESULTS Between-person differences in social stressors were linked to emotional eating, eating in the absence of hunger, and anxiety, whereas between-person differences in negative thoughts were associated with all disinhibited eating variables and anxiety. Between-person differences in avoidance were not related to any outcome. Additionally, between-person differences in social stressors and negative thoughts-as well as within-person deviations (from person-average levels) of social stressors, negative thoughts, and avoidance-were associated with anxiety. In turn, between-person differences in anxiety predicted eating in the absence of hunger and emotional eating, and within-person deviations in anxiety were associated with emotional eating at any given time point. DISCUSSION Findings support elements of both the interpersonal and cognitive-behavioral models of disinhibited eating. Differential trigger effects on anxiety, both at the between- and within-person levels, and significant associations between anxiety and all eating-related outcomes, highlight the potential utility of interventions targeting individual differences in sensitivity to anxiety triggers. PUBLIC SIGNIFICANCE Findings provide support for the interpersonal and cognitive-behavioral models of disinhibited eating, highlighting anxiety as a salient vulnerability and potential mechanistic factor underlying disinhibited eating. Social, cognitive, and behavioral variables were differentially related to anxiety across participants, suggesting potential for future intervention tailoring and intervention selection based on adolescents' sensitivity to anxiety as a trigger for disinhibited eating behavior.
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Affiliation(s)
- Ana M Gutierrez-Colina
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Stephen Aichele
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Isabel Thorstad
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jill E Emerick
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland, USA
| | - Ruby Schrag
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Victoria Thomas
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Holly Spinner
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Thomas Arnold
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Andrew Heroy
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- The Metis Foundation, San Antonio, Texas, USA
| | - Mark C Haigney
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland, USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, Colorado, USA
- Colorado School of Public Health, Aurora, Colorado, USA
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Thomas V, Bizumic B, Cruwys T, Walsh E. Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian). Psychol Trauma 2024; 16:270-279. [PMID: 37166915 DOI: 10.1037/tra0001490] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Moral injury (MI) research has been expanded to populations beyond the military in recent years. A key barrier to further research into MI in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This article addresses this barrier by adapting two existing military measures and exploring their psychometrics in a general civilian sample: the Moral Injury Events Scale-Civilian (MIES-C) and Expressions of Moral Injury Scale-Military (EMIS-C). METHOD A sample of civilian women (n = 192) and men (n = 88) completed the above measures, and additional scales designed to capture theoretically supported primary and secondary markers of MI (guilt, shame, anger; depression, posttraumatic stress symptoms, anxiety). RESULTS Confirmatory factor analyses found that the factor structure of the MIES-C and EMIS-C replicated well within our civilian sample. Discriminant validity was indicated through a significant negative correlation with well-being. Both measures correlated as predicted with each other and measures of MI markers at the total score level. Correlations of individual subscales with each of these measures were more varied. CONCLUSIONS Results shed light on differential relationships between the type of MI event and clinical outcomes, suggesting some conceptual differences in how MI is experienced in general civilian populations. Results suggest that civilian populations are also susceptible to MI, but that existing measures may have problems capturing this effectively. While the MIES-C and EMIS-C are supported for civilian use, further scale construction efforts for this population are warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Victoria Thomas
- Research School of Psychology, Australian National University
| | - Boris Bizumic
- Research School of Psychology, Australian National University
| | - Tegan Cruwys
- Research School of Psychology, Australian National University
| | - Erin Walsh
- Research School of Psychology, Australian National University
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Gananandan K, Thomas V, Woo WL, Boddu R, Kumar R, Raja M, Balaji A, Kazankov K, Mookerjee RP. Fat mass: a novel digital biomarker for remote monitoring that may indicate risk for malnutrition and new complications in decompensated cirrhosis. BMC Med Inform Decis Mak 2023; 23:180. [PMID: 37705043 PMCID: PMC10498640 DOI: 10.1186/s12911-023-02288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/04/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Cirrhosis is associated with sarcopaenia and fat wasting, which drive decompensation and mortality. Currently, nutritional status, through body composition assessment, is not routinely monitored in outpatients. Given the deleterious outcomes associated with poor nutrition in decompensated cirrhosis, there is a need for remotely monitoring this to optimise community care. METHODS A retrospective analysis was conducted on patients monitored remotely with digital sensors post hospital discharge, to assess outcomes and indicators of new cirrhosis complications. 15 patients had daily fat mass measurements as part of monitoring over a median 10 weeks, using a Withing's bioimpedance scale. The Clinical Frailty Score (CFS) was used to assess frailty and several liver disease severity scores were assessed. RESULTS 73.3% (11/15) patients were male with a median age of 63 (52-68). There was a trend towards more severe liver disease based on CLIF-Consortium Acute Decompensation (CLIF-C AD) scores in frail patients vs. those not frail (53 vs 46, p = 0.072). When the cohort was split into patients who gained fat mass over 8 weeks vs. those that lost fat mass, the baseline CLIF-C AD scores and WBC were significantly higher in those that lost fat (58 vs 48, p = 0.048 and 11.2 × 109 vs 4.7 × 109, p = 0.031). CONCLUSIONS This proof-of-principle study shows feasibility for remote monitoring of fat mass and nutritional reserve in decompensated cirrhosis. Our results suggest fat mass is associated with greater severity of acute decompensation and may serve as an indicator of systemic inflammatory response. Further prospective studies are required to validate this digital biomarker.
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Affiliation(s)
- K Gananandan
- Institute for Liver and Digestive Health, University College London, London, UK.
| | - V Thomas
- Institute for Liver and Digestive Health, University College London, London, UK
| | - W L Woo
- Royal Free Hospital, London, UK
| | - R Boddu
- CyberLiver Limited, London, UK
| | - R Kumar
- CyberLiver Limited, London, UK
| | - M Raja
- CyberLiver Limited, London, UK
| | | | - K Kazankov
- Institute for Liver and Digestive Health, University College London, London, UK
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - R P Mookerjee
- Institute for Liver and Digestive Health, University College London, London, UK
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Bauman V, Sanchez N, Repke HE, Spinner H, Thorstad I, Gulley LD, Mains AM, Lavender JM, Thompson KA, Emerick JE, Thomas V, Arnold TB, Heroy A, Gutierrez-Colina AM, Haigney MC, Shomaker LB, Tanofsky-Kraff M. Loss of control eating in relation to blood pressure among adolescent girls with elevated anxiety at-risk for excess weight gain. Eat Behav 2023; 50:101773. [PMID: 37343482 DOI: 10.1016/j.eatbeh.2023.101773] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
Loss of control (LOC)-eating, excess weight, and anxiety are robustly linked, and are independently associated with markers of poorer cardiometabolic health, including hypertension. However, no study has examined whether frequency of LOC-eating episodes among youth with anxiety symptoms and elevated weight status may confer increased risk for hypertension. We examined the relationship between LOC-eating frequency and blood pressure among 39 adolescent girls (14.9 ± 1.8 years; body mass index [BMI] = 29.9 ± 5.6; 61.5 % White; 20.5 % African American/Black; 5 % Multiple Races; 2.5 % Asian; 12.8 % Hispanic/Latino; 30.8 % with reported LOC-eating) with elevated anxiety and above average BMI who enrolled in a clinical trial aimed at preventing excess weight gain. LOC-eating over the past three months was assessed via clinical interview, and blood pressure (systolic and diastolic) was measured with an automatic blood pressure monitor. Adjusting for age, fat mass, and height, LOC-eating episode frequency was significantly, positively associated with diastolic blood pressure (β = 0.38, p = 0.02), but not with systolic blood pressure (β = 0.13, p = 0.41). Replication studies, with larger sample sizes, participants of varying weight-strata, and prospective data are required to elucidate the relationship between LOC-eating and cardiovascular functioning in youth with elevated anxiety.
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Affiliation(s)
- Viviana Bauman
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Natalia Sanchez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA
| | - Hannah E Repke
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Holly Spinner
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Isabel Thorstad
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Lauren D Gulley
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Autumn M Mains
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Katherine A Thompson
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Jill E Emerick
- Department of Pediatrics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Victoria Thomas
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Thomas B Arnold
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Andrew Heroy
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; The Metis Foundation, San Antonio, TX 78216, USA
| | - Ana M Gutierrez-Colina
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Mark C Haigney
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Lauren B Shomaker
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO 80523, USA; Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz and Children's Hospital Colorado, Aurora, CO 80045, USA; Colorado School of Public Health, Aurora, CO 80045, USA
| | - Marian Tanofsky-Kraff
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA; Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
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Boyer M, Janes J, Bennett J, Thomas V, De Hoedt A, Abran J, Aboushwareb T, Salama J, Freedland S. Association between Results from the 17-Gene Genomic Prostate Score Assay and Long-Term Outcomes after External Beam Radiation Therapy in Intermediate- or High-Risk Prostate Cancer Patients, Independent of Race. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1149] [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: 10/31/2022]
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Cheng ML, Thomas V, Vaz N, Hammer MM, Nishino M, Vargas SO, Khalil HA. Lipid pneumonia associated with mineral oil use presenting as fluorine-18-fluorodeoxy-D-glucose–avid lung mass. JTCVS Tech 2022; 15:192-194. [PMID: 36276695 PMCID: PMC9579874 DOI: 10.1016/j.xjtc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
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Coulter A, Collins A, Edwards A, Entwistle V, Finnikin S, Joseph-Williams N, Thomas V, Thomson R. Implementing shared decision-making in UK: Progress 2017-2022. Z Evid Fortbild Qual Gesundhwes 2022; 171:139-143. [PMID: 35610131 DOI: 10.1016/j.zefq.2022.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/06/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
Shared decision making has been on the policy agenda in the UK for at least twelve years, but it lacked a comprehensive approach to delivery. That has changed over the past five years, and we can now see significant progress across all aspects of a comprehensive approach, including leadership at policy, professional and patient levels; infrastructure developments, including the provision of training, tools and campaigns; and practice improvements, such as demonstrations, measurement and coordination. All these initiatives were necessary, but the last, central coordination, would appear to be key to success.
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Affiliation(s)
- Angela Coulter
- Nuffield Department of Population Health, University of Oxford, England, UK.
| | | | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Wales, UK
| | - Vikki Entwistle
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Sam Finnikin
- NHS England and Improvement, England, UK; Institute of Applied Health Research, University of Birmingham, England, UK
| | | | - Victoria Thomas
- National Institute for Health and Care Excellence (NICE), England, UK
| | - Richard Thomson
- Population Health Sciences Institute, University of Newcastle, England, UK
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Viviers M, Edwards L, Asir M, Hibberd J, Rowe R, Phillips S, Thomas V, Keesing M, Sugar A, Allen J. Enhanced rapid review of the applicability of ultrasound in the assessment of sucking, swallowing and laryngeal function in the paediatric population. Int J Lang Commun Disord 2022; 57:422-440. [PMID: 35060665 DOI: 10.1111/1460-6984.12695] [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] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/26/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has renewed interest in the use of ultrasound (US) amongst dysphagia-trained clinicians working with infants and children. US is a portable, minimally intrusive tool which carries reduced risk of aerosol-generation provoked by other instrumental swallowing assessment tools such as fibreoptic endoscopic evaluation of swallowing (FEES). For this reason, US could be a valuable addition to the dysphagia assessment toolkit. A recently published rapid review of US evidence for the assessment of swallowing and laryngeal function in the adult population provided a framework for this neonatal and paediatric review. AIMS This enhanced rapid review aimed to establish the applicability of US as an instrumental assessment tool for sucking, swallowing and laryngeal function in the neonatal and paediatric populations. METHODS & PROCEDURES A rapid review of six electronic databases was conducted to identify articles using US to assess sucking, swallowing or laryngeal function in the selected populations, compared with varied reference tests. Abstract screening was completed according to pre-defined inclusion/exclusion criteria with 10% of articles assessed by a second screener. Data was extracted from the included studies using a pre-developed form. A modified QUADAS-2 tool was used to assess study quality. Results from the included studies were summarised and grouped into sucking, swallowing and laryngeal function data. OUTCOMES & RESULTS Twelve studies using US in the assessment of swallowing and/or laryngeal function met inclusion criteria. No studies using US for assessment of sucking met the inclusion criteria. All were peer-reviewed, primary studies across a range of clinical populations and with a wide geographical spread. Five studies had an overall low risk of bias. Seven studies had at least one domain where risk of bias was judged as high. All studies had high applicability. The two studies assessing swallowing differed in terms of aims and use of US. The studies assessing laryngeal function predominately investigated vocal fold movement and laryngeal pathology. Sensitivity and specificity data were provided or calculated from raw data for nine of the laryngeal function studies (respective ranges of 75%-100% and 80%-100%). CONCLUSIONS & IMPLICATIONS Emerging evidence exists to support the use of US as adjunct to clinical assessment of swallowing and laryngeal function in the neonatal and paediatric population. A paucity of evidence to support use of US in the assessment of sucking exists. Further research is needed to establish evidence-based assessment and analysis protocols as well as development of paediatric data.
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Affiliation(s)
- Mari Viviers
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Maya Asir
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Rebecca Rowe
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sophie Phillips
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Melissa Keesing
- Nelson Marlborough District Health Board, Nelson, New Zealand
| | - Analou Sugar
- Chelsea and Westminster Hospital, Chelsea & Westminster Hospital Foundation Trust, London, UK
| | - Jodi Allen
- The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Beaune G, Yayehd K, Rocher T, Thomas V, Madiot H, Ricard C, Noirclerc N, Douair A, Belle L. [Evaluation of rule out strategy for patients with non-ST-elevation acute coronary syndrome with single measurement of high-sensitivity cardiac troponin I from one sample tested beetween 3 and 6 hours after chest pain onset]. Ann Cardiol Angeiol (Paris) 2021; 70:270-274. [PMID: 34517977 DOI: 10.1016/j.ancard.2021.07.006] [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: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Guidelines recommend to consider excluding non-ST-segment elevation myocardial infarction (NSTEMI) when high-sensitivity cardiac troponin is below the limit of quantification and a single blood sample is taken > 6 h after the onset of chest pain. The aim of our study was to assess such exclusion when a single blood sample was taken 3-6 h after the onset of permanent chest pain. METHODS This observational study included consecutive patients admitted into the emergency room of our hospital with chest pain and suspected NSTEMI, with non-contributive electrocardiograms and a single high-sensitivity cardiac troponin I (hs-cTnI) blood sample taken 3-6 h after the onset of chest pain and hs-cTnI < 4 ng/l (Abbott Diagnostic). Clinical follow-up was undertaken 1 month after admission. RESULTS The mean age of the 432 patients was 48.5 ± 5.6 years and 51% were male. Based on a clinical algorithm, the pre-test probability of NSTEMI was low in 70%, and intermediate in 21% of patients. Among 419 patients with available 1-month follow-up data, there were no myocardial infarctions or deaths. Thirty-eight patients (9%) were admitted into hospital but none for cardiac reasons. CONCLUSIONS Our results suggest that exclusion of NSTEMI in patients with a non-contributive electrocardiogram and a single "negative" troponin test in a blood sample taken 3-6 h after the onset of symptoms is valid.
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Affiliation(s)
- G Beaune
- Laboratoire, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France.
| | - K Yayehd
- Centre hospitalier Universitaire Campus, 03BP30284, Lomé, Togo
| | - T Rocher
- Service d'Accueil Urgences, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
| | - V Thomas
- Laboratoire, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
| | - H Madiot
- Service de Cardiologie, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
| | - C Ricard
- Statistiques Médicales, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
| | - N Noirclerc
- Service de Cardiologie, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
| | - A Douair
- Service de Cardiologie, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
| | - L Belle
- Service de Cardiologie, Centre hospitalier Annecy-Genevois, 1 avenue de l'hôpital, METZ-TESSY 74370 PRINGY, France
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Pearce ME, Jongbloed K, Pooyak S, Christian WM, Teegee MGWWM, Caron NR, Thomas V, Henderson E, Zamar D, Yoshida EM, Schechter MT, Spittal PM. The Cedar Project: exploring the role of colonial harms and childhood maltreatment on HIV and hepatitis C infection in a cohort study involving young Indigenous people who use drugs in two Canadian cities. BMJ Open 2021; 11:e042545. [PMID: 34244246 PMCID: PMC8268907 DOI: 10.1136/bmjopen-2020-042545] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study examined associations between childhood maltreatment, colonial harms and sex/drug-related risks for HIV and hepatitis C virus (HCV) infection among young Indigenous people who use drugs. DESIGN The Cedar Project is a cohort involving young Indigenous people who use drugs in British Columbia (BC), Canada. Indigenous collaborators, collectively known as the Cedar Project Partnership, govern the entire research process. SETTING Vancouver is a large city on the traditional territory of the Coast Salish peoples. Prince George is a mid-sized city, on the traditional territory of Lheidli T'enneh First Nation. PARTICIPANTS 420 participants completed the Childhood Trauma Questionnaire and returned for follow-up from 2003 to 2016. PRIMARY/SECONDARY OUTCOME MEASURES Primary outcomes were HIV and HCV infection over the study period. Secondary outcomes included sex and substance use-related risks. RESULTS Prevalence of childhood maltreatment was 92.6% experienced any maltreatment; 73.4% experienced emotional abuse; 62.6% experienced physical abuse; 60.3% experienced sexual abuse; 69.5% experienced emotional neglect and 79.1% experienced physical neglect. We observed significant associations between childhood maltreatment and apprehensions into residential schools and foster care. All maltreatment types were associated with higher odds of sex/substance use-related risks; sexual abuse was associated with higher odds of HCV infection (adjusted OR: 1.67; 95% CI 1.05 to 2.66; p=0.031). CONCLUSIONS Findings reflect high prevalence of childhood maltreatment and their associations with HIV/HCV risk and HCV infection. Public health prevention and treatment initiatives must be trauma informed and culturally safe to support healing, health, and well-being.
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Affiliation(s)
- Margo E Pearce
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Jongbloed
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sherri Pooyak
- Cree, Saskatoon, Saskatchewan, Canada
- Aboriginal HIV/AIDS Community Based Collaborative Centre, Saskatoon, Saskatchewan, Canada
| | | | - Maaxswxw Gibuu White Wolf Mary Teegee
- Gitk'san and Carrier, Luxgaboo Wolf Clan, Takla Lake First Nation, Prince George, British Columbia, Canada
- Carrier Sekani Family Services, Prince George, British Columbia, Canada
| | - Nadine R Caron
- Sagamok Anishnawbek First Nation (Ojibwa), Massey, Ontario, Canada
- Centre for Excellence in Indigenous Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Thomas
- Wuikinuxv Nation, Prince George, British Columbia, Canada
- The Cedar Project, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Earl Henderson
- Cree, Métis, Prince George, British Columbia, Canada
- Department of Anthropology, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - David Zamar
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- The Cedar Project, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Eric M Yoshida
- Faculty of Medicine, Division of Gastroenterology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin T Schechter
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia M Spittal
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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12
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Ritland L, Thomas V, Jongbloed K, Zamar DS, Teegee MP, Christian WK, Richardson CG, Guhn M, Schechter MT, Spittal PM. The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities. PLoS One 2021; 16:e0252993. [PMID: 34111186 PMCID: PMC8191959 DOI: 10.1371/journal.pone.0252993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/19/2020] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.
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Affiliation(s)
- Lisa Ritland
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Victoria Thomas
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Wuikinuxv Nation
| | - Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David S. Zamar
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Mary P. Teegee
- Takla Lake First Nation, Carrier Sekani Family Services, Prince George, BC, Canada
| | - Wenecwtsin-Kukpi Christian
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- Splatsin te Secwepemc
| | - Chris G. Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M. Spittal
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Abstract
Native extracellular matrix (ECM) possesses the biochemical cues to promote cell survival. However, decellularized, the ECM loses its cell supporting mechanical integrity. We report, here, a novel biohybrid vascular graft of polycaprolactone (PCL), poliglecaprone (PGC) incorporated with human biomatrix as functional materials for vascular tissue interfacing by electrospinning, thus harnessing the biochemical cues from the ECM and the mechanical integrity of the polymer blends. The fabricated fibro-porous tubular small diameter graft (i.d. = 4 mm) from polymer blend was coated with a cocktail of collagenous matrix derived from human placenta called HuBiogel™. The compositional, morphological, and mechanical properties of graft were measured and compared with a non-coated tubular PCL/PGC graft using Fourier Transform infrared spectroscopy (FTIR), x-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM). BCA assay was used to calculate the protein content and coating-uniformity throughout the hybrid graft. Mechanical properties such as tensile strength (1.6 MPa), Young's modulus (2.4 MPa), burst pressure (>1900 mmHg), and suture retention strength (2.3 N) of hybrid graft were found to be comparable to native blood vessels. Protein coating has improved the hydrophilicity and the biocompatibility (cell viability and cell-attachment) enhanced with human umbilical vein endothelial cells (HUVECs) seeded in vitro onto the lumen layer of the graft over two weeks. The overall results promise this new biohybrid graft to be a potential candidate for vascular tissue interface and regeneration.
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Affiliation(s)
- H.N. Patel
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | - Y.K. Vohra
- Center for Nanoscale Materials and Biointegration (CNMB), University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
| | - R. Singh
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
- Vivo Biosciences Inc., Birmingham, AL, 35205, USA
| | - V. Thomas
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
- Center for Nanoscale Materials and Biointegration (CNMB), University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
- Department of Materials Science and Engineering, University of Alabama at Birmingham (UAB), Birmingham, AL, 35294, USA
- Corresponding author. (V. Thomas)
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14
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Ball HL, Taylor CE, Thomas V, Douglas PS. Development and evaluation of 'Sleep, Baby & You'-An approach to supporting parental well-being and responsive infant caregiving. PLoS One 2020; 15:e0237240. [PMID: 32764810 PMCID: PMC7413483 DOI: 10.1371/journal.pone.0237240] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/27/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Previous research indicates that UK parents would value an approach that facilitates meeting their infants’ needs while supporting their own sleep-related well-being throughout their infant’s first year. Six initial stakeholder meetings were held with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The Possums Sleep Program developed and delivered in Brisbane, Australia in a GP clinic setting, was chosen as an appropriate approach. Working collaboratively with a stakeholder group, we translated the Possums Sleep Program into an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Parent and practitioner views of the initial materials were obtained via feedback questionnaires and the tool was revised. The intervention was then field-tested by 164 practitioners who delivered it to at least 535 new parents and babies over 5 UK locations, to capture anonymous parent and practitioner views of the intervention concept, the materials, and their experiences with both. The intervention helps parents recalibrate their expectations of infant sleep development, encourages responsive parenting and experimentation to meet their infant’s needs, offers parents strategies for supporting the development of their babies’ biological sleep regulators and promote their own well-being, and teaches parents to manage negative thinking and anxiety that can impede sleep using the principles of Acceptance and Commitment Therapy. The ‘Sleep, Baby & You’ discussion tool, a 14 page illustrated booklet for parents, was field-tested and evaluated by practitioners and parents who offered enthusiastic feedback. Practitioners reported the ‘Sleep, Baby & You’ materials were easy for them to explain and for parents to understand, and were a good fit with the responsive parenting approaches they employed in other areas of their work. Parents who received the intervention postnatally understood the material and found the suggestions easy to follow. All parents who provided feedback had implemented one or more of the suggested changes, with the majority of changes (70%) being sustained for at least two weeks. Practitioners recommended development of digital and antenatal versions and offered feedback on circumstances that might challenge effective uptake of the intervention. ‘Sleep, Baby & You’ is a promising tool for promoting parental attitude and behaviour-change, that aims to adjust parental expectations and reduce negative thinking around infant sleep, promote responsive infant care in the face of infant-related sleep disruption and fatigue, and support parental well-being during the first year of parenthood. Initial field-testing provided insights useful for further development and subsequent testing via a randomised trial. Support exists for incorporating ‘Sleep, Baby & You’ into an anticipatory, universal intervention to support parents who may experience post-partum fatigue and infant sleep disruption.
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Affiliation(s)
- Helen L. Ball
- Infancy & Sleep Centre, Department of Anthropology, Durham University, United Kingdom
- * E-mail:
| | - Catherine E. Taylor
- Infancy & Sleep Centre, Department of Anthropology, Durham University, United Kingdom
| | - Victoria Thomas
- Dept Paediatrics, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Pamela S. Douglas
- Possums Education & Research Centre, Greenslopes, Brisbane, Australia
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15
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Abreu CM, Thomas V, Knaggs P, Bunkheila A, Cruz A, Teixeira SR, Alpuim P, Francis LW, Gebril A, Ibrahim A, Margarit L, Gonzalez D, Freitas PP, Conlan RS, Mendes Pinto I. Non-invasive molecular assessment of human embryo development and implantation potential. Biosens Bioelectron 2020; 157:112144. [PMID: 32250927 DOI: 10.1016/j.bios.2020.112144] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 12/25/2022]
Abstract
In vitro fertilization (IVF) is the most common assisted reproductive technology used to treat infertility. Embryo selection for transfer in IVF cycles relies on the morphological evaluation by embryologists, either by conventional microscopic assessment or more recently by time-lapse imaging systems. Despite the introduction of time-lapse imaging improvements in IVF success rates have failed to materialize, therefore alternative approaches are needed. Recent studies have shown that embryos resulting in successful pregnancy differ in their secretome and metabolism compared to embryos that fail to implant, suggesting that molecular analysis of embryo culture medium could assist in non-invasive single embryo selection. However, this approach has yet to be adopted clinically due to the lack of appropriate highly sensitive screening technologies needed to assess volume-limited samples. Here we report the detection of hCGβ, IL-8 and TNFα from conditioned culture media of single human embryos using electrochemical impedance spectroscopy. The impedimetric immunosensors revealed that morphologically non-viable embryos produce higher levels of IL-8 and TNFα, associated with abnormal cell division and cell death, respectively. More importantly, hCGβ detection was able to discriminate apparently morphologically identical viable embryos. This work brings an objective dimension to embryo selection, which could overcome the major limitations of morphology-based embryo selection for implantation. Future work should include the validation of these biomarkers in a large patient cohort.
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Affiliation(s)
- Catarina M Abreu
- International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga, 4715-330, Braga, Portugal; Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Victoria Thomas
- Wales Fertility Institute Neath, Neath Port Talbot Hospital, Swansea Bay University Health Board, Port Talbot, SA12 7BX, UK
| | - Paul Knaggs
- Wales Fertility Institute Neath, Neath Port Talbot Hospital, Swansea Bay University Health Board, Port Talbot, SA12 7BX, UK
| | - Adnan Bunkheila
- Singleton Hospital, Swansea Bay University Health Board, Sketty Lane, Swansea, SA2 8QA, UK
| | - Andrea Cruz
- International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga, 4715-330, Braga, Portugal
| | - Sofia R Teixeira
- International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga, 4715-330, Braga, Portugal; Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Pedro Alpuim
- International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga, 4715-330, Braga, Portugal
| | - Lewis W Francis
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Amr Gebril
- Wales Fertility Institute Neath, Neath Port Talbot Hospital, Swansea Bay University Health Board, Port Talbot, SA12 7BX, UK
| | - Ahmed Ibrahim
- Wales Fertility Institute Neath, Neath Port Talbot Hospital, Swansea Bay University Health Board, Port Talbot, SA12 7BX, UK
| | - Lavinia Margarit
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK; Princess of Wales Hospital, Cwm Taf Morgannwg University Health Board, Coity Road, Bridgend, CF31 1RQ, UK
| | - Deyarina Gonzalez
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Paulo P Freitas
- International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga, 4715-330, Braga, Portugal
| | - R Steven Conlan
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK; Centre for NanoHealth, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Inês Mendes Pinto
- International Iberian Nanotechnology Laboratory (INL), Avenida Mestre José Veiga, 4715-330, Braga, Portugal.
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Azeez A, Thomas V, Kutty J. Oesophageal Intramural Hematoma Secondary to Thrombolytic Treatment in Acute Myocardial Infarction. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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17
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Thomas V, Delaune O, Cagniant A, Le Petit G, Fontaine JP. Introducing the MARGOT prototype: An ultra-compact and mobile gas detection system for nuclear explosion monitoring. Appl Radiat Isot 2019; 152:91-100. [DOI: 10.1016/j.apradiso.2019.06.032] [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] [Received: 01/28/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022]
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18
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Lépy MC, Thiam C, Anagnostakis M, Galea R, Gurau D, Hurtado S, Karfopoulos K, Liang J, Liu H, Luca A, Mitsios I, Potiriadis C, Savva MI, Thanh TT, Thomas V, Townson RW, Vasilopoulou T, Zhang M. A benchmark for Monte Carlo simulation in gamma-ray spectrometry. Appl Radiat Isot 2019; 154:108850. [PMID: 31476556 DOI: 10.1016/j.apradiso.2019.108850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/04/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
Monte Carlo (MC) simulation is widely used in gamma-ray spectrometry, however, its implementation is not always easy and can provide erroneous results. The present action provides a benchmark for several MC software for selected cases. The examples are based on simple geometries, two types of germanium detectors and four kinds of sources, to mimic eight typical measurement conditions. The action outputs (input files and efficiency calculation results, including practical recommendations for new users) are made available on a dedicated webpage.
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Affiliation(s)
- M C Lépy
- CEA, LIST, Laboratoire National Henri Becquerel (LNE-LNHB), Bât. 602 PC 111, CEA-Saclay 91191 Gif-sur-Yvette Cedex, France.
| | - C Thiam
- CEA, LIST, Laboratoire National Henri Becquerel (LNE-LNHB), Bât. 602 PC 111, CEA-Saclay 91191 Gif-sur-Yvette Cedex, France
| | - M Anagnostakis
- Nuclear Engineering Department, National Technical University of Athens, 15870 Athens, Greece
| | - R Galea
- National Research Council of Canada - 1200 Montreal Road - Ottawa ON, K1A0R6, Canada
| | - D Gurau
- Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering (IFIN-HH), 30 Reactorului Street, PO Box MG-6, Magurele, Ilfov County, RO, 077125, Romania
| | - S Hurtado
- Universidad de Sevilla, Servicio de Radioisotopos, CITIUS, Avda. Reina Mercedes 4, SP-41012, Sevilla, Spain
| | - K Karfopoulos
- Greek Atomic Energy Commission EEAE- Patriarchou Grigorio & Neapoleos - P.O. Box 60092- P.C. 15341, Agia Paraskevi, Athens, Greece
| | - J Liang
- Ionizing Radiation Devision National Institute of Metrology, No.18, Bei San Huan Dong Lu, Chao Yang District, Beijing, China
| | - H Liu
- Ionizing Radiation Devision National Institute of Metrology, No.18, Bei San Huan Dong Lu, Chao Yang District, Beijing, China
| | - A Luca
- Horia Hulubei National Institute for R&D in Physics and Nuclear Engineering (IFIN-HH), 30 Reactorului Street, PO Box MG-6, Magurele, Ilfov County, RO, 077125, Romania
| | - I Mitsios
- Nuclear Engineering Department, National Technical University of Athens, 15870 Athens, Greece
| | - C Potiriadis
- Greek Atomic Energy Commission EEAE- Patriarchou Grigorio & Neapoleos - P.O. Box 60092- P.C. 15341, Agia Paraskevi, Athens, Greece
| | - M I Savva
- INRASTES, NCSR "DEMOKRITOS" - Terma Patriarchou Grigoriou & Neapoleos - 153 10 Ag. Paraskevi, Athens, Greece
| | - T T Thanh
- University of Science, VNU-HCM, Faculty of Physics & Engineering Physics, Department of Nuclear Physics-Nuclear Engineering, 227, Nguyen Van Cu Street, Ward 4, District 5, Ho Chi Minh City, Viet Nam
| | - V Thomas
- CEA, DAM, DIF, F-91297, Arpajon, France
| | - R W Townson
- National Research Council of Canada - 1200 Montreal Road - Ottawa ON, K1A0R6, Canada
| | - T Vasilopoulou
- INRASTES, NCSR "DEMOKRITOS" - Terma Patriarchou Grigoriou & Neapoleos - 153 10 Ag. Paraskevi, Athens, Greece
| | - M Zhang
- Ionizing Radiation Devision National Institute of Metrology, No.18, Bei San Huan Dong Lu, Chao Yang District, Beijing, China
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Thomas V, Delaune O, Le Petit G, Fontaine JP. The Mobile Analyzer of Radioactive Gases OuTflows (MARGOT): A promising environmental xenon radionuclides detection system. Appl Radiat Isot 2019; 153:108820. [PMID: 31382085 DOI: 10.1016/j.apradiso.2019.108820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/05/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
An ultra-compact and unshielded spectrometer for analysis of atmospheric xenon radionuclides has been developed: the MARGOT system. This system works at ambient temperature and high pressure, and has a 54.3 cm3 inner active volume. Atmospheric xenon radionuclide activities are determined with the electron-photon coincidence technique using both NaI(Tl) detectors and large pixellized Si-PIN detectors. The MARGOT system integrates an enhanced version of the PIPSBox™, Geant4 simulation and first calibration results are discussed.
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Affiliation(s)
- V Thomas
- CEA, DAM, DIF, F-91297, Arpajon, France.
| | - O Delaune
- CEA, DAM, DIF, F-91297, Arpajon, France
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Sha J, Fedtke C, Tilia D, Yeotikar N, Jong M, Diec J, Thomas V, Bakaraju RC. Effect of cylinder power and axis changes on vision in astigmatic participants. Clin Optom (Auckl) 2019; 11:27-38. [PMID: 30936760 PMCID: PMC6431005 DOI: 10.2147/opto.s190120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To ascertain the impact of altering cylinder (cyl) power and axis on vision in astigmatism. METHODS In a prospective, randomized, participant-masked, crossover clinical trial, 28 astigmatic participants were tested for the following conditions on different days: full sphero-cyl correction and undercorrection by 0.25, 0.50, and 0.75 DC while maintaining spherical equivalence. Axis was also misaligned between -30° and +30°, in 10° steps. For each configuration, monocular high- and low-contrast visual acuities (HCVA, LCVA) were measured at 6 m, and participants rated vision clarity (1-10), vision satisfaction (1-10), and vision acceptability (yes/no). Linear mixed models were used to compare visual performance in the overall group and in low, medium, and high cyl subgroups. RESULTS Undercorrecting cyl power affected all groups equally (P≥0.073). Undercorrection by 0.75 DC was significantly different to full cyl power for all variables (P≤0.007), while 0.25 DC undercorrection did not cause any significant decreases (P>0.05). Undercorrection by 0.50 DC was significantly different to full cyl power for HCVA (P=0.006, however not clinically significant) and vision acceptability (P=0.034). Axis misalignment affected the cyl groups differently (P<0.001), with the greatest impact in the high cyl group, followed by the medium then the low-cyl group. Misalignment by ±30° caused significant decreases in almost all cases (P≤0.003), while misalignments by ±10° or ±20° caused significant decreases for some cyl groups and test variables. CONCLUSION Undercorrection of cyl by ≤0.50 DC while maintaining spherical equivalence has no significant effect on HCVA, LCVA, vision clarity, and vision satisfaction, while the amount of axis misalignment that can be tolerated is dependent on the cyl power. These results may have practical ophthalmic applications, such as reducing the total number of stock keeping units of toric contact lenses.
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Affiliation(s)
- J Sha
- Brien Holden Vision Institute, Sydney, NSW, Australia,
| | - C Fedtke
- Brien Holden Vision Institute, Sydney, NSW, Australia,
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia,
| | - D Tilia
- Brien Holden Vision Institute, Sydney, NSW, Australia,
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia,
| | - N Yeotikar
- Brien Holden Vision Institute, Sydney, NSW, Australia,
| | - M Jong
- Brien Holden Vision Institute, Sydney, NSW, Australia,
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia,
| | - J Diec
- Brien Holden Vision Institute, Sydney, NSW, Australia,
| | - V Thomas
- Brien Holden Vision Institute, Sydney, NSW, Australia,
| | - R C Bakaraju
- Brien Holden Vision Institute, Sydney, NSW, Australia,
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia,
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Hunter A, Facey K, Thomas V, Haerry D, Warner K, Klingmann I, May M, See W. EUPATI Guidance for Patient Involvement in Medicines Research and Development: Health Technology Assessment. Front Med (Lausanne) 2018; 5:231. [PMID: 30238004 PMCID: PMC6136274 DOI: 10.3389/fmed.2018.00231] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 12/27/2017] [Accepted: 07/27/2018] [Indexed: 11/13/2022] Open
Abstract
The main aim of health technology assessment (HTA) is to inform decision making by health care policy makers. It is a systematic process that evaluates the use of health technologies and generally involves a critical review of international evidence related to clinical effectiveness of the health technology vs. the best standard of care. It can also include an evaluation of cost effectiveness, and social and ethical impacts in the local health care system. The HTA process advises whether or not a health technology should be used, and if so, how it is best used and which patients are most likely to benefit from it. The importance of patient involvement in HTA is becoming widely recognized, for scientific and democratic reasons. The extent of patient involvement in HTA varies considerably across Europe. Commonly HTA is still focused on quantitative evidence to determine clinical and/or cost effectiveness, but the interest in understanding patients' experiences and preferences is increasing. Some HTA bodies provide support for participation in their processes, but again this varies widely across Europe. The involvement of patients in HTA is determined at the national and regional level, and is not subject to any European-wide legislation. The guidance text presented in this article was developed as part of the work of the European Patients' Academy on Therapeutic Innovation (EUPATI) and covers the interaction between HTA bodies and patients and their representatives when medicines are being assessed. Other EUPATI guidance documents relate to patient involvement in pharmaceutical industry-led research and development, ethics committees, and regulatory authorities. The guidance provides recommendations for activities to support patient involvement in HTA bodies and specific guidance for individual HTA processes. It seeks to improve patient involvement, using the outcomes of published research and consensus-building exercises. It also draws on good practice examples from individual HTA bodies. The guidance is not intended to be prescriptive and should be used according to specific circumstances, national legislation, or the unique needs of each interaction. This article represents the formal publication of the HTA guidance text with discussion about recent progress in, and continuing barriers to, patient involvement in HTA.
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Affiliation(s)
- Amy Hunter
- European Patients' Academy on Therapeutic Innovation (EUPATI).,Genetic Alliance UK, London, United Kingdom
| | - Karen Facey
- European Patients' Academy on Therapeutic Innovation (EUPATI).,University of Edinburgh, Edinburgh, United Kingdom
| | - Victoria Thomas
- European Patients' Academy on Therapeutic Innovation (EUPATI).,The National Institute for Health and Care Excellence, London, United Kingdom
| | - David Haerry
- European Patients' Academy on Therapeutic Innovation (EUPATI).,European Aids Treatment Group, Brussels, Belgium
| | - Kay Warner
- European Patients' Academy on Therapeutic Innovation (EUPATI).,GSK, London, United Kingdom
| | - Ingrid Klingmann
- European Patients' Academy on Therapeutic Innovation (EUPATI).,European Forum for Good Clinical Practice, Brussels, Belgium
| | - Matthew May
- European Patients' Academy on Therapeutic Innovation (EUPATI).,European Patients Forum, Brussels, Belgium
| | - Wolf See
- European Patients' Academy on Therapeutic Innovation (EUPATI).,Bayer, Berlin, Germany
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Rashid A, Thomas V, Shaw T, Leng G. Patient and Public Involvement in the Development of Healthcare Guidance: An Overview of Current Methods and Future Challenges. Patient 2018; 10:277-282. [PMID: 27830457 DOI: 10.1007/s40271-016-0206-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Clinical guidelines and health technology assessments are valuable instruments to improve the quality of healthcare delivery and aim to integrate the best available evidence with real-world, expert context. The role of patient and public involvement in their development has grown in recent decades, and this article considers the international literature exploring aspects of this participation, including the integration of experiential and scientific knowledge, recruitment strategies, models of involvement, stages of involvement, and methods of evaluation. These developments have been underpinned by the parallel rise of public involvement and evidence-based medicine as important concepts in health policy. Improving the recruitment of guideline group chairs, widening evidence reviews to include patient preference studies, adapting guidance presentation to highlight patient preference points and providing clearer instructions on how patient organisations can submit their intelligence are emerging proposals that may further enhance patient and public involvement in their processes.
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Affiliation(s)
- Ahmed Rashid
- National Institute for Health and Care Excellence (NICE), 1st Floor, 10 Spring Gardens, London, SW1A 2BU, UK.
| | - Victoria Thomas
- National Institute for Health and Care Excellence (NICE), 1st Floor, 10 Spring Gardens, London, SW1A 2BU, UK
| | - Toni Shaw
- National Institute for Health and Care Excellence (NICE), 1st Floor, 10 Spring Gardens, London, SW1A 2BU, UK
| | - Gillian Leng
- National Institute for Health and Care Excellence (NICE), 1st Floor, 10 Spring Gardens, London, SW1A 2BU, UK
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Thomas V, Blooi M, Van Rooij P, Van Praet S, Verbrugghe E, Grasselli E, Lukac M, Smith S, Pasmans F, Martel A. Recommendations on diagnostic tools for Batrachochytrium salamandrivorans. Transbound Emerg Dis 2018; 65:e478-e488. [PMID: 29341499 DOI: 10.1111/tbed.12787] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 09/13/2017] [Indexed: 02/05/2023]
Abstract
Batrachochytrium salamandrivorans (Bsal) poses a major threat to amphibian, and more specifically caudata, diversity. Bsal is currently spreading through Europe, and mitigation measures aimed at stopping its spread and preventing its introduction into naïve environments are urgently needed. Screening for presence of Bsal and diagnosis of Bsal-induced disease in amphibians are essential core components of effective mitigation plans. Therefore, the aim of this study was to present an overview of all Bsal diagnostic tools together with their limitations and to suggest guidelines to allow uniform interpretation. Here, we investigate the use of different diagnostic tools in post-mortem detection of Bsal and whether competition between Bd and Bsal occurs in the species-specific Bd and Bsal duplex real-time PCR. We also investigate the diagnostic sensitivity, diagnostic specificity and reproducibility of the Bsal real-time PCR and show the use of immunohistochemistry in diagnosis of Bsal-induced chytridiomycosis in amphibian samples stored in formaldehyde. Additionally, we have drawn up guidelines for the use and interpretation of the different diagnostic tools for Bsal currently available, to facilitate standardization of execution and interpretation.
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Affiliation(s)
- V Thomas
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - M Blooi
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - P Van Rooij
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - S Van Praet
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - E Verbrugghe
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - E Grasselli
- Dipartimento di Scienze della Terra, dell'Ambiente e della Vita, DISTAV, Universita di Genova, Genova, Italy
| | - M Lukac
- Department of Poultry Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - S Smith
- Department of Integrative Biology and Evolution, University of Veterinary Medicine, Vienna, Austria
| | - F Pasmans
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - A Martel
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Abstract
‘Security holds the key’ was the title of a newspaper article concerned with e-commerce (D. Sumner-Smith, The Sunday Times, 6 February, 2000, p. 3.13). However, it applies just as readily to the health sector. The need to safeguard the confidentiality of information that patients share with clinicians is as fundamental as the principle of consent. This issue has come to the fore in the context of the rapid developments and applications of information and communication technologies within society in general and within the health sector in particular. There are also changing societal expectations regarding access to information, confidentiality and disclosure. The emerging scenarios present significant challenges in relation to the traditional methods used to deal with the privacy and confidentiality of personal information (Anderson, 1995). In addition to the impact of new technologies, consideration also needs to be given to the impact of changes in health care organisation and practice, for example multidisciplinary and multi-agency working. Mental health services are in many respects at the vanguard of these changes, where the ideals of community care, shared care and seamless care depend fundamentally on good communication and information sharing. Failures in communicating information, particularly across sectoral boundaries, have led to significant problems in patient care, as revealed in several recent enquiries into homicides (Northamptonshire Health Authority & Northamptonshire Social Services, 1999)
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Shahram SZ, Bottorff JL, Oelke ND, Dahlgren L, Thomas V, Spittal PM. Correction to: The Cedar Project: Using Indigenous-specific determinants of health to predict substance use among young pregnant-involved Indigenous women in Canada. BMC Womens Health 2017; 17:122. [PMID: 29187170 PMCID: PMC5706164 DOI: 10.1186/s12905-017-0464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sana Z Shahram
- Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada. .,Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, Victoria, Canada.
| | - Joan L Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada.,Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Nelly D Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
| | - Leanne Dahlgren
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Patricia M Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Brett J, Staniszewska S, Simera I, Seers K, Mockford C, Goodlad S, Altman D, Moher D, Barber R, Denegri S, Entwistle AR, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. Reaching consensus on reporting patient and public involvement (PPI) in research: methods and lessons learned from the development of reporting guidelines. BMJ Open 2017; 7:e016948. [PMID: 29061613 PMCID: PMC5665282 DOI: 10.1136/bmjopen-2017-016948] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Patient and public involvement (PPI) is inconsistently reported in health and social care research. Improving the quality of how PPI is reported is critical in developing a higher quality evidence base to gain a better insight into the methods and impact of PPI. This paper describes the methods used to develop and gain consensus on guidelines for reporting PPI in research studies (updated version of the Guidance for Reporting Patient and Public Involvement (GRIPP2)). METHODS There were three key stages in the development of GRIPP2: identification of key items for the guideline from systematic review evidence of the impact of PPI on health research and health services, a three-phase online Delphi survey with a diverse sample of experts in PPI to gain consensus on included items and a face-to-face consensus meeting to finalise and reach definitive agreement on GRIPP2. Challenges and lessons learnt during the development of the reporting guidelines are reported. DISCUSSION The process of reaching consensus is vital within the development of guidelines and policy directions, although debate around how best to reach consensus is still needed. This paper discusses the critical stages of consensus development as applied to the development of consensus for GRIPP2 and discusses the benefits and challenges of consensus development.
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Affiliation(s)
- Jo Brett
- Department of Midwifery, Community and Public Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxfordshire, UK
| | - Sophie Staniszewska
- Division of Health Sciences, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Iveta Simera
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, EQUATOR Network, Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Kate Seers
- Division of Health and Social Care Research, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carole Mockford
- Division of Health Sciences, RCN Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susan Goodlad
- Centre for Research in Psychology, Behaviour and Acheivement, University of Coventry, Coventry, UK
| | - Doug Altman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, EQUATOR Network, Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, Oxford, UK
| | - David Moher
- Ottawa Hospital Research Institute, School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rosemary Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Denegri
- INVOLVE, National Institute of Health Research (NIHR), University of Southampton, Southampton, UK
| | | | | | - Christopher Morris
- Peninsula Cerebra Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | | | - Victoria Thomas
- Patient and Public Involvement Unit, Public Involvement Programme, National Institute for Health and Clinical Excellence, London, UK
| | - Colin Tysall
- UNTRAP, University of Warwick, Coventry, Warwicks, UK
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27
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Shahram SZ, Bottorff JL, Oelke ND, Kurtz DLM, Thomas V, Spittal PM, And For The Cedar Project Partnership. Mapping the social determinants of substance use for pregnant-involved young Aboriginal women. Int J Qual Stud Health Well-being 2017; 12:1275155. [PMID: 28140776 PMCID: PMC5328333 DOI: 10.1080/17482631.2016.1275155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is a dearth of knowledge about the social determinants of substance use among young pregnant-involved Indigenous women in Canada from their perspectives. As part of life history interviews, 17 young pregnant-involved Indigenous women with experiences with substances completed a participant-generated mapping activity CIRCLES (Charting Intersectional Relationships in the Context of Life). As women created their maps, they discussed how different social determinants impacted their experiences with pregnancy and substance use. The social determinants identified and used by women to explain determinants of their substance use were grouped into 10 themes: traumatic life histories; socioeconomic status; culture, identity and spirituality; shame and guilt; mental wellness; family connections; romantic and platonic relationships; strength and hope; mothering; and the intersections of determinants. We conclude that understanding the context and social determinants of substance use from a woman-informed perspective is paramount to informing effective and appropriate programs to support young Indigenous women who use substances.
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Affiliation(s)
- Sana Z Shahram
- a Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | - Joan L Bottorff
- b Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada.,c Faculty of Health Sciences , Australian Catholic University , Melbourne , Australia
| | - Nelly D Oelke
- d School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | - Donna L M Kurtz
- d School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | | | - Patricia M Spittal
- f School of Population and Public Health , University of British Columbia , Vancouver , Canada
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Bloem C, Gomes D, Kendall S, Kaufman B, Thomas V, Aluisio A. 196EMF Evaluation of the Utilization and Impact of Point-of-Care Ultrasound in Acute Obstetrical Care in the North East Region of Haiti. Ann Emerg Med 2017. [DOI: 10.1016/j.annemergmed.2017.07.223] [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: 10/18/2022]
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Shahram SZ, Bottorff JL, Oelke ND, Dahlgren L, Thomas V, Spittal PM. The Cedar Project: Using Indigenous-specific determinants of health to predict substance use among young pregnant-involved Indigenous women in Canada. BMC Womens Health 2017; 17:84. [PMID: 28915868 PMCID: PMC5603064 DOI: 10.1186/s12905-017-0437-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/02/2016] [Accepted: 08/28/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Indigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population. METHODS Using descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs' lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health's ability to predict heavy versus light substance use in this group was tested (N = 291). RESULTS Important distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women's experiences with pregnancy and substance use was provided. CONCLUSIONS This analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women's social, political and historical contexts in relation to their experiences with pregnancy and substance use.
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Affiliation(s)
- Sana Z. Shahram
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, STN CSC Victoria, Victoria, BC V8W 2Y2 Canada
- 15890 Greenhow Road, Oyama, BC V4V 2E6 Canada
| | - Joan L. Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Nelly D. Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
| | - Leanne Dahlgren
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 1190 Hornby Street 4th Floor, Vancouver, BC V6Z 2K5 Canada
| | | | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - For the Cedar Project Partnership
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 1190 Hornby Street 4th Floor, Vancouver, BC V6Z 2K5 Canada
- Wuikinuxv Nation, The Cedar Project, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
- Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, STN CSC Victoria, Victoria, BC V8W 2Y2 Canada
- 15890 Greenhow Road, Oyama, BC V4V 2E6 Canada
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Thomas V, Davidson M, Zakavi P, Tsuchiya N, van Boxtel J. Simulated forward and backward self motion, based on realistic parameters, causes motion induced blindness. Sci Rep 2017; 7:9767. [PMID: 28851914 PMCID: PMC5574926 DOI: 10.1038/s41598-017-09424-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
Motion Induced Blindness (MIB) is a well-established visual phenomenon whereby highly salient targets disappear when viewed against a moving background mask. No research has yet explored whether contracting and expanding optic flow can also trigger target disappearance. We explored MIB using mask speeds corresponding to driving at 35, 50, 65 and 80 km/h in simulated forward (expansion) and backward (contraction) motion as well as 2-D radial movement, random, and static mask motion types. Participants (n = 18) viewed MIB targets against masks with different movement types, speed, and target locations. To understand the relationship between saccades, pupil response and perceptual disappearance, we ran two additional eye-tracking experiments (n = 19). Target disappearance increased significantly with faster mask speeds and upper visual field target presentation. Simulated optic flow and 2-D radial movement caused comparable disappearance, and all moving masks caused significantly more disappearance than a static mask. Saccades could not entirely account for differences between conditions, suggesting that self-motion optic flow does cause MIB in an artificial setting. Pupil analyses implied that MIB disappearance induced by optic flow is not subjectively salient, potentially explaining why MIB is not noticed during driving. Potential implications of MIB for driving safety and Head-Up-Display (HUD) technologies are discussed.
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Affiliation(s)
- Victoria Thomas
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, 3800 VIC, Australia.
| | - Matthew Davidson
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, 3800 VIC, Australia
| | - Parisa Zakavi
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Naotsugu Tsuchiya
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, 3800 VIC, Australia
| | - Jeroen van Boxtel
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, 3800 VIC, Australia.
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Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, Altman DG, Moher D, Barber R, Denegri S, Entwistle A, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. Res Involv Engagem 2017; 3:13. [PMID: 29062538 PMCID: PMC5611595 DOI: 10.1186/s40900-017-0062-2] [Citation(s) in RCA: 290] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/19/2017] [Indexed: 05/06/2023]
Abstract
BACKGROUND While the patient and public involvement (PPI) evidence base has expanded over the past decade, the quality of reporting within papers is often inconsistent, limiting our understanding of how it works, in what context, for whom, and why. OBJECTIVE To develop international consensus on the key items to report to enhance the quality, transparency, and consistency of the PPI evidence base. To collaboratively involve patients as research partners at all stages in the development of GRIPP2. METHODS The EQUATOR method for developing reporting guidelines was used. The original GRIPP (Guidance for Reporting Involvement of Patients and the Public) checklist was revised, based on updated systematic review evidence. A three round Delphi survey was used to develop consensus on items to be included in the guideline. A subsequent face-to-face meeting produced agreement on items not reaching consensus during the Delphi process. RESULTS One hundred forty-three participants agreed to participate in round one, with an 86% (123/143) response for round two and a 78% (112/143) response for round three. The Delphi survey identified the need for long form (LF) and short form (SF) versions. GRIPP2-LF includes 34 items on aims, definitions, concepts and theory, methods, stages and nature of involvement, context, capture or measurement of impact, outcomes, economic assessment, and reflections and is suitable for studies where the main focus is PPI. GRIPP2-SF includes five items on aims, methods, results, outcomes, and critical perspective and is suitable for studies where PPI is a secondary focus. CONCLUSIONS GRIPP2-LF and GRIPP2-SF represent the first international evidence based, consensus informed guidance for reporting patient and public involvement in research. Both versions of GRIPP2 aim to improve the quality, transparency, and consistency of the international PPI evidence base, to ensure PPI practice is based on the best evidence. In order to encourage its wide dissemination this article is freely accessible on The BMJ and Research Involvement and Engagement journal websites.
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Affiliation(s)
- S. Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - J. Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - I. Simera
- Centre for Tropical Medicine and Global Health and UK EQUATOR Centre, University of Oxford, Oxford, UK
| | - K. Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | | | | | - D. G. Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - D. Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - R. Barber
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S. Denegri
- National Institute for Health Research, UCL School of Life and Medical Sciences, London, UK
| | | | | | - C. Morris
- University of Exeter Medical School, Exeter, UK
| | | | - V. Thomas
- Public Involvement Programme, National Institute for Health and Care Excellence, London, UK
| | - C. Tysall
- Warwick Medical School, Coventry, UK
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Staniszewska S, Brett J, Simera I, Seers K, Mockford C, Goodlad S, Altman DG, Moher D, Barber R, Denegri S, Entwistle A, Littlejohns P, Morris C, Suleman R, Thomas V, Tysall C. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ 2017; 358:j3453. [PMID: 28768629 PMCID: PMC5539518 DOI: 10.1136/bmj.j3453] [Citation(s) in RCA: 686] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background While the patient and public involvement (PPI) evidence base has expanded over the past decade, the quality of reporting within papers is often inconsistent, limiting our understanding of how it works, in what context, for whom, and why.Objective To develop international consensus on the key items to report to enhance the quality, transparency, and consistency of the PPI evidence base. To collaboratively involve patients as research partners at all stages in the development of GRIPP2.Methods The EQUATOR method for developing reporting guidelines was used. The original GRIPP (Guidance for Reporting Involvement of Patients and the Public) checklist was revised, based on updated systematic review evidence. A three round Delphi survey was used to develop consensus on items to be included in the guideline. A subsequent face-to-face meeting produced agreement on items not reaching consensus during the Delphi process.Results 143 participants agreed to participate in round one, with an 86% (123/143) response for round two and a 78% (112/143) response for round three. The Delphi survey identified the need for long form (LF) and short form (SF) versions. GRIPP2-LF includes 34 items on aims, definitions, concepts and theory, methods, stages and nature of involvement, context, capture or measurement of impact, outcomes, economic assessment, and reflections and is suitable for studies where the main focus is PPI. GRIPP2-SF includes five items on aims, methods, results, outcomes, and critical perspective and is suitable for studies where PPI is a secondary focus.Conclusions GRIPP2-LF and GRIPP2-SF represent the first international evidence based, consensus informed guidance for reporting patient and public involvement in research. Both versions of GRIPP2 aim to improve the quality, transparency, and consistency of the international PPI evidence base, to ensure PPI practice is based on the best evidence. In order to encourage its wide dissemination this article is freely accessible on The BMJ and Research Involvement and Engagement journal websites.
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Affiliation(s)
- S Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - J Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - I Simera
- Centre for Tropical Medicine and Global Health and UK EQUATOR Centre, University of Oxford, UK
| | - K Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | | | | | - D G Altman
- Centre for Statistics in Medicine, University of Oxford, UK
| | - D Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - R Barber
- School of Health and Related Research, Section of Public Health, University of Sheffield, Sheffield, UK
| | - S Denegri
- National Institute for Health Research, UCL School of Life and Medical Sciences, London, UK
| | | | | | - C Morris
- University of Exeter Medical School, Exeter, UK
| | - R Suleman
- Warwick Medical School, Coventry, UK
| | - V Thomas
- Public Involvement Programme, National Institute for Health and Care Excellence, London, UK
| | - C Tysall
- Warwick Medical School, Coventry, UK
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Thomas V, Sofin RGS, Allen M, Thomas H, Biju PR, Jose G, Unnikrishnan NV. Optical analysis of samarium doped sodium bismuth silicate glass. Spectrochim Acta A Mol Biomol Spectrosc 2017; 171:144-148. [PMID: 27504818 DOI: 10.1016/j.saa.2016.07.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/22/2016] [Accepted: 07/31/2016] [Indexed: 06/06/2023]
Abstract
Samarium doped sodium bismuth silicate glass was synthesized using the melt quenching method. Detailed optical spectroscopic studies of the glassy material were carried out in the UV-Vis-NIR spectral range. Using the optical absorption spectra Judd-Ofelt (JO) parameters are derived. The calculated values of the JO parameters are utilized in evaluating the various radiative parameters such as electric dipole line strengths (Sed), radiative transition probabilities (Arad), radiative lifetimes (τrad), fluorescence branching ratios (β) and the integrated absorption cross- sections (σa) for stimulated emission from various excited states of Sm3+‡ ion. The principal fluorescence transitions are identified by recording the fluorescence spectrum. Our analysis revealed that the novel glassy system has the optimum values for the key parameters viz. spectroscopic quality factor, optical gain, stimulated emission cross section and quantum efficiency, which are required for a high performance optical amplifier. Calculated chromaticity co-ordinates (0.61, 0.38) also confirm its application potential in display devices.
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Affiliation(s)
- V Thomas
- Department of Physics, College of Science, Sultan Qaboos University, AlKhoud, Oman; Department of Physics, Christian College Chengannur, University of Kerala, India.
| | - R G S Sofin
- Department of Physics, College of Science, Sultan Qaboos University, AlKhoud, Oman
| | - M Allen
- UDSMM, Université du Littoral Côte d'Opale, 59140 Dunkerque, France
| | - H Thomas
- Department of Physics, Christian College Chengannur, University of Kerala, India
| | - P R Biju
- School of Pure and Applied Physics, Mahatma Gandhi University, Kottayam 686560, India
| | - G Jose
- Institute for Materials Research, School of Process, Environmental and Materials Engineering, University of Leeds, UK
| | - N V Unnikrishnan
- School of Pure and Applied Physics, Mahatma Gandhi University, Kottayam 686560, India
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Shahram SZ, Bottorff JL, Kurtz DLM, Oelke ND, Thomas V, Spittal PM. Understanding the Life Histories of Pregnant-Involved Young Aboriginal Women With Substance Use Experiences in Three Canadian Cities. Qual Health Res 2017; 27:249-259. [PMID: 27401489 DOI: 10.1177/1049732316657812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite attention paid to substance use during pregnancy, understandings of young Aboriginal women's experiences based on their perspectives have been virtually absent in the published literature. This study's objective was to understand the life experiences of pregnant-involved young Aboriginal women with alcohol and drugs. Semi-structured interviews to gather life histories were conducted with 23 young Aboriginal women who had experiences with pregnancy, and alcohol and drug use. Transcribed interviews were analyzed for themes to describe the social and historical contexts of women's experiences and their self-representations. The findings detail women's strategies for survival, inner strength, and capacities for love, healing, and resilience. Themes included the following: intersectional identities, life histories of trauma (abuse, violence, and neglect; intergenerational trauma; separations and connections), the ever-presence of alcohol and drugs, and the highs and lows of pregnancy and mothering. The findings have implications for guiding policy and interventions for supporting women and their families.
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Affiliation(s)
- Sana Z Shahram
- The University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Addictions Research of BC, University of Victoria, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
- Australian Catholic University, Melbourne, Australia
| | - Donna L M Kurtz
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Nelly D Oelke
- The University of British Columbia, Kelowna, British Columbia, Canada
- Department of Community Health Services, Cumming School of Medicine, University of Alberta, Alberta, Canada
| | - Victoria Thomas
- Wuikinuxv Nation, Vancouver, British Columbia, Canada
- The Cedar Project, Vancouver, British Columbia, Canada
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Postma DS, Dekhuijzen R, van der Molen T, Martin RJ, van Aalderen W, Roche N, Guilbert TW, Israel E, van Eickels D, Khalid JM, Herings RMC, Overbeek JA, Miglio C, Thomas V, Hutton C, Hillyer EV, Price DB. Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids. Allergy Asthma Immunol Res 2017; 9:116-125. [PMID: 28102056 PMCID: PMC5266109 DOI: 10.4168/aair.2017.9.2.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/04/2016] [Indexed: 11/20/2022]
Abstract
Purpose Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). Methods This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. Results Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. Conclusions In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.
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Affiliation(s)
- Dirkje S Postma
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Thys van der Molen
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard J Martin
- Department of Medicine, National Jewish Health, and University of Colorado Denver, Denver, CO, USA
| | | | - Nicolas Roche
- University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France
| | | | - Elliot Israel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, The Netherlands
| | | | | | | | | | | | - David B Price
- Research in Real Life, Cambridge, UK.,Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Lipworth B, Skinner D, Devereux G, Thomas V, Ling Zhi Jie J, Martin J, Carter V, Price DB. It is important to distinguish between HFrEF and HFpEF when interpreting these data. Heart 2016; 102:1934. [PMID: 27836947 DOI: 10.1136/heartjnl-2016-310557] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | | | - Graham Devereux
- Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre for Academic Primary Care, University of Aberdeen, UK
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Tabner A, Johnson G, Jones M, Patel R, Husk K, Parish R, Rees J, Henstridge V, Clark I, Thomas V, Hearnshaw C. PAEDIATRICIANS: ARE THEY JUST LITTLE ADULTS? Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.36] [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: 11/04/2022]
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38
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Liew Z, Thomas V, Eastham K. 'It's just a fluid level'. Arch Dis Child Educ Pract Ed 2016; 101:198. [PMID: 26310958 DOI: 10.1136/archdischild-2014-308087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/30/2015] [Indexed: 11/04/2022]
Affiliation(s)
- ZheYi Liew
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Victoria Thomas
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK
| | - Katherine Eastham
- Department of Paediatrics, Sunderland Royal Hospital, Sunderland, UK
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Rejeena I, Thomas V, Mathew S, Lillibai B, Nampoori VPN, Radhakrishnan P. Spectral and Lensing Characteristics of Gel-Derived Strontium Tartrate Single Crystals Using Dual-Beam Thermal Lens Technique. J Fluoresc 2016; 26:1549-54. [PMID: 27465706 DOI: 10.1007/s10895-016-1875-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/02/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
The Dual Beam mode-matched thermal lens spectrometry is a sensible technique for direct measurements of the thermal properties of tartrate crystalline materials. Here we report the measurement of thermal diffusivity of Strontium Tartrate single crystals incorporated with Rhodamine 6G using the thermal lens experiment. The respective crystals were prepared by solution-gel method at room temperature. The absorption characteristics of three different Strontium Tartrate crystals viz. pure, electric field applied and magnetic field applied were also carried out.
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Affiliation(s)
- I Rejeena
- International School of Photonics, Cochin University of Science and Technology, Cochin, Kerala, 682022, India. .,M. S.M. College, Kayamkulam, Kerala, India.
| | - V Thomas
- Christian College, Chengannur, Kerala, India
| | - S Mathew
- M. S.M. College, Kayamkulam, Kerala, India
| | - B Lillibai
- International School of Photonics, Cochin University of Science and Technology, Cochin, Kerala, 682022, India
| | - V P N Nampoori
- International School of Photonics, Cochin University of Science and Technology, Cochin, Kerala, 682022, India
| | - P Radhakrishnan
- International School of Photonics, Cochin University of Science and Technology, Cochin, Kerala, 682022, India
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van der Molen T, Postma DS, Martin RJ, Herings RMC, Overbeek JA, Thomas V, Miglio C, Dekhuijzen R, Roche N, Guilbert T, Israel E, van Aalderen W, Hillyer EV, van Rysewyk S, Price DB. Erratum to: Effectiveness of initiating extrafine-particle versus fine-particle inhaled corticosteroids as asthma therapy in the Netherlands. BMC Pulm Med 2016; 16:105. [PMID: 27450521 PMCID: PMC4958282 DOI: 10.1186/s12890-016-0270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Dirkje S Postma
- University of Groningen, University Medical Center Groningen, Department Pulmonary Medicine and Tuberculosis, Groningen, The Netherlands
| | - Richard J Martin
- National Jewish Health and the University of Colorado, Denver, USA
| | - Ron M C Herings
- PHARMO Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | | | | | | | - Nicolas Roche
- Groupe Hospitalier Cochin, AP-HP and University Paris Descartes (EA2511), Paris, France
| | - Theresa Guilbert
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Elliot Israel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wim van Aalderen
- Emma's Children Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Simon van Rysewyk
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore
| | - David B Price
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore. .,Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Lipworth B, Skinner D, Devereux G, Thomas V, Ling Zhi Jie J, Martin J, Carter V, Price DB. Underuse of β-blockers in heart failure and chronic obstructive pulmonary disease. Heart 2016; 102:1909-1914. [PMID: 27380949 PMCID: PMC5136686 DOI: 10.1136/heartjnl-2016-309458] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Although β-blockers are an established therapy in heart failure (HF) guidelines, including for patients with chronic obstructive pulmonary disease (COPD), there remain concerns regarding bronchoconstriction even with cardioselective β-blockers. We wished to assess the real-life use of β-blockers for patients with HF and comorbid COPD. METHODS We evaluated data from the Optimum Patient Care Research Database over a period of 1 year for co-prescribing of β-blockers with either an ACE inhibitor (ACEI) or angiotensin-2 receptor blocker (ARB) in patients with HF alone versus HF+COPD. Association with inhaler therapy was also evaluated. RESULTS We identified 89 861 patients with COPD, 24 237 with HF and 10 853 with both conditions. In patients with HF+COPD, the mean age was 79 years; 60% were male, and 27% had prior myocardial infarction. Of patients with HF+COPD, 22% were taking a β-blocker in conjunction with either ACEI/ARB (n=2416) compared with 41% of patients with HF only (n=10 002) (adjusted OR 0.54, 95% CI 0.51 to 0.58, p<0.001). Among HF+COPD patients taking inhaled corticosteroid (ICS) with long-acting β-agonist (LABA) and long-acting muscarinic antagonist, 27% of patients were taking an ACEI/ARB with β-blockers (n=778) versus 46% taking an ACEI/ARB without β-blockers (n=1316). Corresponding figures for those patients taking ICS/LABA were 20% (n=583) versus 48% (n=1367), respectively. CONCLUSIONS These data indicate a substantial unmet need for patients with COPD who should be prescribed β-blockers more often for concomitant HF.
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Affiliation(s)
- Brian Lipworth
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | | | - Graham Devereux
- Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Roche N, Colice G, Israel E, Martin RJ, Dorinsky PM, Postma DS, Guilbert TW, Grigg J, van Aalderen WMC, Barion F, Hillyer EV, Thomas V, Burden A, Brett McQueen R, Price DB. Cost-Effectiveness of Asthma Step-Up Therapy as an Increased Dose of Extrafine-Particle Inhaled Corticosteroid or Add-On Long-Acting Beta2-Agonist. Pulm Ther 2016. [DOI: 10.1007/s41030-016-0014-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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van der Molen T, Postma DS, Martin RJ, Herings RMC, Overbeek JA, Thomas V, Miglio C, Dekhuijzen R, Roche N, Guilbert T, Israel E, van Aalderen W, Hillyer EV, van Rysewyk S, Price DB. Effectiveness of initiating extrafine-particle versus fine-particle inhaled corticosteroids as asthma therapy in the Netherlands. BMC Pulm Med 2016; 16:80. [PMID: 27184175 PMCID: PMC4869182 DOI: 10.1186/s12890-016-0234-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/27/2016] [Indexed: 11/25/2022] Open
Abstract
Background Most randomised clinical trials typically exclude a significant proportion of asthma patients, including those at higher risk of adverse events, with comorbidities, obesity, poor inhaler technique and adherence, or smokers. However, these patients might differentially benefit from extrafine-particle inhaled corticosteroids (ICS). This matched cohort, database study, compared the effectiveness of extrafine-particle with fine-particle ICS in a real-life population initiating ICS therapy in the Netherlands. Methods Data were from the Pharmo Database Network, comprising pharmacy and hospital discharge records, representative of 20 % of the Dutch population. The study population included patients aged 12 − 60, with a General Practice-recorded diagnosis for asthma (International Classification of Primary Care code R96), when available, ≥2 prescriptions for asthma therapy at any time in their recorded history, and receiving first prescription of ICS therapy as either extrafine-particle (ciclesonide or hydrofluoroalkane beclomethasone dipropionate [BDP]) or fine-particle ICS (fluticasone propionate or non-extrafine-particle-BDP). Patients were matched (1:1) on relevant demographic and clinical characteristics over 1-year baseline. Primary outcomes were severe exacerbation rates, risk domain asthma control and overall asthma control during the year following first ICS prescription. Secondary outcomes, treatment stability and being prescribed higher versus lower category of short-acting β2 agonists (SABA) dose, were compared over a 1-year outcome period using conditional logistic regression models. Results Following matching, 1399 patients were selected in each treatment cohort (median age: 43 years; males: 34 %). Median (interquartile range) initial ICS doses (fluticasone-equivalents in μg) were 160 (160 − 320) for extrafine-particle versus 500 (250 − 500) for fine-particle ICS (p < 0.001). Following adjustment for residual confounders, matched patients prescribed extrafine-particle ICS had significantly lower rates of exacerbations (adjusted rate ratio [95 % CI], 0.59 [0.47–0.73]), and significantly higher odds of achieving asthma control and treatment stability in the year following initiation than those prescribed fine-particle ICS, and this occurred at lower prescribed doses. Patients prescribed extrafine-particle ICS had lower odds of being prescribed higher doses of SABA (0.50 [0.44–0.57]). Conclusion In this historical, matched study, extrafine-particle ICS was associated with better odds of asthma control than fine-particle ICS in patients prescribed their first ICS therapy in the Netherlands. Of importance, this was reached at significantly lower prescribed dose. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0234-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Dirkje S Postma
- Department of Pulmonary Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Ron M C Herings
- Pharmo Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- Pharmo Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | | | | | | | - Nicolas Roche
- Groupe Hospitalier Cochin, AP-HP and University Paris Descartes, Paris, France
| | - Theresa Guilbert
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Elliot Israel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wim van Aalderen
- Emma's Children Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Simon van Rysewyk
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore
| | - David B Price
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore. .,Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, AB25 2ZD, Aberdeen, UK.
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Price DB, Colice G, Israel E, Roche N, Postma DS, Guilbert TW, van Aalderen WM, Grigg J, Hillyer EV, Thomas V, Martin RJ. Add-on LABA in a separate inhaler as asthma step-up therapy versus increased dose of ICS or ICS/LABA combination inhaler. ERJ Open Res 2016; 2:00106-2015. [PMID: 27730200 PMCID: PMC5005184 DOI: 10.1183/23120541.00106-2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/09/2016] [Indexed: 01/01/2023] Open
Abstract
Asthma management guidelines recommend adding a long-acting β2-agonist (LABA) or increasing the dose of inhaled corticosteroid (ICS) as step-up therapy for patients with uncontrolled asthma on ICS monotherapy. However, it is uncertain which option works best, which ICS particle size is most effective, and whether LABA should be administered by separate or combination inhalers. This historical, matched cohort study compared asthma-related outcomes for patients (aged 12-80 years) prescribed step-up therapy as a ≥50% extrafine ICS dose increase or add-on LABA, via either a separate inhaler or a fine-particle ICS/LABA fixed-dose combination (FDC) inhaler. Risk-domain asthma control was the primary end-point in comparisons of cohorts matched for asthma severity and control during the baseline year. After 1:2 cohort matching, the increased extrafine ICS versus separate ICS+LABA cohorts included 3232 and 6464 patients, respectively, and the fine-particle ICS/LABA FDC versus separate ICS+LABA cohorts included 7529 and 15 058 patients, respectively (overall mean age 42 years; 61-62% females). Over one outcome year, adjusted OR (95% CI) for achieving asthma control were 1.25 (1.13-1.38) for increased ICS versus separate ICS+LABA and 1.06 (1.05-1.09) for ICS/LABA FDC versus separate ICS+LABA. For patients with asthma, increased dose of extrafine-particle ICS, or add-on LABA via ICS/LABA combination inhaler, is associated with significantly better outcomes than ICS+LABA via separate inhalers.
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Affiliation(s)
- David B. Price
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Gene Colice
- Washington Hospital Center and George Washington University School of Medicine, Washington, DC, USA
| | - Elliot Israel
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicolas Roche
- University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France
| | - Dirkje S. Postma
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Jonathan Grigg
- Blizard Institute, Queen Mary University of London, London, UK
| | | | - Victoria Thomas
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Richard J. Martin
- National Jewish Health and the University of Colorado Denver, Denver, CO, USA
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Yadav S, Ladkany R, Fulbright J, Dreyfuss H, Reeves A, Campian S, Thomas V, Zakalik D. Abstract P2-09-06: Multi-gene panel testing for hereditary cancer risk. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-09-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Multi-gene panels are widely available for assessing hereditary cancer risk in high risk individuals. Due to the use of these panels, many genetic mutations other than BRCA 1 or 2 can be detected which can potentially affect management. This study presents the results of multi-gene panel testing performed at Beaumont Health System.
Methods:All patients who underwent multi-gene panel testing at Beaumont Health System between November 1, 2012 and January 15, 2015 were included in this study. This cohort consisted of patients who met criteria for genetic testing due to personal or family history. All patients received comprehensive pre and post-test genetic counseling. The panels ranged from 5 to 43 genes associated with risk for breast and other cancers.
Results: 653 multi-gene panel tests were performed. The majority of these consisted of either a 5 gene high risk breast panel (25%), an 18 gene moderate to high risk breast panel (21%), or a 9 gene high risk breast and gynecologic panel (17%). 184 variants of undetermined significance (VUS) were identified with a pooled VUS rate of 28%. Among the commonly used panels, there was a positive correlation between VUS rate and the number of genes included in the panel (r = 0.86, p = 0.01, Range 6% to 70%). A pathogenic mutation was identified in one or more genes in 65 (10%) panels for a total of 67 mutations. Of these, 17 mutations were in BRCA1 or BRCA2 gene. Fifty non-BRCA deleterious mutations were identified with the following frequencies: CHEK2(12), MUTYH(7 monoallelic, 1 biallelic), TP53(4), PTEN(4), ATM(4), MSH6(3), PALB2(3), MSH2(2), CDH1(2), APC(2), NF1(2), BARD1(2), MLH1(1) and PMS2(1). Of these non-BRCA mutations, 41(82%) had a significant impact on management.
Conclusions: Our study demonstrates that multi-gene panel testing identifies several genes that can impact management and would likely not have been discovered by pedigree analysis alone. However, this added detection is associated with a higher VUS rate, especially using larger panels. Further research is needed to better define the role of multi-gene panel testing in high risk patients, with a focus on choosing appropriate genes, understanding the magnitude of cancer risk and delineating impact on management.
Citation Format: Yadav S, Ladkany R, Fulbright J, Dreyfuss H, Reeves A, Campian S, Thomas V, Zakalik D. Multi-gene panel testing for hereditary cancer risk. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-06.
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Affiliation(s)
- S Yadav
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - R Ladkany
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - J Fulbright
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - H Dreyfuss
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - A Reeves
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - S Campian
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - V Thomas
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
| | - D Zakalik
- Beaumont Health System, Royal Oak, MI; Nancy and James Grosfeld Cancer Genetics Center, Beaumont Health System, Royal Oak, MI
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Smith P, Endris R, Kronvall G, Thomas V, Verner-Jeffreys D, Wilhelm C, Dalsgaard I. Epidemiological cut-off values for Flavobacterium psychrophilum MIC data generated by a standard test protocol. J Fish Dis 2016; 39:143-154. [PMID: 25546427 DOI: 10.1111/jfd.12336] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 11/07/2014] [Indexed: 06/04/2023]
Abstract
Epidemiological cut-off values were developed for application to antibiotic susceptibility data for Flavobacterium psychrophilum generated by standard CLSI test protocols. The MIC values for ten antibiotic agents against Flavobacterium psychrophilum were determined in two laboratories. For five antibiotics, the data sets were of sufficient quality and quantity to allow the setting of valid epidemiological cut-off values. For these agents, the cut-off values, calculated by the application of the statistically based normalized resistance interpretation method, were ≤16 mg L(-1) for erythromycin, ≤2 mg L(-1) for florfenicol, ≤0.025 mg L(-1) for oxolinic acid (OXO), ≤0.125 mg L(-1) for oxytetracycline and ≤20 (1/19) mg L(-1) for trimethoprim/sulphamethoxazole. For ampicillin and amoxicillin, the majority of putative wild-type observations were 'off scale', and therefore, statistically valid cut-off values could not be calculated. For ormetoprim/sulphadimethoxine, the data were excessively diverse and a valid cut-off could not be determined. For flumequine, the putative wild-type data were extremely skewed, and for enrofloxacin, there was inadequate separation in the MIC values for putative wild-type and non-wild-type strains. It is argued that the adoption of OXO as a class representative for the quinolone group would be a valid method of determining susceptibilities to these agents.
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Affiliation(s)
- P Smith
- Department of Microbiology, School of Natural Sciences, National University of Ireland, Galway, Ireland
| | - R Endris
- Merck Animal Health, Summit, NJ, USA
| | - G Kronvall
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden
| | - V Thomas
- MSD Animal Health Innovation, GmbH Zur Propstei, Schwabenheim, Germany
| | | | - C Wilhelm
- MSD Animal Health Innovation, GmbH Zur Propstei, Schwabenheim, Germany
| | - I Dalsgaard
- National Veterinary Institute, Technical University of Denmark, Frederiksburg, Denmark
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Chrystyn H, Dekhuijzen R, Rand C, Bosnic-Anticevich S, Roche N, Lavorini F, Thomas V, Steele J, Raju P, Freeman D, Small I, Canvin J, Price D. P154 Evaluation of Inhaler Technique Mastery for Budesonide Formoterol Spiromax® Compared with Symbicort Turbohaler® in Adult Patients with Asthma: Primary Results From the Easy Low Instruction Over Time [ELIOT] Study: Abstract P154 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.291] [Citation(s) in RCA: 3] [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: 11/03/2022]
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Skinner D, Lipworth B, Devereux G, Thomas V, Ling J, Martin J, Carter V, Price D. P24 Underuse of beta-blockers in patients with heart failure and COPD. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.161] [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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Jones R, Martin J, Thomas V, Skinner D, Marshall J, Price D. P130 Effectiveness and safety of initiating treatment with fluticasone/salmeterol via MDI versus DPI in COPD: Abstract P130 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.267] [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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Abstract
We review a case history of a young child who was admitted to an in-patient mental health unit due to extremely challenging behaviour and review the legal issues that had to be considered in ensuring that there was appropriate legal authority for the child's admission and treatment. In this particular case, the patient was detained for assessment under section 2 of the Mental Health Act 1983. This case demonstrates that all clinicians working in this area require a good understanding of the law in relation to treatment of children with mental disorder, which is extremely complex.
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Affiliation(s)
| | | | - Lisa Rippon
- Northumberland, Tyne and Wear NHS Foundation Trust
| | - Paul McArdle
- Northumberland, Tyne and Wear NHS Foundation Trust
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