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Fabian B, Foster C, Asher A, Hassan K, Paulsen I, Tetu S. Identifying the suite of genes central to swimming in the biocontrol bacterium Pseudomonas protegens Pf-5. Microb Genom 2024; 10:001212. [PMID: 38546328 PMCID: PMC11004494 DOI: 10.1099/mgen.0.001212] [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: 01/01/2024] [Accepted: 02/20/2024] [Indexed: 04/12/2024] Open
Abstract
Swimming motility is a key bacterial trait, important to success in many niches. Biocontrol bacteria, such as Pseudomonas protegens Pf-5, are increasingly used in agriculture to control crop diseases, where motility is important for colonization of the plant rhizosphere. Swimming motility typically involves a suite of flagella and chemotaxis genes, but the specific gene set employed for both regulation and biogenesis can differ substantially between organisms. Here we used transposon-directed insertion site sequencing (TraDIS), a genome-wide approach, to identify 249 genes involved in P. protegens Pf-5 swimming motility. In addition to the expected flagella and chemotaxis, we also identified a suite of additional genes important for swimming, including genes related to peptidoglycan turnover, O-antigen biosynthesis, cell division, signal transduction, c-di-GMP turnover and phosphate transport, and 27 conserved hypothetical proteins. Gene knockout mutants and TraDIS data suggest that defects in the Pst phosphate transport system lead to enhanced swimming motility. Overall, this study expands our knowledge of pseudomonad motility and highlights the utility of a TraDIS-based approach for analysing the functions of thousands of genes. This work sets a foundation for understanding how swimming motility may be related to the inconsistency in biocontrol bacteria performance in the field.
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Affiliation(s)
- B.K. Fabian
- School of Natural Sciences, Macquarie University, Sydney, Australia
- ARC Centre of Excellence in Synthetic Biology, Macquarie University, Sydney, Australia
| | - C. Foster
- School of Natural Sciences, Macquarie University, Sydney, Australia
| | - A. Asher
- School of Natural Sciences, Macquarie University, Sydney, Australia
| | - K.A. Hassan
- ARC Centre of Excellence in Synthetic Biology, Macquarie University, Sydney, Australia
- School of Environmental and Life Sciences, University of Newcastle, Newcastle, Australia
| | - I.T. Paulsen
- School of Natural Sciences, Macquarie University, Sydney, Australia
- ARC Centre of Excellence in Synthetic Biology, Macquarie University, Sydney, Australia
| | - S.G. Tetu
- School of Natural Sciences, Macquarie University, Sydney, Australia
- ARC Centre of Excellence in Synthetic Biology, Macquarie University, Sydney, Australia
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2
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Foster C. Use Dignity, Not Its Parasites or Offspring. Am J Bioeth 2023; 23:54-56. [PMID: 38010671 DOI: 10.1080/15265161.2023.2272921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
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3
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Goddard A, Wang Q, Foster C, Perou C, Gupta GP. Tumor-Myeloid Cell Crosstalk Pathways Associated with Abscopal Responses in Breast Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e233. [PMID: 37784931 DOI: 10.1016/j.ijrobp.2023.06.1150] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To identify predictive biomarkers for combined radiotherapy (RT) and immune checkpoint inhibitor (ICI) therapy, which can induce systemic anti-tumor immune responses (i.e., "abscopal" responses) in breast cancer. MATERIALS/METHODS Four Trp53-/- Balb/c breast cancer syngeneic allograft models with low tumor mutational burden and resistance to dual ICI (anti-PD1 and anti-CTLA4, BioXcell) were used. Two lines exhibited abscopal responses to RT (8Gyx3) plus ICI combination therapy (i.e., "abscopal models"), whereas the other two did not (i.e., "non-abscopal models"). We performed spatial transcriptomics analysis (GeoMx whole transcriptome assay) of pan-cytokeratin positive (panCK+) tumor and tumor-adjacent CD45+ immune cell segments in orthotopically implanted tumors 10 days after initiating treatment with IgG control, RT alone, ICI alone, or RT/ICI combination (N>5 per group). Genes selectively induced by RT/ICI in panCK+ and CD45+ segments in abscopal models and were not induced in non-abscopal models were identified using two-tailed t-tests and FDR correction for multiple testing (FDR<5%). In vitro analyses of RT-induced secreted inflammatory signaling were conducted by exposing supernatant from irradiated (8Gy) tumor cells to a RAW264.7 macrophage cell line expressing an interferon-inducible luciferase reporter construct, followed by luciferase signal quantification (Invivogen). RESULTS Hierarchical clustering of immune-related genes in CD45+ immune segments from breast cancer models with abscopal responses to RT/ICI revealed global differences in tumor-adjacent immune profiles at baseline and after RT/ICI treatment. Abscopal responsive breast cancer models at baseline showed an enrichment of myeloid cell subtypes expressing complement protein C1q, Ccl8, and Csf1r in tumor-adjacent CD45+ immune cells, and CD8+ T cells expressing Ccl5. 10 days after treatment with RT/ICI, tumor-adjacent CD45+ immune cells in abscopal models were enriched in Cxcl10, Irf7, and FcgRIV, whereas these genes were not induced in non-abscopal models. CyTOF analyses confirmed the induction of inflamed professional antigen presenting cells (CD11c+CD80+IA/IE+) by RT/ICI in abscopal models. Within panCK+ tumor segments, RT/ICI in abscopal models selectively induced Isg15 and Zbp1, both of which are involved in secreted inflammatory signaling. Consistently, RT-induced secreted inflammatory signaling from tumor cells to macrophages evaluated in vitro was significantly greater in abscopal models compared to non-abscopal models. CONCLUSION Breast cancer models with abscopal responses to RT/ICI show increased Isg15- and Zbp1-dependent secreted inflammatory crosstalk that activates Cxcl10 and Irf7 expression in tumor-adjacent myeloid cells, which warrants further investigation as a potential predictive biomarker for combined RT/ICI therapy in breast cancer.
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Affiliation(s)
- A Goddard
- University of North Carolina, Chapel Hill, NC
| | - Q Wang
- University of North Carolina, Chapel Hill, NC
| | - C Foster
- University of North Carolina, Chapel Hill, NC
| | - C Perou
- Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC
| | - G P Gupta
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
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Foster C. Ethically Alluring but Legally Destructive. Am J Bioeth 2023; 23:85-87. [PMID: 37450537 DOI: 10.1080/15265161.2023.2217135] [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] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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Wheelwright S, Maunsell R, Taylor S, Drinkwater N, Erridge C, Foster C, Hardcastle M, Hogden A, Lawson I, Lisiecka D, Mcdermott C, Morrison KE, Muir C, Recio-Saucedo A, White S. Development of 'gastrostomy tube - is it for me?', a web-based patient decision aid for people living with motor neurone disease considering having a gastrostomy tube placed. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:1-9. [PMID: 37332172 DOI: 10.1080/21678421.2023.2220743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
Objective: To develop and pilot a web-based patient decision aid (PDA) to support people living with motor neurone disease (plwMND) considering having a gastrostomy tube placed. Methods: In Phase 1, content and design were informed by semi-structured interviews, literature reviews and a prioritization survey. In Phase 2, the prototype PDA was tested with users and developed iteratively with feedback from surveys and 'think-aloud' interviews. Phase 1 and 2 participants were plwMND, carers and healthcare professionals (HCPs). In Phase 3, the PDA was evaluated by plwMND using validated questionnaires and HCPs provided feedback in focus groups. Results: Sixteen plwMND, 16 carers and 25 HCPs took part in Phases 1 and 2. Interviews and the literature review informed a prioritization survey with 82 content items. Seventy-seven per cent (63/82) of the content of the PDA was retained. A prototype PDA, which conforms to international standards, was produced and improved during Phase 2. In Phase 3, 17 plwMND completed questionnaires after using the PDA. Most plwMND (94%) found the PDA completely acceptable and would recommend it to others in their position, 88% had no decisional conflict, 82% were well prepared and 100% were satisfied with their decision-making. Seventeen HCPs provided positive feedback and suggestions for use in clinical practice. Conclusion: Gastrostomy Tube: Is it for me? was co-produced with stakeholders and found to be acceptable, practical and useful. Freely available from the MND Association website, the PDA is a valuable tool to support the shared decision-making process for gastrostomy tube placement.
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Affiliation(s)
| | - R Maunsell
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | - S Taylor
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | - N Drinkwater
- Motor Neurone Disease Association, Northampton, UK
| | - C Erridge
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Foster
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | | | - A Hogden
- School of Population Health, University of New South Wales, Sydney, Australia
| | - I Lawson
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | - D Lisiecka
- Munster Technological University - Kerry Campus, Republic of Ireland, Tralee, UK
| | | | - K E Morrison
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - C Muir
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | - A Recio-Saucedo
- Centre for Psychosocial Research in Cancer: CentRIC, University of Southampton, Southampton, UK
| | - S White
- University of Sheffield, Sheffield, UK, and
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Foster C, Dalabih A, Mack JM, Cox CM. Pediatric procedural sedation in pediatric oncology patients: does the number of sedations matter? Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00575-x] [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: 01/28/2023]
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Conibear J, Nossiter J, Foster C, West D, Cromwell D, Navani N. The National Lung Cancer Audit: The Impact of COVID-19. Clin Oncol (R Coll Radiol) 2022; 34:701-707. [PMID: 36180356 PMCID: PMC9474418 DOI: 10.1016/j.clon.2022.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
Since 2014, the National Lung Cancer Audit (NLCA) has been evaluating the performance of the UK NHS lung cancer services against established standards of care. Prior to the onset of the COVID-19 pandemic, the NLCA's annual reports revealed a steady stream of improvements in early diagnosis, access to surgery, treatment with anti-cancer therapies, input from specialist nursing and survival for patients with lung cancer in the NHS. In January 2022, the NLCA reported on the negative impact COVID-19 has had on all aspects of the lung cancer diagnosis and treatment pathway within the NHS. This article details the fundamental changes made to the NLCA data collection and analysis process during the COVID-19 pandemic and details the negative impact COVID-19 had on NHS lung cancer patient outcomes during 2020.
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Affiliation(s)
- J Conibear
- Barts Cancer Centre, St. Bartholomew's Hospital, London, UK.
| | - J Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - C Foster
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - D West
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - D Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - N Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospital, London, UK
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8
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Foster C. Loving Wisdom, Living Wisdom, Teaching Wisdom. AJOB Neurosci 2022; 13:262-264. [PMID: 36272164 DOI: 10.1080/21507740.2022.2126542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Increasing numbers of children with perinatally acquired HIV (PaHIV) are transitioning into adult care. People living with behaviourally acquired HIV are known to be at more risk of psychosis than uninfected peers. Young adults living with PaHIV face numerous risk factors; biological: lifelong exposure to a neurotrophic virus, antiretroviral medication and immune dysfunction during brain development, and environmental; social deprivation, ethnicity-related discrimination, and migration-related issues. To date, there is little published data on the prevalence of psychotic illness in young people growing up with PaHIV. METHODS We conducted a retrospective case note review of all individuals with PaHIV aged over 18 years registered for follow up at a dedicated clinic in the UK (n = 184). RESULTS In total, 12/184 (6.5%), median age 23 years (interquartile range 21-26), had experienced at least one psychotic episode. The presentation and course of the psychotic episodes experienced by our cohort varied from short-lived symptoms to long term illness and nine (75%) appear to have developed a severe and enduring mental illness requiring long term care. CONCLUSION The prevalence of psychosis in our cohort was clearly above the lifetime prevalence of psychosis in UK individuals aged 16-34 years, which has been reported to be 0.5-1.0%. This highlights the importance of clinical vigilance regarding the mental health of young people growing up with PaHIV and the need to integrate direct access to mental health services within the HIV centres providing medical care.
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Affiliation(s)
- I Mallik
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
- Department of Medicine, Imperial College London, London, UK, and Imperial College NIHR BRC, London, UK
| | - T Pasvol
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - G Frize
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - S Ayres
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - A Barrera
- Oxford Health NHS Trust, Oxford, UK and Oxford University Department of Psychiatry, Oxford, UK
| | - S Fidler
- Department of Medicine, Imperial College London, London, UK, and Imperial College NIHR BRC, London, UK
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London, UK
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10
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Shrestha LB, Foster C, Rawlinson W, Tedla N, Bull RA. Evolution of the SARS-CoV-2 omicron variants BA.1 to BA.5: Implications for immune escape and transmission. Rev Med Virol 2022; 32:e2381. [PMID: 35856385 PMCID: PMC9349777 DOI: 10.1002/rmv.2381] [Citation(s) in RCA: 211] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 12/15/2022]
Abstract
The first dominant SARS‐CoV‐2 Omicron variant BA.1 harbours 35 mutations in its Spike protein from the original SARS‐CoV‐2 variant that emerged late 2019. Soon after its discovery, BA.1 rapidly emerged to become the dominant variant worldwide and has since evolved into several variants. Omicron is of major public health concern owing to its high infectivity and antibody evasion. This review article examines the theories that have been proposed on the evolution of Omicron including zoonotic spillage, infection in immunocompromised individuals and cryptic spread in the community without being diagnosed. Added to the complexity of Omicron's evolution are the multiple reports of recombination events occurring between co‐circulating variants of Omicron with Delta and other variants such as XE. Current literature suggests that the combination of the novel mutations in Omicron has resulted in the variant having higher infectivity than the original Wuhan‐Hu‐1 and Delta variant. However, severity is believed to be less owing to the reduced syncytia formation and lower multiplication in the human lung tissue. Perhaps most challenging is that several studies indicate that the efficacy of the available vaccines have been reduced against Omicron variant (8–127 times reduction) as compared to the Wuhan‐Hu‐1 variant. The administration of booster vaccine, however, compensates with the reduction and improves the efficacy by 12–35 fold. Concerningly though, the broadly neutralising monoclonal antibodies, including those approved by FDA for therapeutic use against previous SARS‐CoV‐2 variants, are mostly ineffective against Omicron with the exception of Sotrovimab and recent reports suggest that the Omicron BA.2 is also resistant to Sotrovimab. Currently two new Omicron variants BA.4 and BA.5 are emerging and are reported to be more transmissible and resistant to immunity generated by previous variants including Omicron BA.1 and most monoclonal antibodies. As new variants of SARS‐CoV‐2 will likely continue to emerge it is important that the evolution, and biological consequences of new mutations, in existing variants be well understood.
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Affiliation(s)
- Lok Bahadur Shrestha
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - Charles Foster
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,Serology and Virology Division, Department of Microbiology, New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - William Rawlinson
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,Serology and Virology Division, Department of Microbiology, New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Nicodemus Tedla
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Rowena A Bull
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia.,The Kirby Institute, UNSW, Sydney, New South Wales, Australia
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Gould R, Roberts NW, Murtagh EM, Hillsdon M, Foster C. Remote, face-to-face, and group-based interventions for promoting strength training in healthy community-based adults. Hippokratia 2022. [DOI: 10.1002/14651858.cd014825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Nia W Roberts
- Bodleian Health Care Libraries; University of Oxford; Oxford UK
| | - Elaine M Murtagh
- Department of Physical Education and Sport Sciences; University of Limerick; Limerick Ireland
| | - Melvyn Hillsdon
- School of Sport and Health Sciences; University of Exeter; Exeter UK
| | - Charles Foster
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies; University of Bristol; Bristol UK
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12
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Mellin J, Le Prevost M, Kenny J, Sturgeon K, Thompson LC, Foster C, Kessler HH, Goswami N, Klein N, Judd A, Castro H. Arterial Stiffness in a Cohort of Young People Living With Perinatal HIV and HIV Negative Young People in England. Front Cardiovasc Med 2022; 9:821568. [PMID: 35299977 PMCID: PMC8921599 DOI: 10.3389/fcvm.2022.821568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 12/19/2022] Open
Abstract
Background Antiretroviral therapy (ART) has increased life expectancy and consequently the risk of cardiovascular disease (CVD) in adults living with HIV. We investigated the levels and predictors of arterial stiffness in young people (YP) living with perinatal HIV (PHIV) and HIV negative YP in the Adolescents and Adults Living with Perinatal HIV (AALPHI) study. Methods AALPHI was a prospective study evaluating the impact of HIV infection and exposure to ART on YP living with PHIV (aged 13–21 years) who had known their HIV status for at least 6 months, and HIV negative YP (aged 13–23 years) who either had a sibling, friend or parent living with HIV. Participants were enrolled from HIV clinics and community services in England. Two hundred and thirteen PHIV and 65 HIV negative YP (42% siblings of PHIV) had pulse wave velocity (PWV) measurements taken (Vicorder software) from the supra-sternal notch to the middle of the thigh cuff, at their second interview in the study between 2015 and 2017. Average PWV was calculated from the three closest readings (≥3 and ≤ 12 m/s) within 0.6 m/s of each other. Linear regression examined predictors of higher (worse) PWV, including age, sex, HIV status and height as a priori, ethnicity, born outside UK/Ireland, alcohol/nicotine/drug use, weight, waist-to-hip-ratio, mean arterial pressure (MAP), caffeine 2 h before PWV and nicotine on day of PWV. A separate PHIV model included CD4, viral load, years taking ART and ART regimen. Findings One hundred and twenty eight (60%) PHIV and 45 (69%) HIV negative YP were female (p = 0.18), with median (IQR) age 18 (16, 20) and 18 (16, 21) years (p = 0.48) respectively. Most PHIV were taking a combination of three ART drugs from two classes. There was a trend toward higher (worse) mean PWV in the PHIV group than the HIV negative group [unvariable analysis 6.15 (SD 0.83) m/s vs. 5.93 (0.70) m/s, respectively, unadjusted p = 0.058], which was statistically significant in the multivariable analysis [adjusted p (ap) = 0.020]. In multivariable analysis being male (ap = 0.002), older age (ap < 0.001), higher MAP (ap < 0.001) and nicotine use on day of measurement (ap = 0.001) were also predictors of higher PWV. The predictors were the same in the PHIV model. Interpretation By late adolescence PHIV had worse PWV in comparison to HIV negative peers, and traditional risk factors for CVD (higher arterial pressure, being male and older age) were associated with higher PWV values. Regular detailed monitoring of cardiovascular risk factors should become standard of care for every young person with PHIV worldwide.
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Affiliation(s)
- J Mellin
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - M Le Prevost
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - J Kenny
- Guy's and St. Thomas' National Heath Service Foundation Trust, Evelina London Children's Hospital, St. Thomas' Hospital, London, United Kingdom
| | - K Sturgeon
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - L C Thompson
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - C Foster
- Imperial College Healthcare National Heath Service Trust, St. Mary's Hospital, London, United Kingdom
| | - H H Kessler
- Diagnostic and Research Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - N Klein
- Department of Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - A Judd
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - H Castro
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
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Porter K, Burch N, Campbell C, Danbury C, Foster C, Gabe S, Goddard A, Harp K, Holdoway A, Hughes T, Ball KL, Nightingale J, Rochford A, Keene AR, Smith A, Smith T, De Silva A. Supporting people who have eating and drinking difficulties. Clin Med (Lond) 2022; 21:e344-e350. [PMID: 35192476 DOI: 10.7861/clinmed.2021-0161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Eating and drinking are essential for maintenance of nutrition and hydration, but are also important for pleasure and social interactions. The ability to eat and drink hinges on a complex and coordinated system, resulting in significant potential for things to go wrong.The Royal College of Physicians (RCP) has published updated guidance on how to support people who have eating and drinking difficulties, particularly towards the end of life.Decisions about nutrition and hydration and when to start, continue or stop treatment are some of the most challenging to make in medical practice. The newly updated guidance aims to support healthcare professionals to work together with patients, their families and carers to make decisions around nutrition and hydration that are in the best interests of the patient. It covers the factors affecting our ability to eat and drink, strategies to support oral nutrition and hydration, techniques of clinically-assisted nutrition and hydration, and the legal and ethical framework to guide decisions about giving and withholding treatment, emphasising the two key concepts of capacity and best interests.This article aims to provide an executive summary of the guidance.
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Affiliation(s)
| | | | | | | | - Charles Foster
- Green Templeton College, Oxford, UK and barrister, 4-5 Gray's Inn Square, London, UK
| | - Simon Gabe
- London North West University Healthcare NHS Trust, London, UK
| | - Andrew Goddard
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK and president, Royal College of Physicians, London, UK
| | - Katie Harp
- Royal Hospital for Neuro-disability, London, UK
| | - Anne Holdoway
- BMI Bath Clinic, Bath, UK, Dorothy House Hospice, Bradford-on-Avon, UK and Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Tom Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | | | | | - Alex Ruck Keene
- 39 Essex Chambers, London, UK and visiting professor, Dickson Poon School of Law, London, UK
| | - Alison Smith
- Herts Valleys Clinical Commissioning Group, Hemel Hempstead, UK
| | - Trevor Smith
- University Hospital Southampton NHS Foundation Trust, Southampton, UK and president, British Association for Parenteral and Enteral Nutrition, Redditch, UK
| | - Aminda De Silva
- Royal Berkshire NHS Foundation Trust, Reading, UK and chair of the working party
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Foster C, Cook G, Lee R. M096 TREATING ANOTHER CASE OF CHOLINERGIC URTICARIA? --- NO SWEAT! Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Foster C. Ectoparasiticides and the precautionary principle. Vet Rec 2021; 188:156-157. [PMID: 34651723 DOI: 10.1002/vetr.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Asad H, Collins IJ, Goodall RL, Crichton S, Hill T, Doerholt K, Foster C, Lyall H, Post FA, Welch S, Winston A, Sabin CA, Judd A. Mortality and AIDS-defining events among young people following transition from paediatric to adult HIV care in the UK. HIV Med 2021; 22:631-640. [PMID: 33939876 PMCID: PMC8612219 DOI: 10.1111/hiv.13096] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV. METHODS Records of people aged ≥ 13 years on 31 December 2015 in the UK paediatric HIV cohort (Collaborative HIV Paediatric Study) were linked to those of adults in the UK Collaborative HIV Cohort (CHIC) cohort. We calculated time from transition to a new AIDS event/death, with follow-up censored at the last visit or 31 December 2015, whichever was the earliest. Cumulative incidence of and risk factors for AIDS/mortality were assessed using Kaplan-Meier and Cox regression. RESULTS At the final paediatric visit, the 474 participants [51% female, 80% black, 60% born outside the UK, median (interquartile range) age at antiretroviral therapy (ART) initiation = 9 (5-13) years] had a median age of 18 (17-19) years and CD4 count of 471 (280-663) cell/μL; 89% were prescribed ART and 60% overall had a viral load ≤ 400 copies/mL. Over median follow-up in adult care of 3 (2-6) years, 35 (8%) experienced a new AIDS event (n = 25) or death (n = 14) (incidence = 1.8/100 person-years). In multivariable analyses, lower CD4 count at the last paediatric visit [adjusted hazard ratio = 0.8 (95% confidence interval: 0.7-1.0)/100 cells/μL increment] and AIDS diagnosis in paediatric care [2.7 (1.4-5.5)] were associated with a new AIDS event/mortality in adult care. CONCLUSIONS Young people with perinatally acquired HIV transitioning to adult care with markers of disease progression in paediatric care experienced poorer outcomes in adult care. Increased investment in multidisciplinary specialized services is required to support this population at high risk of morbidity and mortality.
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Affiliation(s)
- H Asad
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood‐Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health EnglandLondonUK
- Institute for Global HealthUCLLondonUK
| | - IJ Collins
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
| | - RL Goodall
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
- Institute for Global HealthUCLLondonUK
| | - S Crichton
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
| | - T Hill
- Institute for Global HealthUCLLondonUK
| | - K Doerholt
- St George’s University Hospitals NHS Foundation TrustLondonUK
| | - C Foster
- Imperial College Healthcare NHS TrustLondonUK
| | - H Lyall
- Imperial College Healthcare NHS TrustLondonUK
| | - FA Post
- King’s College Hospital NHS Foundation TrustLondonUK
| | - S Welch
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - CA Sabin
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood‐Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health EnglandLondonUK
- Institute for Global HealthUCLLondonUK
| | - A Judd
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
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17
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Foster C, Gilbar R. Is there a New Duty to Warn Family Members in English Medical Law? ABC V ST George's Healthcare NHS Trust and Others [2020] EWHC 4551. Med Law Rev 2021; 29:359-372. [PMID: 33694361 DOI: 10.1093/medlaw/fwab006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford OX1 3UL, UK
| | - Roy Gilbar
- School of Law, Netanya Academic College, Netanya, Israel
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18
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Jeschke MG, Phelan HA, Wolf S, Romanowski K, Rehou S, Saetamal A, Weber J, Schulz J, New C, Wiktor A, Foster C, Deeter L, Tuohy K. State of the Science Burn Research: Burns in the Elderly. J Burn Care Res 2021; 41:65-83. [PMID: 31999337 DOI: 10.1093/jbcr/irz163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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19
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Rawlinson WD, van Hal S, Yeang M, Condylios A, Naing Z, Au JP, Ruiz da Silva M, Foster C. Background, testing methods, and laboratory approaches to SARS coronavirus-2 (SARS-CoV-2) and covid19. Pathology 2021. [PMCID: PMC8221913 DOI: 10.1016/j.pathol.2021.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Rawlinson WD, van Hal S, Yeang M, Condylios A, Naing Z, Au JP, Ruiz da Silva M, Foster C. Background, testing methods, and laboratory approaches to SARS coronavirus-2 (SARS-CoV-2) and Covid19. Pathology 2021. [PMCID: PMC8221975 DOI: 10.1016/j.pathol.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Steventon JJ, Foster C, Furby H, Helme D, Wise RG, Murphy K. Hippocampal Blood Flow Is Increased After 20 min of Moderate-Intensity Exercise. Cereb Cortex 2021; 30:525-533. [PMID: 31216005 PMCID: PMC7703728 DOI: 10.1093/cercor/bhz104] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/01/2019] [Accepted: 04/25/2019] [Indexed: 01/17/2023] Open
Abstract
Long-term exercise interventions have been shown to be a potent trigger for both neurogenesis and vascular plasticity. However, little is known about the underlying temporal dynamics and specifically when exercise-induced vascular adaptations first occur, which is vital for therapeutic applications. In this study, we investigated whether a single session of moderate-intensity exercise was sufficient to induce changes in the cerebral vasculature. We employed arterial spin labeling magnetic resonance imaging to measure global and regional cerebral blood flow (CBF) before and after 20 min of cycling. The blood vessels’ ability to dilate, measured by cerebrovascular reactivity (CVR) to CO2 inhalation, was measured at baseline and 25-min postexercise. Our data showed that CBF was selectively increased by 10–12% in the hippocampus 15, 40, and 60 min after exercise cessation, whereas CVR to CO2 was unchanged in all regions. The absence of a corresponding change in hippocampal CVR suggests that the immediate and transient hippocampal adaptations observed after exercise are not driven by a mechanical vascular change and more likely represents an adaptive metabolic change, providing a framework for exploring the therapeutic potential of exercise-induced plasticity (neural, vascular, or both) in clinical and aged populations.
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Affiliation(s)
- J J Steventon
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK.,School of Physics and Astronomy, The Parade, Cardiff University, Cardiff, CF24 3AA, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - C Foster
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - H Furby
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK.,Institute of Neurology, University College London, London, WC1B 5EH, UK
| | - D Helme
- Department of Anaesthetics and Intensive Care Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - R G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - K Murphy
- School of Physics and Astronomy, The Parade, Cardiff University, Cardiff, CF24 3AA, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
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22
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23
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Foster C. Withdrawing treatment from patients with prolonged disorders of consciousness: the presumption in favour of the maintenance of life is legally robust. J Med Ethics 2021; 47:119-120. [PMID: 32409624 DOI: 10.1136/medethics-2020-106280] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient's best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge's job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.The presumption is best regarded as a presumption of law. It has long been recognised as part of the way in which the English law discharges its obligations under Article 2 of the European Convention on Human Rights (the right to life). But even if it is a 'mere' evidential presumption it cannot, on the facts of most cases involving applications for the withdrawal of life-sustaining treatment from patients in prolonged disorders of consciousness, be rebutted.
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Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford, Oxfordshire, UK
- Green Templeton College, University of Oxford, Oxford, UK
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24
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Foster C, Shohfi E, Petersen M. P158 ONE IN A MILLION: ANAPHYLAXIS TO VARIVAX® IN A NON-IMMUNE HEALTHCARE WORKER. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.090] [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: 10/23/2022]
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25
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Lindenmayer DB, Blanchard W, Blair D, McBurney L, Taylor C, Scheele BC, Westgate MJ, Robinson N, Foster C. The response of arboreal marsupials to long‐term changes in forest disturbance. Anim Conserv 2020. [DOI: 10.1111/acv.12634] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- D. B. Lindenmayer
- National Environmental Science Program Threatened Species Recovery Hub Fenner School of Environment and Society The Australian National University Canberra ACT Australia
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - W. Blanchard
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - D. Blair
- National Environmental Science Program Threatened Species Recovery Hub Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - L. McBurney
- National Environmental Science Program Threatened Species Recovery Hub Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - C. Taylor
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - B. C. Scheele
- National Environmental Science Program Threatened Species Recovery Hub Fenner School of Environment and Society The Australian National University Canberra ACT Australia
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - M. J. Westgate
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - N. Robinson
- National Environmental Science Program Threatened Species Recovery Hub Fenner School of Environment and Society The Australian National University Canberra ACT Australia
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
| | - C. Foster
- Fenner School of Environment and Society The Australian National University Canberra ACT Australia
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26
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Foster C. 'Who are you today?' Problems of identity in psychiatry. BJPsych Int 2020; 17:60-62. [PMID: 34287420 PMCID: PMC8280790 DOI: 10.1192/bji.2020.6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
Our attributes change. Sometimes they are changed so dramatically (for instance by organic brain disease, traumatic brain injury or psychiatric disease) that it is hard to see any significant continuity with the premorbid person. Sometimes this can have important ethical and legal consequences, but the problems are often ignored. This article highlights some of the difficulties.
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Affiliation(s)
- Charles Foster
- Visiting Professor, Faculty of Law, University of Oxford, UK.
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27
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Murtagh EM, Murphy MH, Milton K, Roberts NW, O'Gorman CS, Foster C. Interventions outside the workplace for reducing sedentary behaviour in adults under 60 years of age. Cochrane Database Syst Rev 2020; 7:CD012554. [PMID: 32678471 PMCID: PMC7389819 DOI: 10.1002/14651858.cd012554.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adults spend a majority of their time outside the workplace being sedentary. Large amounts of sedentary behaviour increase the risk of type 2 diabetes, cardiovascular disease, and both all-cause and cardiovascular disease mortality. OBJECTIVES Primary • To assess effects on sedentary time of non-occupational interventions for reducing sedentary behaviour in adults under 60 years of age Secondary • To describe other health effects and adverse events or unintended consequences of these interventions • To determine whether specific components of interventions are associated with changes in sedentary behaviour • To identify if there are any differential effects of interventions based on health inequalities (e.g. age, sex, income, employment) SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SportDiscus, and ClinicalTrials.gov on 14 April 2020. We checked references of included studies, conducted forward citation searching, and contacted authors in the field to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster RCTs of interventions outside the workplace for community-dwelling adults aged 18 to 59 years. We included studies only when the intervention had a specific aim or component to change sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles/abstracts and full-text articles for study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted trial authors for additional information or data when required. We examined the following primary outcomes: device-measured sedentary time, self-report sitting time, self-report TV viewing time, and breaks in sedentary time. MAIN RESULTS We included 13 trials involving 1770 participants, all undertaken in high-income countries. Ten were RCTs and three were cluster RCTs. The mean age of study participants ranged from 20 to 41 years. A majority of participants were female. All interventions were delivered at the individual level. Intervention components included personal monitoring devices, information or education, counselling, and prompts to reduce sedentary behaviour. We judged no study to be at low risk of bias across all domains. Seven studies were at high risk of bias for blinding of outcome assessment due to use of self-report outcomes measures. Primary outcomes Interventions outside the workplace probably show little or no difference in device-measured sedentary time in the short term (mean difference (MD) -8.36 min/d, 95% confidence interval (CI) -27.12 to 10.40; 4 studies; I² = 0%; moderate-certainty evidence). We are uncertain whether interventions reduce device-measured sedentary time in the medium term (MD -51.37 min/d, 95% CI -126.34 to 23.59; 3 studies; I² = 84%; very low-certainty evidence) We are uncertain whether interventions outside the workplace reduce self-report sitting time in the short term (MD -64.12 min/d, 95% CI -260.91 to 132.67; I² = 86%; very low-certainty evidence). Interventions outside the workplace may show little or no difference in self-report TV viewing time in the medium term (MD -12.45 min/d, 95% CI -50.40 to 25.49; 2 studies; I² = 86%; low-certainty evidence) or in the long term (MD 0.30 min/d, 95% CI -0.63 to 1.23; 2 studies; I² = 0%; low-certainty evidence). It was not possible to pool the five studies that reported breaks in sedentary time given the variation in definitions used. Secondary outcomes Interventions outside the workplace probably have little or no difference on body mass index in the medium term (MD -0.25 kg/m², 95% CI -0.48 to -0.01; 3 studies; I² = 0%; moderate-certainty evidence). Interventions may have little or no difference in waist circumference in the medium term (MD -2.04 cm, 95% CI -9.06 to 4.98; 2 studies; I² = 65%; low-certainty evidence). Interventions probably have little or no difference on glucose in the short term (MD -0.18 mmol/L, 95% CI -0.30 to -0.06; 2 studies; I² = 0%; moderate-certainty evidence) and medium term (MD -0.08 mmol/L, 95% CI -0.21 to 0.05; 2 studies, I² = 0%; moderate-certainty evidence) Interventions outside the workplace may have little or no difference in device-measured MVPA in the short term (MD 1.99 min/d, 95% CI -4.27 to 8.25; 4 studies; I² = 23%; low-certainty evidence). We are uncertain whether interventions improve device-measured MVPA in the medium term (MD 6.59 min/d, 95% CI -7.35 to 20.53; 3 studies; I² = 70%; very low-certainty evidence). We are uncertain whether interventions outside the workplace improve self-reported light-intensity PA in the short-term (MD 156.32 min/d, 95% CI 34.34 to 278.31; 2 studies; I² = 79%; very low-certainty evidence). Interventions may have little or no difference on step count in the short-term (MD 226.90 steps/day, 95% CI -519.78 to 973.59; 3 studies; I² = 0%; low-certainty evidence) No data on adverse events or symptoms were reported in the included studies. AUTHORS' CONCLUSIONS Interventions outside the workplace to reduce sedentary behaviour probably lead to little or no difference in device-measured sedentary time in the short term, and we are uncertain if they reduce device-measured sedentary time in the medium term. We are uncertain whether interventions outside the workplace reduce self-reported sitting time in the short term. Interventions outside the workplace may result in little or no difference in self-report TV viewing time in the medium or long term. The certainty of evidence is moderate to very low, mainly due to concerns about risk of bias, inconsistent findings, and imprecise results. Future studies should be of longer duration; should recruit participants from varying age, socioeconomic, or ethnic groups; and should gather quality of life, cost-effectiveness, and adverse event data. We strongly recommend that standard methods of data preparation and analysis are adopted to allow comparison of the effects of interventions to reduce sedentary behaviour.
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Affiliation(s)
- Elaine M Murtagh
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute (HRI), University of Limerick, Limerick, Ireland
| | - Marie H Murphy
- Sport & Exercise Sciences Research Institute, University of Ulster, Newtownabbey, UK
- Doctoral College, University of Ulster, Newtownabbey, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nia W Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Clodagh Sm O'Gorman
- Graduate Entry Medical School, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Charles Foster
- Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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Hindocha A, Randell P, Seery P, Rahimi T, Kirkhope N, Raghunanan S, Foster C, Tudor-Williams G, Lyall H. The optimal time to test for sero-reversion in HIV-exposed uninfected infants: the later the better? HIV Med 2020; 21:453-456. [PMID: 32441839 DOI: 10.1111/hiv.12862] [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] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES HIV-exposed uninfected (HEU) infants are tested for loss of maternal antibody (sero-reversion) at 18 months of age. Highly sensitive fourth-generation antigen/antibody assays can detect very low levels of antibody, leading to retesting. We audited serological screening outcomes in HEU infants at two National Health Service (NHS) Trusts. METHODS HEU infants born between January 2013 and August 2016 were identified via case records. Data collected included gestation; age at testing; test results and assay type. RESULTS One hundred and forty-two infants were identified, of whom 21 were excluded from analysis. One hundred and one (83%) were born at term and 20 (17%) preterm (< 37/40 weeks of gestation), and the median age at first serology was 19.1 [interquartile range (IQR) 18.1; 21.4] months. Initial serology was positive in 10 of 121 infants (8.3%), and the median age of these 10 infants was 18.3 (IQR 18.1; 18.8) months, whereas those with negative serology (n = 111) had a median age of 19.2 (IQR 18.1; 21.5) months (P = 0.12). All infants with positive HIV serology were born at term. Seven of 10 infants had reactive serology on two fourth-generation assays. Subsequent serology was available for eight of 10 infants, with a median age of 21.3 months. Five of the eight (63%) were negative. One was reactive but HIV RNA polymerase chain reaction (PCR) was negative, and one was reactive on screening but negative on confirmatory testing. The remaining child was still seropositive at 24.7 months but had a non-reactive result at 29.4 months. CONCLUSIONS Overall, 8.3% of HEU infants required repeat testing to confirm loss of antibody. Delaying testing until 22 months of age reduces retesting to < 2%, with associated resource and emotional implications. Positive serology at 22 months should prompt an HIV RNA PCR to exclude infection.
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Affiliation(s)
- A Hindocha
- Imperial College Healthcare NHS Trust, London, UK
| | - P Randell
- Imperial College Healthcare NHS Trust, London, UK
| | - P Seery
- Imperial College Healthcare NHS Trust, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - T Rahimi
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - N Kirkhope
- Imperial College Healthcare NHS Trust, London, UK
| | - S Raghunanan
- Imperial College Healthcare NHS Trust, London, UK
| | - C Foster
- Imperial College Healthcare NHS Trust, London, UK
| | - G Tudor-Williams
- Imperial College Healthcare NHS Trust, London, UK.,Imperial College London, London, UK
| | - H Lyall
- Imperial College Healthcare NHS Trust, London, UK
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29
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Foster C. To Be Coherently Beneficient, Be Communitarian. Am J Bioeth 2020; 20:77-79. [PMID: 32116182 DOI: 10.1080/15265161.2020.1714796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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30
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Reidy C, Foster C, Rogers A. A novel exploration of the support needs of people initiating insulin pump therapy using a social network approach: a longitudinal mixed-methods study. Diabet Med 2020; 37:298-310. [PMID: 31618464 PMCID: PMC7003843 DOI: 10.1111/dme.14155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/14/2022]
Abstract
AIMS To establish what practical and emotional means of support are required on initiation of insulin pump therapy and how needs change over time, using GENIE, a social network intervention. METHODS The study's longitudinal design used semi-structured interviews, surveys (PAID, CLARKE) and HbA1c values at time of pump initiation, and at 3 and 6 months. Interviews used GENIE to capture participants' expectations and experiences of pump therapy and associated support and resources. Thematic analysis was used with sequential, time-ordered matrices. RESULTS A total of 16 adults undertook 47 interviews. A total of 94 services, resources and activities were acquired, while tally, frequency and value of network members increased over time. The novelty of pump therapy impacted on participants' self-management needs. Key themes included: 1) the independent nature of managing diabetes; 2) overcoming the challenges and illness burden associated with pump use; 3) the need for responsive and tailored emotional and practical support; and 4) useful resources when incorporating pump therapy. GENIE was thought to be novel and beneficial. CONCLUSIONS A social network approach determined what resources and support people with diabetes require when incorporating a new health technology. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities as their needs changed. The novelty of pump therapy creates new illness-related work, but mobilisation of personally valued flexible, tailored support can improve the process of adaptation.
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Affiliation(s)
- C. Reidy
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex School of Health SciencesFaculty of Environmental and Life Sciences, University of Southampton
| | - C. Foster
- Macmillan Survivorship Research GroupSchool of Health Sciences, Faculty of Environmental and Life Sciences, University of SouthamptonSouthamptonUK
| | - A. Rogers
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex School of Health SciencesFaculty of Environmental and Life Sciences, University of Southampton
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31
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Maunsell R, Bloomfield S, Erridge C, Foster C, Hardcastle M, Hogden A, Kidd A, Lisiecka D, McDermott C, Morrison K, Recio-Saucedo A, Rickenbach L, White S, Williams P, Wheelwright S. Developing a web-based patient decision aid for gastrostomy in motor neurone disease. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Alsharqi M, Huckstep OJ, Williamson W, Mohamed A, Tan C, Lapidaire W, Telles F, Arnold L, Monteiro C, Dawes H, Foster C, Lewandowski AJ, Leeson P. P374 Prediction of an adverse cardiovascular response to physical exercise from resting echocardiography imaging in young adults with suboptimal blood pressure. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.222] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
British Heart Foundation (BHF) grants (PG/13/58/30397)
Background
Young adults with mildly elevated blood pressure are less likely to engage with physical activity. This may be because early hypertension alters myocardial response to moderate exercise, leading to greater perceived exertion and lower levels of enjoyment. As atrial and ventricular function are closely coupled we investigated whether subclinical atrial changes at rest may identify this myocardial response.
Purpose
To identify whether subclinical changes in left atrial function at rest predict response to exercise by performing left atrial deep-phenotyping in a cohort of young adults with a range of blood pressures.
Methods
Seventy-one full-term born young adults (25.25 ± 5.13 years) were enrolled in the Young Adult Cardiovascular Health sTudy (YACHT) to undergo baseline clinical and cardiovascular phenotyping including detailed blood pressure measurement. Cardiopulmonary exercise testing combined with echocardiography imaging was performed to assess the myocardial response to physical exercise at 40%, 60% and 80% of peak exercise load for all participants. Left ventricular ejection fraction and global longitudinal strain were measured from an apical four chamber view at each exercise load, and resting left atrial phasic function was assessed by conventional and speckle tracking echocardiography from apical four and two chamber views (figure 1).
Results
In this young cohort with a range of blood pressure (120.9 ± 12.96/70.85 ± 9.78 mmHg), resting left atrial reservoir and conduit function, but not left atrial structural measures, showed good correlation with left ventricular ejection fraction and global longitudinal strain during 40%, 60% and 80% of peak exercise. The association between resting left atrial conduit with left ventricular deformation at 60% of peak exercise intensity remained significant when adjusted for age, sex and mean arterial pressure (P = 0.007).
Conclusion
Left atrial phasic function at rest predicts left ventricular responses to physical exercise in this cohort of young adults, which may relate to early subclinical left atrial remodelling in early hypertension. These findings require validation in other cohorts and investigation of whether this exercise limitation can be overcome in young hypertensives.
Abstract P374 Figure 1
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Affiliation(s)
- M Alsharqi
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - O J Huckstep
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - W Williamson
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - A Mohamed
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - C Tan
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - W Lapidaire
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - F Telles
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - L Arnold
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - C Monteiro
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - H Dawes
- Oxford Brookes University, Faculty of Health and Life Sciences, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - C Foster
- University of Bristol, Centre for Exercise, Nutrition & Health Sciences, School of Policy Studies, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A J Lewandowski
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - P Leeson
- University of Oxford, Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford, United Kingdom of Great Britain & Northern Ireland
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33
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Foster C. Deal with the real, not the notional patient, and don't ignore important uncertainties. J Med Ethics 2019; 45:800-801. [PMID: 31604833 DOI: 10.1136/medethics-2019-105857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
There is a strong presumption in favour of the maintenance of life. Given sufficient evidence, it can be rebutted. But the epistemic uncertainties about the best interests of patients in prolonged disorders of consciousness ('PDOC') and the wishes that they should be presumed to have are such that, in most PDOC cases, the presumption cannot be rebutted. It is conventional and wrong (or at least unsupported by the evidence) to assume that PDOC patients have no interest in continued existence. Treatment withdrawal/continuation decisions should focus on the patient as he or she actually is, and should not unjustifiably assume that the premorbid patient continues to exist unchanged, and that the actual patient has the same interests as the premorbid patient and would make the same decisions in relation to treatment as the premorbid patient would have done.
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Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
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Abstract
Rosamond Rhodes contends, by reference to seven examples, that medical ethics is distinctly different from non-medical ethics. Each of those examples, on proper examination, illustrates precisely the opposite contention. It is clear not only that medical ethics relies on the same principles as non-medical (and indeed non-professional) ethics, but that it should so rely. A distinctively medical ethics would be dangerous: it would divorce ethical medical decision-making from the patients whom medicine exists to serve.
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Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
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35
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Foster C, Powell K. The profession's responsibility towards the environment. Vet Rec 2019; 185:634-635. [PMID: 31757919 DOI: 10.1136/vr.l6556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Keith Powell
- Barefoot Vets, Ty-Ysgubor, Llanbedr, Crickhowell, Powys NP8 1SY
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36
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37
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Dobson G, Klein N, Veys P, Qasim W, Silva J, Cheng IL, Shingadia D, Tudor-Williams G, Watters SA, Lyall H, Rao A, Foster C, Bamford A. Persistence of HIV reservoir following successful haematopoietic stem cell transplant for juvenile myelomonocytic leukaemia in a child with perinatally acquired HIV. J Virus Erad 2019; 5:174-177. [PMID: 31700667 PMCID: PMC6816122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This report describes a case of juvenile myelomonocytic leukaemia (JMML) on a background of both perinatally acquired HIV infection and congenital cytomegalovirus, and management of antiretroviral therapy during haematopoietic stem cell transplant. Peripheral blood HIV viral load remained below the lower limit of detection throughout and following transplant and is currently <20 RNA copies/mL. The child is currently in remission from JMML, but HIV DNA remains detectable despite myeloablative conditioning and sustained plasma HIV viral suppression.
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Affiliation(s)
- G Dobson
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK
| | - N Klein
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - P Veys
- UCL Great Ormond Street Institute of Child Health,
London,
UK,Paediatric Bone Marrow Transplant Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - W Qasim
- UCL Great Ormond Street Institute of Child Health,
London,
UK,Paediatric Immunology Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - J Silva
- Paediatric Bone Marrow Transplant Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - IL Cheng
- Paediatric Pharmacy Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - D Shingadia
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - G Tudor-Williams
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK,Division of Infectious Diseases,
Imperial College London,
London,
UK
| | - SA Watters
- UCL Great Ormond Street Institute of Child Health,
London,
UK
| | - H Lyall
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK
| | - A Rao
- Paediatric Haematology Department,
Great Ormond Street Hospital NHS Foundation Trust,
London,
UK
| | - C Foster
- Paediatric Infectious Diseases Department,
St Mary's Hospital,
Imperial College Healthcare NHS Foundation Trust,
London,
UK
| | - A Bamford
- Paediatric Infectious Diseases Department,
Great Ormond Street Hospital for Children NHS Foundation Trust,
London,
UK,UCL Great Ormond Street Institute of Child Health,
London,
UK,Corresponding author: Alasdair Bamford
Paediatric Infectious Diseases Department,
Great Ormond Street Hospital,
Great Ormond Street,
LondonWC1N 3JH,
UK
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38
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Sodergren SC, Wheelwright SJ, Permyakova NV, Patel M, Calman L, Smith PWF, Din A, Richardson A, Fenlon D, Winter J, Corner J, Foster C. Supportive care needs of patients following treatment for colorectal cancer: risk factors for unmet needs and the association between unmet needs and health-related quality of life-results from the ColoREctal Wellbeing (CREW) study. J Cancer Surviv 2019; 13:899-909. [PMID: 31512164 PMCID: PMC6881415 DOI: 10.1007/s11764-019-00805-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022]
Abstract
Purpose To investigate unmet needs of patients with colorectal cancer (CRC) at the end of treatment and whether unmet needs improve over time. Identify predictors of need following treatment and whether unmet need is associated with worse health-related quality of life (HRQoL). Methods As part of the UK ColoREctal Wellbeing (CREW) cohort study, patients treated for CRC completed the Supportive Care Needs Survey Short Form-34 (SCNS SF-34) 15 and 24 months following surgery, along with questionnaires measuring HRQoL, wellbeing, life events, social support, and confidence to manage their cancer before surgery, 3, 9, 15, and 24 months post-surgery. Results The SCNS SF-34 was completed by 526 patients at 15 months and 510 patients at 24 months. About one-quarter of patients had at least one moderate or severe unmet need at both time points. Psychological and physical unmet needs were the most common and did not improve over time. Over 60% of patients who reported 5 or more moderate or severe unmet needs at 15 months experienced the same level of unmet need at 24 months. HRQoL at the beginning of treatment predicted unmet needs at the end of treatment. Unmet needs, specifically physical, psychological, and health system and information needs, were associated with poorer health and HRQoL at the end of treatment. Conclusions Unmet needs persist over time and are associated with HRQoL. Evaluation of HRQoL at the start of treatment would help inform the identification of vulnerable patients. Assessment and care planning in response to unmet needs should be integrated into person-centred care. Implications for Cancer Survivors Early identification of CRC patients at risk of unmet needs will help infrom personalised survivorship care plans. The implementation of personalised and tailored services are likely to confer HRQoL gains. Electronic supplementary material The online version of this article (10.1007/s11764-019-00805-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S C Sodergren
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - S J Wheelwright
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - N V Permyakova
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - M Patel
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - L Calman
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - P W F Smith
- Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
| | - A Din
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
| | - A Richardson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - J Winter
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Corner
- Executive Office, University of Nottingham, Nottingham, UK
| | - C Foster
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, S017 1BJ, UK.
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39
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Foster C, Dominguez S, Tagarro A, Nastouli E, Palma P, Gkouleli R, Heaney J, Giaquinto C, Rossi P, Rojo P. The CARMA study – children on early suppressive therapy: total HIV-1 DNA quantitation 12 years post ART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31041-4] [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: 10/23/2022] Open
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40
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Dobson G, Klein N, Veys P, Qasim W, Silva J, Cheng I, Shingadia D, Tudor-Williams G, Watters S, Lyall H, Rao A, Foster C, Bamford A. Persistence of HIV reservoir following successful haematopoietic stem cell transplant for juvenile myelomonocytic leukaemia in a child with perinatally acquired HIV. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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Foster C. It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness. J Med Ethics 2019; 45:265-270. [PMID: 30765416 DOI: 10.1136/medethics-2018-105250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/07/2018] [Revised: 01/15/2019] [Accepted: 01/23/2019] [Indexed: 05/23/2023]
Abstract
In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient's best interest to remain alive. And second (and more controversially and repercussively), that even if permanent unconsciousness can be unequivocally demonstrated, the presumption is not rebutted. This is because there is plainly more to human existence than consciousness (or consciousness the markers of which can ever be demonstrated by medical investigations). It can never be said that the identity of the patient whose best interests are at stake evaporates (so eliminating the legal or ethical subject) when that person ceases to be conscious. Nor can it be said that the best interests of an unconscious person do not mandate continued biological existence. We simply cannot know. That uncertainty is legally conclusive, and (subject to resource allocation questions and views about the relevance of family wishes and the previously expressed wishes of the patient) should be ethically conclusive.
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Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
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42
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Busico M, das Neves A, Carini F, Pedace M, Villalba D, Foster C, García Urrutia J, Garbarini M, Jereb S, Sacha V, Estenssoro E. Follow-up program after intensive care unit discharge. Med Intensiva 2019; 43:243-254. [PMID: 30833016 DOI: 10.1016/j.medin.2018.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/03/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. METHODS The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. CONCLUSION The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS.
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Affiliation(s)
- M Busico
- Clínica Olivos, SMG, Buenos Aires, Argentina; Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina.
| | - A das Neves
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital San Martín de La Plata, La Plata, Argentina
| | - F Carini
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Pedace
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D Villalba
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Clínica Basilea, Buenos Aires, Argentina
| | - C Foster
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - J García Urrutia
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Alejandro Posadas, Buenos Aires, Argentina
| | - M Garbarini
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Jereb
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Alejandro Posadas, Buenos Aires, Argentina
| | - V Sacha
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - E Estenssoro
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital San Martín de La Plata, La Plata, Argentina
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43
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Shin W, Wu A, Massidda MW, Foster C, Thomas N, Lee DW, Koh H, Ju Y, Kim J, Kim HJ. A Robust Longitudinal Co-culture of Obligate Anaerobic Gut Microbiome With Human Intestinal Epithelium in an Anoxic-Oxic Interface-on-a-Chip. Front Bioeng Biotechnol 2019; 7:13. [PMID: 30792981 PMCID: PMC6374617 DOI: 10.3389/fbioe.2019.00013] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/18/2019] [Indexed: 01/01/2023] Open
Abstract
The majority of human gut microbiome is comprised of obligate anaerobic bacteria that exert essential metabolic functions in the human colon. These anaerobic gut bacteria constantly crosstalk with the colonic epithelium in a mucosal anoxic-oxic interface (AOI). However, in vitro recreation of the metabolically mismatched colonic AOI has been technically challenging. Furthermore, stable co-culture of the obligate anaerobic commensal microbiome and epithelial cells in a mechanically dynamic condition is essential for demonstrating the host-gut microbiome crosstalk. Here, we developed an anoxic-oxic interface-on-a-chip (AOI Chip) by leveraging a modified human gut-on-a-chip to demonstrate a controlled oxygen gradient in the lumen-capillary transepithelial interface by flowing anoxic and oxic culture medium at various physiological milieus. Computational simulation and experimental results revealed that the presence of the epithelial cell layer and the flow-dependent conditioning in the lumen microchannel is necessary and sufficient to create the steady-state vertical oxygen gradient in the AOI Chip. We confirmed that the created AOI does not compromise the viability, barrier function, mucin production, and the expression and localization of tight junction proteins in the 3D intestinal epithelial layer. Two obligate anaerobic commensal gut microbiome, Bifidobacterium adolescentis and Eubacterium hallii, that exert metabolic cross-feeding in vivo, were independently co-cultured with epithelial cells in the AOI Chip for up to a week without compromising any cell viability. Our new protocol for creating an AOI in a microfluidic gut-on-a-chip may enable to demonstrate the key physiological interactions of obligate anaerobic gut microbiome with the host cells associated with intestinal metabolism, homeostasis, and immune regulation.
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Affiliation(s)
- Woojung Shin
- Department of Biomedical Engineering, The University of Texas at Austin Austin, TX, United States
| | - Alexander Wu
- Department of Biomedical Engineering, The University of Texas at Austin Austin, TX, United States
| | - Miles W Massidda
- Department of Biomedical Engineering, The University of Texas at Austin Austin, TX, United States
| | - Charles Foster
- Department of Biomedical Engineering, The University of Texas at Austin Austin, TX, United States
| | - Newin Thomas
- Department of Biomedical Engineering, The University of Texas at Austin Austin, TX, United States
| | - Dong-Woo Lee
- Department of Biotechnology, College of Life Science and Technology, Yonsei University, Seoul, South Korea
| | - Hong Koh
- Department of Pediatrics, Severance Fecal Microbiota Transplantation Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Youngwon Ju
- Department of Chemistry, Research Institute for Basic Sciences, Kyung Hee University, Seoul, South Korea
| | - Joohoon Kim
- Department of Chemistry, Research Institute for Basic Sciences, Kyung Hee University, Seoul, South Korea.,KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, South Korea
| | - Hyun Jung Kim
- Department of Biomedical Engineering, The University of Texas at Austin Austin, TX, United States.,Department of Medical Engineering, Yonsei University College of Medicine, Seoul, South Korea
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44
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Germuska M, Chandler HL, Stickland RC, Foster C, Fasano F, Okell TW, Steventon J, Tomassini V, Murphy K, Wise RG. Dual-calibrated fMRI measurement of absolute cerebral metabolic rate of oxygen consumption and effective oxygen diffusivity. Neuroimage 2019; 184:717-728. [PMID: 30278214 PMCID: PMC6264385 DOI: 10.1016/j.neuroimage.2018.09.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 01/14/2023] Open
Abstract
Dual-calibrated fMRI is a multi-parametric technique that allows for the quantification of the resting oxygen extraction fraction (OEF), the absolute rate of cerebral metabolic oxygen consumption (CMRO2), cerebral vascular reactivity (CVR) and baseline perfusion (CBF). It combines measurements of arterial spin labelling (ASL) and blood oxygenation level dependent (BOLD) signal changes during hypercapnic and hyperoxic gas challenges. Here we propose an extension to this methodology that permits the simultaneous quantification of the effective oxygen diffusivity of the capillary network (DC). The effective oxygen diffusivity has the scope to be an informative biomarker and useful adjunct to CMRO2, potentially providing a non-invasive metric of microvascular health, which is known to be disturbed in a range of neurological diseases. We demonstrate the new method in a cohort of healthy volunteers (n = 19) both at rest and during visual stimulation. The effective oxygen diffusivity was found to be highly correlated with CMRO2 during rest and activation, consistent with previous PET observations of a strong correlation between metabolic oxygen demand and effective diffusivity. The increase in effective diffusivity during functional activation was found to be consistent with previously reported increases in capillary blood volume, supporting the notion that measured oxygen diffusivity is sensitive to microvascular physiology.
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Affiliation(s)
- M Germuska
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - H L Chandler
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - R C Stickland
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - C Foster
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - F Fasano
- Siemens Healthcare Ltd, Frimley, Camberley, UK
| | - T W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - J Steventon
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - V Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - K Murphy
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - R G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK.
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45
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Abstract
Over the last quarter of a century, English medical law has taken an increasingly firm stand against medical paternalism. This is exemplified by cases such as Bolitho v City and Hackney Health Authority, Chester v Afshar, and Montgomery v Lanarkshire Health Board. In relation to decision-making on behalf of incapacitous adults, the actuating principle of the Mental Capacity Act 2005 is respect for patient autonomy. The only lawful acts in relation to an incapacitous person are acts which are in the best interests of that person. The 2005 Act requires a holistic assessment of best interests. Best interests are wider than 'medical best interests'. The 2018 judgment of the Supreme Court in An NHS Trust v Y (which concerned the question of whether a court needed to authorise the withdrawal of life-sustaining clinically administered nutrition/hydration (CANH) from patients in prolonged disorders of consciousness (PDOC)) risks reviving medical paternalism. The judgment, in its uncritical endorsement of guidelines from various medical organisations, may lend inappropriate authority to medical judgments of best interests and silence or render impotent non-medical contributions to the debate about best interests-so frustrating the 2005 Act. To minimise these dangers, a system of meditation should be instituted whenever it is proposed to withdraw (at least) life-sustaining CANH from (at least) patients with PDOC, and there needs to be a guarantee of access to the courts for families, carers and others who wish to challenge medical conclusions about withdrawal. This would entail proper public funding for such challenges.
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Affiliation(s)
- Charles Foster
- Faculty of Law, University of Oxford, Oxford OX1 3UL, UK
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46
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Affiliation(s)
- Keith Powell
- Honddu Veterinary Practice, Ffrwdgrech Estate, Brecon, Powys LD3 8LA
| | - Charles Foster
- Green Templeton College, University of Oxford, Oxford OX2 6HG
| | - Simon Evans
- Chief Executive, Wye and Usk Foundation, The Right Bank, The Square, Talgarth, Brecon LD3 0BW
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47
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Affiliation(s)
- Keith Powell
- Honddu Veterinary Practice, Ffrwdgrech Estate, Brecon, Powys LD3 8LA
| | - Charles Foster
- Green Templeton College, University of Oxford, Oxford OX2 6HG
| | - Simon Evans
- Chief Executive, Wye and Usk Foundation, The Right Bank, The Square, Talgarth, Brecon LD3 0BW
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Ali UM, Judge A, Foster C, Brooke A, James K, Marriott T, Lamb SE. Do portable nursing stations within bays of hospital wards reduce the rate of inpatient falls? An interrupted time-series analysis. Age Ageing 2018; 47:818-824. [PMID: 30010697 PMCID: PMC6201822 DOI: 10.1093/ageing/afy097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background falls can negatively affect patients, resulting in loss of independence and functional decline and have substantial healthcare costs. Hospitals are a high-risk falls environment and regularly introduce, but seldom evaluate, policies to reduce inpatient falls. This study evaluated whether introducing portable nursing stations in ward bays to maximise nurse-patient contact time reduced inpatient falls. Methods inpatient falls data from local hospital incident reporting software (Datix) were collected monthly (April 2014-December 2017) from 17 wards in Stoke Mandeville and Wycombe General Hospitals, the UK. Portable nursing stations were introduced in bays on these wards from April 2016. We used a natural experimental study design and interrupted time series analysis to evaluate changes in fall rates, measured by the monthly rate of falls per 1000 occupied bed days (OBDs). Results the wards reported 2875 falls (April 2014-December 2017). The fallers' mean age was 78 (SD = 13) and 58% (1624/2817) were men. Most falls, 99.41% (2858/2875), resulted in none, low or moderate harm, 0.45% (13/2875) in severe harm and 0.14% (4/2875) in death. The monthly falls rate increased by 0.119 per 1000 OBDs (95% CI: 0.045, 0.194; P = 0.002) before April 2016, then decreased by 0.222 per 1000 OBDs (95% CI: -0.350, -0.093; P = 0.001) until December 2017. At 12 months post-intervention, the absolute difference between the estimated post-intervention trend and pre-intervention projected estimate was 2.84 falls per 1000 OBDs, a relative reduction of 26.71%. Conclusion portable nursing stations were associated with lower monthly falls rates and could reduce inpatient falls across the NHS.
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Affiliation(s)
- U M Ali
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
| | - A Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - C Foster
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - A Brooke
- Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - K James
- Oxford Academic Health Sciences Network, Oxford, UK
| | - T Marriott
- Oxford Academic Health Sciences Network, Oxford, UK
| | - S E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Rehabilitation Research in Oxford, University of Oxford, Oxford, UK
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Bossley M, Steiner A, Brakes P, Shrimpton J, Foster C, Rendell L. Tail walking in a bottlenose dolphin community: the rise and fall of an arbitrary cultural 'fad'. Biol Lett 2018; 14:rsbl.2018.0314. [PMID: 30185606 DOI: 10.1098/rsbl.2018.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/06/2018] [Indexed: 11/12/2022] Open
Abstract
Social learning of adaptive behaviour is widespread in animal populations, but the spread of arbitrary behaviours is less common. In this paper, we describe the rise and fall of a behaviour called tail walking, where a dolphin forces the majority of its body vertically out of the water and maintains the position by vigourously pumping its tail, in a community of Indo-Pacific bottlenose dolphins (Tursiops aduncus). The behaviour was introduced into the wild following the rehabilitation of a wild female individual, Billie, who was temporarily co-housed with trained dolphins in a dolphinarium. This individual was sighted performing the behaviour seven years after her 1988 release, as was one other female dolphin named Wave. Initial production of the behaviour was rare, but following Billie's death two decades after her release, Wave began producing the behaviour at much higher rates, and several other dolphins in the community were subsequently sighted performing the behaviour. Social learning is the most likely mechanism for the introduction and spread of this unusual behaviour, which has no known adaptive function. These observations demonstrate the potential strength of the capacity for spontaneous imitation in bottlenose dolphins, and help explain the origin and spread of foraging specializations observed in multiple populations of this genus.
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Affiliation(s)
- M Bossley
- WDC, PO Box 720, Port Adelaide BC, Port Adelaide, SA 5142, Australia
| | - A Steiner
- Les Brussattes 1, 2904 Bressaucourt, Switzerland
| | - P Brakes
- WDC, PO Box 720, Port Adelaide BC, Port Adelaide, SA 5142, Australia.,Centre for Ecology and Conservation, University of Exeter, Tremough, Penryn, Cornwall TR10 9FE, UK
| | - J Shrimpton
- WDC, PO Box 720, Port Adelaide BC, Port Adelaide, SA 5142, Australia
| | - C Foster
- WDC, PO Box 720, Port Adelaide BC, Port Adelaide, SA 5142, Australia
| | - L Rendell
- Centre for Social Learning and Cognitive Evolution, and Sea Mammal Research Unit, School of Biology, University of St Andrews, Fife KY16 9TH, UK
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McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, 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Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [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] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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