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McGrath D, Lee H, Sun C, Kawabori M, Zhan Y. Right transaxillary transcatheter aortic valve replacement is comparable to left despite challenges. Gen Thorac Cardiovasc Surg 2024:10.1007/s11748-024-02015-z. [PMID: 38460099 DOI: 10.1007/s11748-024-02015-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/03/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Transaxillary access is the most popular alternative to transfemoral transcatheter aortic valve replacement. Although left transaxillary access is generally preferred, right transaxillary transcatheter aortic valve replacement could be challenging because of the opposing axillary artery and aortic curvatures, which may warrant procedural modifications to improve alignment. Our aim is to compare our single center's outcomes for left and right transaxillary access groups and to evaluate procedural modifications for facilitating right transaxillary transcatheter aortic valve replacement. METHODS Patient characteristics and outcomes were compared for consecutive left or right axillary TAVRs performed from 6/2016 to 6/2022 with SAPIEN 3. The effects of our previously reported "flip-n-flex" technique on procedural efficiency and new conduction disturbances were subanalyzed in the right axillary group. RESULTS Right and left transaxillary transcatheter aortic valve replacement were performed in 25 (18 with the "flip-n-flex" technique) and 26 patients, respectively. There were no significant differences between patient characteristics or outcomes. Right axillary subanalysis showed the "flip-n-flex" technique group had significantly shorter fluoroscopy times (21.2 ± 6.2 vs 29.6 ± 12.4 min, p = 0.03) and a trend towards less permanent pacemaker implantation (6.3% vs. 42.9%, p = 0.07) compared to the group without "flip-n-flex". CONCLUSIONS In our study, despite anatomical challenges, right transaxillary transcatheter aortic valve replacement is comparable to left access. The "flip-n-flex" technique advances right transaxillary as an appealing access for patients with few options.
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Affiliation(s)
| | - Hansuh Lee
- Tufts University School of Medicine, Boston, MA, USA
| | - Charley Sun
- Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Yong Zhan
- Division of Cardiac Surgery, CardioVascular Center, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
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2
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Rick B, McGrath D, McCoy SW, Armstrong WH. Unchanged frequency and decreasing magnitude of outbursts from ice-dammed lakes in Alaska. Nat Commun 2023; 14:6138. [PMID: 37783682 PMCID: PMC10545694 DOI: 10.1038/s41467-023-41794-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Abstract
Glacial lakes can form and grow due to glacial retreat, and rapid lake drainage can produce destructive floods. Outburst flood compilations show a temporal increase in frequency; however, recent studies highlight the role of observational bias, creating uncertainty about current and future glacial-lake hazards. Here, we focus on the Alaska region, which generated a third of previously documented outbursts globally. Using multitemporal satellite imagery, we documented 1150 drainages from 106 ice-dammed lakes between 1985 and 2020. Documented events became more frequent over time, however, accounting for increasing image availability reveals no significant increase occurred. Most lakes decreased in area and volume, suggesting a reduction in regional flood hazard. Our satellite-based approach documented 60% more events in a 35-year period than had previously been documented over 100 years. This suggests that outburst floods have historically been underreported and warrants systematic study of other regions.
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Affiliation(s)
- B Rick
- Department of Geosciences, Colorado State University, Fort Collins, CO, 80523, USA.
- Alaska Climate Adaptation Science Center, Fairbanks, AK, 99775, USA.
| | - D McGrath
- Department of Geosciences, Colorado State University, Fort Collins, CO, 80523, USA
| | - S W McCoy
- Department of Geological Sciences and Engineering, University of Nevada, Reno, NV, 89557, USA
| | - W H Armstrong
- Department of Geological and Environmental Sciences, Appalachian State University, Boone, NC, 28607, USA
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3
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Delungahawatta T, Dunne SS, Hyde S, Halpenny L, McGrath D, O'Regan A, Dunne CP. Advances in e-learning in undergraduate clinical medicine: a systematic review. BMC Med Educ 2022; 22:711. [PMID: 36207721 PMCID: PMC9540295 DOI: 10.1186/s12909-022-03773-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND E-learning is recognised as a useful educational tool and is becoming more common in undergraduate medical education. This review aims to examine the scope and impact of e-learning interventions on medical student learning in clinical medicine, in order to aid medical educators when implementing e-learning strategies in programme curricula. METHODS A systematic review compliant with PRISMA guidelines that appraises study design, setting and population, context and type of evaluations. Specific search terms were used to locate articles across nine databases: MEDLINE/PubMed, ScienceDirect, EMBASE, Cochrane Library, ERIC, Academic Search Complete, CINAHL, Scopus and Google Scholar. Only studies evaluating e-learning interventions in undergraduate clinical medical education between January 1990 and August 2021 were selected. Of the 4,829 papers identified by the search, 42 studies met the inclusion criteria. RESULTS The 42 studies included varied in scope, cognitive domain, subject matter, design, quality and evaluation. The most popular approaches involved multimedia platforms (33%) and case-based approaches (26%), were interactive (83%), asynchronous (71%) and accessible from home (83%). Twelve studies (29%) evaluated usability, all of which reported positive feedback. Competence in use of technology, high motivation and an open attitude were key characteristics of successful students and preceptors. CONCLUSIONS Medical education is evolving consistently to accommodate rapid changes in therapies and procedures. In today's technologically adept world, e-learning is an effective and convenient pedagogical approach for the teaching of undergraduate clinical medicine.
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Affiliation(s)
| | - S S Dunne
- School of Medicine, University of Limerick, Limerick, Ireland
| | - S Hyde
- School of Medicine, University of Limerick, Limerick, Ireland
| | - L Halpenny
- School of Medicine, University of Limerick, Limerick, Ireland
| | - D McGrath
- School of Medicine, University of Limerick, Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4I), University of Limerick, Limerick, Ireland
| | - A O'Regan
- School of Medicine, University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland.
- Centre for Interventions in Infection, Inflammation & Immunity (4I), University of Limerick, Limerick, Ireland.
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McGrath D, Sun C, Kawabori M, Zhan Y. TCT-595 Alternative Peripheral vs Transfemoral Access for Transcatheter Aortic Valve Replacement: A Meta-Analysis of Propensity-Matched Studies. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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McGrath D, Zhan Y. Cranial nerve injury: A word of caution for transcarotid transcatheter aortic valve replacement. Int J Cardiol 2022; 356:44. [PMID: 35306027 DOI: 10.1016/j.ijcard.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Daniel McGrath
- Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States of America
| | - Yong Zhan
- Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States of America.
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6
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McGrath D, Salehi P, Weintraub A, Zhan Y. Transcarotid transcatheter aortic valve replacement with cerebral embolic protection. J Card Surg 2022; 37:1779-1782. [PMID: 35301761 DOI: 10.1111/jocs.16417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
There remains concern about the risk of stroke with transcarotid transcatheter aortic valve replacement (TAVR). We describe the use of the Sentinel cerebral protection device with transcarotid TAVR in a patient at high risk for embolic complications. Deployment of the Sentinel filter in the innominate artery accommodated the insertion of the TAVR device through the bovine aortic arch via the contralateral carotid artery. By adapting the "flip-n-flex" technique from our previous transaxillary TAVR experience, we performed left transcarotid TAVR with the Sentinel device in an ergonomic manner and achieved coaxial placement of the transcatheter valve. Inspection of the Sentinel filter after the case revealed captured embolic debris.
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Affiliation(s)
- Daniel McGrath
- Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Payam Salehi
- Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Andrew Weintraub
- Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yong Zhan
- Cardiovascular Center, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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7
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Worobetz A, O'Callaghan M, Walsh J, Casey M, Hayes P, Bengoechea EG, Woods C, McGrath D, Glynn LG. Exercise Compared to Mindfulness for Physical and Mental Wellbeing in Medical Students. Ir Med J 2022; 115:560. [PMID: 35532732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Aim Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The 'MED-WELL' programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the 'MED-WELL' programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the 'MED-WELL' programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration.
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Affiliation(s)
- A Worobetz
- School of Medicine, University of Limerick, Limerick, Ireland
| | - M O'Callaghan
- School of Medicine, University of Limerick, Limerick, Ireland
| | - J Walsh
- Department of Psychology, National University of Ireland, Galway, Ireland
| | - M Casey
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
| | - P Hayes
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
| | - E G Bengoechea
- HRB Primary Care Clinical Trials Network Ireland
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - C Woods
- HRB Primary Care Clinical Trials Network Ireland
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Ireland
| | - D McGrath
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
| | - L G Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
- HRB Primary Care Clinical Trials Network Ireland
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8
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O’Connell N, O’Connor K, McGrath D, Vagge L, Mockler D, Jennings R, Darker CD. Early Intervention in Psychosis services: A systematic review and narrative synthesis of the barriers and facilitators to implementation. Eur Psychiatry 2021; 65:e2. [PMID: 34913421 PMCID: PMC8792869 DOI: 10.1192/j.eurpsy.2021.2260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services target the early manifestation of psychosis and provide multidisciplinary care. They demonstrate effectiveness and cost-effectiveness. Implementation of EIP services is inconsistent and piecemeal. This systematic review and narrative synthesis aims to identify barriers and facilitators to EIP service implementation. METHODS We conducted an electronic search of databases (EMBASE, Medline, Web of Science, and PsychINFO) to detect papers reporting EIP service implementation findings and associated barriers and facilitators. The search occurred between June to August 2020, and again in January 2021. Articles meeting inclusion criteria were extracted and narratively synthesized. A quality assessment was conducted using the Mixed Methods Appraisal Tool. RESULTS Twenty-three studies were selected. The most common study design was descriptive accounts of implementation. Patient age ranged varied from 14 to 35 years. We identified three barrier and facilitator domains: (a) system; (b) services; and (c) staff, and a range of subdomains. The most frequent subdomains were "funding" and "strength of collaboration and communication between EIP and outside groups and services". Associations between domains and subdomains were evident, particularly between systems and services. CONCLUSIONS A range of barriers and facilitators to EIP implementation exist. Some of these are generic factors germane across health systems and services, while others are specific to EIP services. A thorough prior understanding of these challenges and enablers are necessary before implementation is attempted. Accounting for these issues within local and national contexts may help predict and increase the likelihood of services' success, stability, and longevity.
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Affiliation(s)
- N. O’Connell
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - K. O’Connor
- National Clinical Programme for Early Intervention in Psychosis,
Health Service ExecutiveDublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of
Psychiatry, University College Cork
| | - D. McGrath
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - L. Vagge
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
| | - D. Mockler
- Rise, South Lee Mental Health Services, Cork & Department of
Psychiatry, University College Cork
- Trinity College Dublin Library, Trinity College
Dublin, Dublin, Ireland
| | - R. Jennings
- National Clinical Programme for Early Intervention in Psychosis,
Health Service ExecutiveDublin, Ireland
| | - C. D. Darker
- Discipline of Public Health and Primary Care, Institute of Population
Health, School of Medicine, Trinity College Dublin,
Dublin, Ireland
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9
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Hayes CB, Murray SR, Lyne SJ, Cryan MC, Mullin M, McGrath D. Not really a smoker? Prevalence and attitudes to social occasional smoking in Trinity College Dublin. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Occasional smoking is defined as any smoking which occurs on a less than daily basis. Social smoking is a sub-group of occasional smoking which is smoking primarily carried out in social contexts. Data on occasional cigarette smoking and the subset of social smoking among third-level students are limited. This study assessed the prevalence of and attitudes to occasional/social smoking among undergraduates and postgraduates in an Irish university
Aims
(1) To determine the prevalence of occasional/social smoking among third-level students; (2) To evaluate students' attitudes to occasional/social smoking, including perceived benefits and harm; (3) To explore when students commenced occasional/social smoking, their reasons and their continued smoking habits; and (4) To determine any influence of other factors e.g. alcohol consumption on occasional/social smoking.
Methods
Anonymous online survey of undergraduates and postgraduates, via email and social media using Survey Monkey. Data were analysed in Microsoft Excel.
Results
1,310/18,407 (7.1%) of students responded. 1,267/1,310 (96.7%) provided adequate data for analysis. 423/1267 (33.4%) self-reported as current smokers of whom 106/1267 (8.4%) classified themselves as daily and 317/1267 (25%) as occasional smokers. The occasional smokers comprised 266/1267 (21%) social smokers and 51/1267 (4%) non-social smokers. Occasional smokers tended to start smoking later and think less about quitting than daily smokers. 386/423 (97.2%) of all current smokers reported that alcohol increased their smoking habits.
Conclusions
Prevalence of self-reported occasional smoking among university students was higher than daily smoking. Most occasional smokers primarily smoked in social contexts. All current smokers reported that alcohol increased cigarette intake. Effective intervention campaigns tailored to determinants of occasional/social smoking are needed as part of induction to third level.
Key messages
Prevalence of self-reported occasional smoking among university students is higher than daily smoking. Most occasional smokers smoke primarily in a social environment. Campaigns tailored to determinants of occasional/social smoking are needed for university entrants as part of induction to third level.
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Affiliation(s)
- CB Hayes
- Trinity College Dublin, Institute of Population Health, Dublin, Ireland
| | - SR Murray
- Trinity College Dublin, Institute of Population Health, Dublin, Ireland
| | - SJ Lyne
- Trinity College Dublin, Institute of Population Health, Dublin, Ireland
| | - MC Cryan
- Trinity College Dublin, Institute of Population Health, Dublin, Ireland
| | - M Mullin
- Trinity College Dublin, Institute of Population Health, Dublin, Ireland
| | - D McGrath
- Trinity College Dublin, Institute of Population Health, Dublin, Ireland
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10
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Linnane B, O'Connell N, Obande E, Dunne S, Clancy C, Kiernan M, McGrath D, O'Sullivan K, O'Sullivan L, Dunne C. Assessment of the microbial load of airway clearance devices used by a cohort of children with cystic fibrosis. Infect Prev Pract 2021; 3:100153. [PMID: 34647008 PMCID: PMC8498708 DOI: 10.1016/j.infpip.2021.100153] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background Positive expiratory pressure (PEP) devices are an important element of the management of cystic fibrosis, and of other respiratory diseases. Whereas there have been reports in the literature of contamination of airway clearance devices and their surfaces by microbial pathogens, there is little evidence available regarding such contamination and its contribution to respiratory infection. Aim To establish whether pathogenic bacteria can contaminate PEP devices in the context of normal cleaning and maintenance practices. Methods Patients' home-use clearance devices were brought to a routine clinic appointment and collected for microbiology sampling and analysis. The patients were provided with replacement devices. Nineteen such devices were collected from 17 patients, reflecting use of multiple devices by some patients. Swabs were taken and cultured from each patient's used device, the patient's airway, as well as from new unopened and unused devices that acted as controls. Results Seven of 19 devices (37%) tested positive for presence of pathogenic bacteria. Device-cleaning methods varied among patients and non-sterilization methods were found to be ineffective at removing pathogens. Microbial species found on the devices did not correlate with those identified from airway swabs. Conclusion This study demonstrates the presence of pathogens on positive expiratory pressure devices. The potential for transmission of these pathogens to the patient's airway and the risk of infection remains unclear and requires further study.
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Affiliation(s)
- B. Linnane
- Paediatric Cystic Fibrosis Department, University Hospital Limerick, Limerick, Ireland
- National Children's Research Centre, Crumlin, Dublin, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - N.H. O'Connell
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
- Department of Clinical Microbiology, University Limerick Hospital Group, Limerick, Ireland
| | - E. Obande
- Paediatric Cystic Fibrosis Department, University Hospital Limerick, Limerick, Ireland
- National Children's Research Centre, Crumlin, Dublin, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - S.S. Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - C. Clancy
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - M.G. Kiernan
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - D. McGrath
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
| | - K.J. O'Sullivan
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
- Rapid Innovation Unit – Confirm Centre for Smart Manufacturing, School of Design & Health Research Institute, University of Limerick, Limerick, Ireland
| | - L. O'Sullivan
- Rapid Innovation Unit – Confirm Centre for Smart Manufacturing, School of Design & Health Research Institute, University of Limerick, Limerick, Ireland
| | - C.P. Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and School of Medicine, University of Limerick, Limerick, Ireland
- Corresponding author. Address: School of Medicine, University of Limerick, Castletroy, Limerick, Ireland. Tel.: +353-(0)86-0430739.
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11
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Zhan Y, Kooperkamp H, Lofftus S, McGrath D, Kawabori M, Chen FY. Conventional open versus hybrid aortic arch repair: a meta-analysis of propensity-matched studies. J Thorac Dis 2021; 13:4714-4722. [PMID: 34527312 PMCID: PMC8411138 DOI: 10.21037/jtd-21-183] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/02/2021] [Indexed: 12/03/2022]
Abstract
Background Comparison of conventional (open) surgical versus hybrid aortic arch repair remains debatable. While the majority of previous comparative studies including meta-analyses contained primarily risk-unadjusted cohorts, those focusing on propensity-matched comparisons were limited by their small sample size. We aimed to compare outcomes of these two approaches through an up-to-date search and meta-analysis of the best evidence currently available in the literature. Methods The PubMed/MEDLINE, EMBASE, and Cochrane library from inception to September 2019 were searched to identify articles reporting propensity-score matching data on open versus hybrid aortic arch repair. Patients’ baseline characteristics and clinical outcomes were extracted from the articles and pooled for analysis. Heterogeneity and biases were assessed among the included studies. Results Five studies, including a total of 378 patients (189 pairs), were included in the study. The two groups were similar in patients’ baseline characteristics. Stroke rate favoured the open group [2.1% versus 14.3%, OR 0.18 (0.07, 0.46), P=0.0004, I2=0%]. There was no significant difference between the two groups with regard to paraplegia. The hybrid group had numerically higher short-term mortality, but lower rate of acute renal failure requiring dialysis. There was a statistically significant difference between the mid-term survivals of the open and hybrid groups, with lower pooled mortality seen for the open group at 1-year and 2-years (P=0.02). Conclusions Open and hybrid repairs do not offer equivalent outcomes. Compared with hybrid aortic arch repair, conventional surgical aortic repair could be associated with favourable outcomes including postoperative stroke. Hybrid repair does not appear to provide better survival. Operative approaches should be carefully selected in treating aortic arch pathology.
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Affiliation(s)
- Yong Zhan
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Hannah Kooperkamp
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Serena Lofftus
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel McGrath
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Masashi Kawabori
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Frederick Y Chen
- Division of Cardiac Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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12
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Hassan S, McGrath D, Barnes R, Middleton S. Radiofrequency Ablation (Rafaelo Procedure) for the Treatment of Hemorrhoids: A Case Series in the United Kingdom. Ann Coloproctol 2021; 39:164-167. [PMID: 34407371 PMCID: PMC10169552 DOI: 10.3393/ac.2021.00276.0039] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/19/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose Hemorrhoidal disease remains a common condition that can have a significant effect on a patient's quality of life. Various methods have been introduced over the years; however, their overall success rates remain low. Although the traditional Milligan Morgan technique is effective, the associated pain level prevents it from being an attractive form of treatment. This study was devised to assess the safety and efficacy associated with a novel minimally invasive approach, radiofrequency ablation (RFA). Methods Forty-two patients underwent RFA at a single center, by 1 of 2 surgeons. This was performed under local anesthetic and sedation. Outcomes including postoperative pain levels, recurrence rates, and patient satisfaction scores were recorded and analyzed using medians and interquartile ranges. Results The median postoperative pain score was 2.5/10 (interquartile range [IQR], 0-4.5) and the overall patient satisfaction score was 9/10 (IQR, 6.5-10). Recurrence rates (6-12 months following the procedure) were low at 12% and all patients reported milder symptoms at recurrence. There were no serious adverse complications. Conclusion The results from this case series supports other limited data in concluding that RFA is a safe and effective method in the treatment of hemorrhoids and patients report a high level of satisfaction following.
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Affiliation(s)
- Sarah Hassan
- Department of General Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Daniel McGrath
- Department of General Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Richard Barnes
- Department of Anaesthetics, Royal Berkshire Hospital, Reading, United Kingdom
| | - Simon Middleton
- Department of General Surgery, Royal Berkshire Hospital, Reading, United Kingdom
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13
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Abstract
OBJECTIVES The objective of this study was to understand the variables or study habits that inform study in undergraduate and postgraduate students attending Trinity College Dublin. METHODS A descriptive, cross-sectional anonymous online survey was used to gather data to explore student study habits. Survey 1 was completed by participants in April 2019 and survey 2 was completed by participants in April 2020, during the COVID-19 restrictions. RESULTS A total of 1557 participants completed survey 1 in 2019, and 1793 participants completed survey 2 in 2020. In both surveys a majority reported using caffeine, library study, sleep pattern adjustment and excercise to aid academic performance. Survey 2 participants reported COVID-19 resulted in increased difficulty studying (91%). In particular loss of structure and routine was negatively impacted by the pandemic (92%), and increased feelings of stress were reported (75%). CONCLUSIONS Our study suggests a potential role of the college environment as a target for the implementation of interventions to promote student learning, healthy study habits and well-being. The global pandemic has resulted in additional challenging demands for universities to serve an essential role in supporting college students study habits.
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Affiliation(s)
- C Clarke
- Dublin North Mental Health Services, Millmount Avenue, Drumcondra, Dublin 9, Ireland
| | - M Mullin
- College Health Service, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - D McGrath
- College Health Service, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - N Farrelly
- College Health Service, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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14
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Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S, Colson P, Cudemus Deseda G, Dabboura S, Eckner D, Eden M, Eitel I, Frank D, Frey N, Funamoto M, Goßling A, Graf T, Hagl C, Kirchhof P, Kupka D, Landmesser U, Lipinski J, Lopes M, Majunke N, Maniuc O, McGrath D, Möbius-Winkler S, Morrow DA, Mourad M, Noel C, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Reichenspurner H, Sandri M, Schulze PC, H G Schwinger R, Sinning JM, Aksoy A, Skurk C, Szczanowicz L, Thiele H, Tietz F, Varshney A, Wechsler L, Westermann D. Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study. Circulation 2020; 142:2095-2106. [PMID: 33032450 PMCID: PMC7688081 DOI: 10.1161/circulationaha.120.048792] [Citation(s) in RCA: 243] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. METHODS Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort. RESULTS Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). CONCLUSIONS In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
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Affiliation(s)
- Benedikt Schrage
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Peter Moritz Becher
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Alexander Bernhardt
- Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida (H.B.)
| | - Stefan Blankenberg
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Stefan Brunner
- Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.)
| | - Gaston Cudemus Deseda
- Division of Anesthesia, Critical Care and Pain Medicine (G.C.D.), Massachusetts General Hospital, Boston
| | - Salim Dabboura
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.)
| | - Matthias Eden
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.)
| | - Derk Frank
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Masaki Funamoto
- Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston
| | - Alina Goßling
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.)
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik (C.H.), LMU Klinikum, Munich, Germany
| | - Paulus Kirchhof
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham National Health ServiceTrusts, United Kingdom (P.K.)
| | - Danny Kupka
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).,Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.)
| | - Jerry Lipinski
- Department of Internal Medicine, University of California, San Diego (J.L.)
| | - Mathew Lopes
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Octavian Maniuc
- Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.)
| | - Daniel McGrath
- Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.)
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.)
| | - Curt Noel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.)
| | | | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).,Department of Anesthesia and Intensive Care, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) ISMETT (Istituto Mediterraneo trapianti e terapie avanzate), UPMC (University of Pittsburgh Medical Center)Italy, Palermo, Italy (F.P.)
| | - Sandeep M Patel
- Department of Interventional Cardiology, St. Rita's Medical Center, Lima, OH (S.M.P.)
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.)
| | - Vittorio Pazzanese
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.)
| | - Hermann Reichenspurner
- Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany
| | - Marcus Sandri
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.)
| | | | - Jan-Malte Sinning
- University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.)
| | - Adem Aksoy
- University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.)
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).,Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.)
| | - Lukasz Szczanowicz
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Franziska Tietz
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Anubodh Varshney
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Lukas Wechsler
- Medizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.)
| | - Dirk Westermann
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
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15
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Carter B, Law J, Hewitt J, Parmar KL, Boyle JM, Casey P, Maitra I, Pearce L, Moug SJ, Ross B, Oleksiewicz J, Fearnhead N, Jump C, Boyle J, Shaw A, Barker J, Hughes J, Randall J, Tonga I, Kynaston J, Boal M, Eardley N, Kane E, Reader H, Mahapatra SR, Garner-Jones M, Tan JJ, Mohamed S, George R, Whiteman E, Malik K, Smart CJ, Bogdan M, Chaudhury MP, Sharma V, Subar D, Patel P, Chok SM, Lim E, Adhiyaman V, Davies G, Ross E, Maitra R, Steele CW, Roxburgh C, Griffiths S, Blencowe NS, Kirkham EN, Abraham JS, Griffiths K, Abdulaal Y, Iqbal MR, Tarazi M, Hill J, Khan A, Farrell I, Conn G, Patel J, Reddy H, Sarveswaran J, Arunachalam L, Malik A, Ponchietti L, Pawelec K, Goh YM, Vitish-Sharma P, Saad A, Smyth E, Crees A, Merker L, Bashir N, Williams G, Hayes J, Walters K, Harries R, Singh R, Henderson NA, Polignano FM, Knight B, Alder L, Kenchington A, Goh YL, Dicurzio I, Griffiths E, Alani A, Knight K, MacGoey P, Ng GS, Mackenzie N, Maitra I, Moug S, Ong K, McGrath D, Gammeri E, Lafaurie G, Faulkner G, Di Benedetto G, McGovern J, Subramanian B, Narang SK, Nowers J, Smart NJ, Daniels IR, Varcada M, Gala T, Cornish J, Barber Z, O'Neill S, McGregor R, Robertson AG, Paterson-Brown S, Raymond T, Thaha MA, English WJ, Forde CT, Paine H, Morawala A, Date R, Casey P, Bolton T, Gleaves X, Fasuyi J, Durakovic S, Dunstan M, Allen S, Riga A, Epstein J, Pearce L, Gaines E, Howe A, Choonara H, Dewi F, Bennett J, King E, McCarthy K, Taylor G, Harris D, Nageswaran H, Stimpson A, Siddiqui K, Lim LI, Ray C, Smith L, McColl G, Rahman M, Kler A, Sharma A, Parmar K, Patel N, Crofts P, Baldari C, Thomas R, Stechman M, Aldridge R, O'Kelly J, Wilson G, Gallegos N, Kalaiselvan R, Rajaganeshan R, Mackenzie A, Naik P, Singh K, Gandraspulli H, Wilson J, Hancorn K, Khawaja A, Nicholas F, Marks T, Abbott C, Chandler S. Association between preadmission frailty and care level at discharge in older adults undergoing emergency laparotomy. Br J Surg 2020; 107:218-226. [DOI: 10.1002/bjs.11392] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/20/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.
Methods
The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.
Results
A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.
Conclusion
Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.
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Affiliation(s)
- B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Law
- Department of Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Hewitt
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - K L Parmar
- Manchester Cancer Research Centre, Manchester, NorthWest Deanery, UK
| | - J M Boyle
- Royal College of Surgeons of England, London, UK
| | - P Casey
- Health Education North West, Manchester, NorthWest Deanery, UK
| | - I Maitra
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - L Pearce
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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16
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Buechler KF, Moi S, Noar B, McGrath D, Villela J, Clancy M, Shenhav A, Colleymore A, Valkirs G, Lee T. Simultaneous Detection of Seven Drugs of Abuse by the TriageTM Panel for Drugs of Abuse. Clin Chem 2019. [DOI: 10.1093/clinchem/38.9.1678] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
This novel, competitive immunoassay simultaneously detects seven drugs of abuse in urine. A urine sample is placed in contact with lyophilized reagents, the reaction mixture is allowed to come to equilibrium (10 min), and then the whole mixture is applied to a solid phase that contains various immobilized antibodies in discrete drug-class-specific zones. After a washing step, the operator visually examines each zone for the presence of a red bar. The method incorporates present threshold concentrations that are independent for each drug. In the absence of drug or in the presence of drug in quantities less than the threshold concentration, no colored bar is visible. Samples containing drug(s) at or above the threshold concentration cause a red bar to appear for the appropriate drug(s). Positive and negative procedural control zones are incorporated into each determination. The performance of the assay methodology matches that of instrumented immunoassay systems.
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Affiliation(s)
| | - S Moi
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | - B Noar
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | - D McGrath
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | - J Villela
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | - M Clancy
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | - A Shenhav
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | | | - G Valkirs
- Biosite Diagnostics, Inc., San Diego, CA 92121
| | - T Lee
- Biosite Diagnostics, Inc., San Diego, CA 92121
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17
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Kulessa B, Booth AD, O'Leary M, McGrath D, King EC, Luckman AJ, Holland PR, Jansen D, Bevan SL, Thompson SS, Hubbard B. Seawater softening of suture zones inhibits fracture propagation in Antarctic ice shelves. Nat Commun 2019; 10:5491. [PMID: 31792201 PMCID: PMC6889338 DOI: 10.1038/s41467-019-13539-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/23/2018] [Accepted: 11/04/2019] [Indexed: 12/05/2022] Open
Abstract
Suture zones are abundant on Antarctic ice shelves and widely observed to impede fracture propagation, greatly enhancing ice-shelf stability. Using seismic and radar observations on the Larsen C Ice Shelf of the Antarctic Peninsula, we confirm that such zones are highly heterogeneous, consisting of multiple meteoric and marine ice bodies of diverse provenance fused together. Here we demonstrate that fracture detainment is predominantly controlled by enhanced seawater content in suture zones, rather than by enhanced temperature as previously thought. We show that interstitial seawater can reduce fracture-driving stress by orders of magnitude, promoting both viscous relaxation and the development of micro cracks, the incidence of which scales inversely with stress intensity. We show how simple analysis of viscous buckles in ice-penetrating radar data can quantify the seawater content of suture zones and their modification of the ice-shelf’s stress regime. By limiting fracture, enhancing stability and restraining continental ice discharge into the ocean, suture zones act as vital regulators of Antarctic mass balance. Suture zones are abundant on Antarctic ice shelves and widely observed to impede fracture propagation. Here we show that fracture detainment is principally controlled by the zones’ enhanced seawater contents, reducing fracture-driving stresses by orders of magnitude and therefore greatly enhancing stability.
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Affiliation(s)
- Bernd Kulessa
- Glaciology Group, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK. .,School of Technology, Environments and Design, University of Tasmania, Hobart, TAS, 7001, Australia.
| | - Adam D Booth
- Institute of Applied Geoscience, School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, UK
| | - Martin O'Leary
- Glaciology Group, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Daniel McGrath
- Department of Geosciences, Colorado State University, Fort Collins, CO, 80523-1036, USA
| | - Edward C King
- British Antarctic Survey, Natural Environment Research Council, Madingley Road, Cambridge, CB3 0ET, UK
| | - Adrian J Luckman
- Glaciology Group, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Paul R Holland
- British Antarctic Survey, Natural Environment Research Council, Madingley Road, Cambridge, CB3 0ET, UK
| | - Daniela Jansen
- Glaciology Group, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.,Division of Glaciology, Alfred-Wegener Institute for Polar and Marine Research, 27568, Bremerhaven, Germany
| | - Suzanne L Bevan
- Glaciology Group, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Sarah S Thompson
- Glaciology Group, College of Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.,Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS, 7001, Australia
| | - Bryn Hubbard
- Centre for Glaciology, Department of Geography and Earth Sciences, Aberystwyth University, Aberystwyth, SY23 3DB, UK
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18
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Egan S, Brama P, McGrath D. Research trends in equine movement analysis, future opportunities and potential barriers in the digital age: A scoping review from 1978 to 2018. Equine Vet J 2019; 51:813-824. [PMID: 30659639 DOI: 10.1111/evj.13076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/20/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since Muybridge's 'horse in motion', researchers in the equine movement analysis field continue to improve objective analysis and performance monitoring while ensuring representative data capture. However, subjective evaluation remains the primary method of equine gait analysis in the applied setting, despite evidence highlighting the unreliability of this approach. OBJECTIVES To map research trends, limitations and opportunities across the diverse equine gait analysis literature. STUDY DESIGN Joanna Briggs Institute and Cochrane systematic scoping review. METHODS Search terms were chosen based on the 'PICO' framework and included keywords such as: Equine, Gait, Kinematics and Analysis. Studies were excluded based on predetermined criteria by two independent researchers. Data were extracted from 510 articles from 1978 to 2018. RESULTS Insights derived from movement analysis appear to be driven by tool availability. Observational research (42.9%) was the most popular study design. Use of wearable technology as a primary research tool is established within the field, accounting for 13.5% of studies. Analysis of limitations identified 17.8% of studies citing challenges to the transferability of research results. Restricted sample size appears to be an underlying contributor to many of the limitations identified. In terms of research opportunities, advances in intervention studies were called for (10.4% of studies) in the following three areas; clinical, rehabilitative exercise and performance/training. MAIN LIMITATIONS This review was confined to research in the English language. CONCLUSIONS Standardised research reporting may alleviate sample size issues by facilitating data pooling, database creation and meta-analyses. Large holistic data collections and application frameworks based on wearable technologies are not reflected in the current equine gait analysis literature and thus represent an interesting opportunity for this field. Progress and lessons learned from the human field of movement analysis can be useful in supporting this potential development.
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Affiliation(s)
- S Egan
- Institute for Sport and Health, School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - P Brama
- Section Veterinary Clinical Sciences, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - D McGrath
- Institute for Sport and Health, School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
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Wentzell S, Moran L, Dobranowski J, Levinson A, Hannigan A, Dunne CP, McGrath D. E-learning for chest x-ray interpretation improves medical student skills and confidence levels. BMC Med Educ 2018; 18:256. [PMID: 30419883 PMCID: PMC6233516 DOI: 10.1186/s12909-018-1364-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Radiology is an important aspect of medicine to which medical students often do not receive sufficient exposure. The aim of this project was to determine whether the integration of an innovative e-learning module on chest x-ray interpretation of the heart would enhance the radiological interpretive skills, and improve the confidence, of first year graduate entry medical students. METHODS All first-year graduate entry (all students had a prior university degree) medical students at the University of Limerick (n = 152) during academic year 2015-16 were invited to participate in this study. An assessment instrument was developed which consisted of 5 radiological cases to be interpreted over a designated and supervised 15-min time period. Students underwent a pre-, mid- and post-intervention assessment of their radiology interpretative skills. An online e-module was provided following the pre-test and additional practice cases were provided following the mid-intervention test. Assessment scores and confidence levels were compared pre-, mid- and post-intervention. RESULTS The overall performance (out of a total score of 25) for the 87 students who completed all three assessments increased from 13.2 (SD 3.36) pre-intervention to 14.3 (SD 2.97) mid-intervention to 15.8 (SD 3.40) post-intervention. This change over time was statistically significant (p < 0.001) with a medium effect size (eta-squared = 0.35). Increases from pre- to post-intervention were observed in each of the five areas assessed, although performance remained poor in diagnosis post-intervention. Of the 118 students who provided feedback after the intervention, 102 (86.4%) stated that they would recommend the resource to a colleague to improve their interpretative skills. CONCLUSIONS This study suggests that early exposure to e-learning radiology modules is beneficial in undergraduate medical school curricula. Further studies are encouraged to assess how long the improvement may last before attrition.
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Affiliation(s)
- S. Wentzell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - L. Moran
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - J. Dobranowski
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - A. Levinson
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | - A. Hannigan
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - C. P. Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - D. McGrath
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Keane S, Clarke M, Murphy M, McGrath D, Smith D, Farrelly N, MacHale S. Disordered eating behaviour in young adults with type 1 diabetes mellitus. J Eat Disord 2018; 6:9. [PMID: 29744106 PMCID: PMC5930421 DOI: 10.1186/s40337-018-0194-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/05/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The combination of eating disorders and diabetes is associated with increased risk of morbidity and mortality. The aim of this study is to compare the prevalence of disordered eating behaviour (DEB) in young adults with type 1 diabetes mellitus to a sample of non-diabetic controls, and to examine the relationship of DEB to glycaemic control. METHODS The Eating Disorder Examination Questionnaire (EDE-Q) was administered to 51 individuals aged 18-30 years attending an outpatient diabetic clinic in a large university teaching hospital. Glycaemic control was assessed by the glycosylated haemoglobin (HbA1c). The control group comprised a consecutive sample of 236 male and female students aged 18-30 years attending a university primary health care service. RESULTS The mean global EDE-Q score for the diabetes group was 0.82 ± 1.1 (mean ± SD) and the mean for the control group was 1.4 ± 1.3 (mean ± SD). The diabetes group was significantly more likely to have a lower global EDE-Q score compared to the control group. There was no association between the global EDE-Q score of the diabetes group and HbA1c level. CONCLUSIONS We did not find increased levels of disordered eating behavior (DEB) in young adults with type 1 diabetes mellitus compared to a non-diabetic control sample.
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Affiliation(s)
- S Keane
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M Clarke
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - M Murphy
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - D McGrath
- 2Trinity College Health Service, Dublin, Ireland
| | - D Smith
- 3Department of Endocrinology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - N Farrelly
- 2Trinity College Health Service, Dublin, Ireland
| | - S MacHale
- 1Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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O’Leary DP, Deering-McCarthy E, McGrath D, Walsh D, Coffey JC. Identification of the optimal visual recording system in open abdominal surgery – a prospective observational study. J Vis Commun Med 2016; 39:127-132. [DOI: 10.1080/17453054.2016.1240584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Agha K, Akbari K, Abbas SH, Middleton S, McGrath D. Acrometastasis following colorectal cancer: A case report and review of literature. Int J Surg Case Rep 2016; 29:158-161. [PMID: 27863343 PMCID: PMC5118610 DOI: 10.1016/j.ijscr.2016.10.078] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/10/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Colorectal cancer commonly metastasises to the liver, peritoneum and lungs. Bony metastases are uncommon in colorectal cancer and in particular metastases to the hands or feet (acrometastasis) are an extremely rare occurrence. CASE PRESENTATION A 65-year-old male with a colonic malignancy underwent elective anterior resection. Intra-operatively he was found to have a pelvic collection necessitating an end colostomy. Histology confirmed complete Dukes B tumour excision with no evidence of lymph node metastases. The patient underwent chemo-radiotherapy but was unsuitable for reversal of Hartmann's due to elevated CEA levels and asymmetrical thickening of the rectal stump with a solitary lung nodule identified at a one-year surveillance CT. The lung nodule was resected revealing metastatic adenocarcinoma and biopsies from the rectal stump showed chronic inflammatory changes. The patient was offered further chemotherapy. However, six years after his original surgery the patient presented with an acutely painful left foot with radiographic appearances of an infiltrative sclerotic and lucent lesion confirmed as a calcaneal acrometastasis on Magnetic Resonance Imaging (MRI). DISCUSSION Diagnosis of acrometastasis is challenging and generally constitutes a wider metastatic process with poor prognosis. Patients are often asymptomatic or present with symptoms mimicking benign lesions such as arthritis, infection or ligamentous sprains of the hands or feet. Therefore, there should be a high index of suspicion and prompt radiological investigation is warranted in order to exclude disease recurrence. CONCLUSION Although acrometastasis may indicate a poor prognosis, timely diagnosis and intervention may facilitate improvement of long-term survival and symptomatic management.
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Affiliation(s)
- Kozar Agha
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom; West Midlands Deanery, Postgraduate School of Surgery, 213 Hagley Road, Edgbaston, B16 9RG, United Kingdom
| | - Khalid Akbari
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom
| | - Syed Husain Abbas
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom.
| | - Simon Middleton
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom
| | - Daniel McGrath
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom
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Gouda P, Kitt K, Evans DS, Goggin D, McGrath D, Last J, Hennessy M, Arnett R, O'Flynn S, Dunne F, O'Donovan D. Irish Medical Students Understanding of the Intern Year. Ir Med J 2016; 109:387. [PMID: 27685481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1,224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce.
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Affiliation(s)
- P Gouda
- National University of Ireland, Galway
- University of Alberta
| | - K Kitt
- National University of Ireland, Galway
| | - D S Evans
- Department of Public Health, HSE West
| | - D Goggin
- Department of Public Health, HSE West
| | | | - J Last
- University College Dublin
| | | | | | | | | | - D O'Donovan
- National University of Ireland, Galway
- Department of Public Health, HSE West
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Weeda ER, Kohn CG, Fermann GJ, Peacock WF, Tanner C, McGrath D, Crivera C, Schein JR, Coleman CI. External validation of prognostic rules for early post-pulmonary embolism mortality: assessment of a claims-based and three clinical-based approaches. Thromb J 2016; 14:7. [PMID: 26977136 PMCID: PMC4790043 DOI: 10.1186/s12959-016-0081-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/25/2016] [Indexed: 12/23/2022] Open
Abstract
Background Studies show the In-hospital Mortality for Pulmonary embolism using Claims daTa (IMPACT) rule can accurately identify pulmonary embolism (PE) patients at low-risk of early mortality in a retrospective setting using only claims for the index admission. We sought to externally validate IMPACT, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI) and Hestia for predicting early mortality. Methods We identified consecutive adults admitted for objectively-confirmed PE between 10/21/2010 and 5/12/2015. Patients undergoing thrombolysis/embolectomy within 48 h were excluded. All-cause in-hospital and 30 day mortality (using available Social Security Death Index data through January 2014) were assessed and prognostic accuracies of IMPACT, PESI, sPESI and Hestia were determined. Results Twenty-one (2.6 %) of the 807 PE patients died before discharge. All rules classified 26.1–38.3 % of patients as low-risk for early mortality. Fatality among low-risk patients was 0 % (sPESI and Hestia), 0.4 % (IMPACT) and 0.6 % (PESI). IMPACT’s sensitivity was 95.2 % (95 % confidence interval [CI] = 74.1–99.8 %), and the sensitivities of clinical rules ranged from 91 (PESI)-100 % (sPESI and Hestia). Specificities of all rules ranged between 26.8 and 39.1 %. Of 573 consecutive patients in the 30 day mortality analysis, 33 (5.8 %) died. All rules classified 27.9–38.0 % of patients as low-risk, and fatality occurred in 0 (Hestia)-1.4 % (PESI) of low-risk patients. IMPACT’s sensitivity was 97.0 % (95%CI = 82.5–99.8 %), while sensitivities for clinical rules ranged from 91 (PESI)-100 % (Hestia). Specificities of rules ranged between 29.6 and 39.8 %. Conclusion In this analysis, IMPACT identified low-risk PE patients with similar accuracy as clinical rules. While not intended for prospective clinical decision-making, IMPACT appears useful for identification of low-risk PE patient in retrospective claims-based studies. Electronic supplementary material The online version of this article (doi:10.1186/s12959-016-0081-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erin R Weeda
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT 06269 USA ; University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT USA
| | - Christine G Kohn
- University of Saint Joseph School of Pharmacy, Hartford, CT USA ; University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX USA
| | | | - Daniel McGrath
- University of Saint Joseph School of Pharmacy, Hartford, CT USA
| | | | | | - Craig I Coleman
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Storrs, CT 06269 USA ; University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT USA
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Morrison A, McGrath D, Wallace ES. Motor abundance and control structure in the golf swing. Hum Mov Sci 2016; 46:129-47. [PMID: 26784706 DOI: 10.1016/j.humov.2016.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 11/16/2022]
Abstract
Variability and control structure are under-represented areas of golf swing research. This study investigated the use of the abundant degrees of freedom in the golf swing of high and intermediate skilled golfers using uncontrolled manifold (UCM) analysis. The variance parallel to (VUCM) and orthogonal to (VOrth) the UCM with respect to the orientation and location of the clubhead were calculated. The higher skilled golfers had proportionally higher values of VUCM than lower skilled players for all measured outcome variables. Motor synergy was found in the control of the orientation of the clubhead and the combined outcome variables but not for clubhead location. Clubhead location variance zeroed-in on impact as has been previously shown, whereas clubhead orientation variance increased near impact. Both skill levels increased their control over the clubhead location leading up to impact, with more control exerted over the clubhead orientation in the early downswing. The results suggest that to achieve higher skill levels in golf may not lie simply in optimal technique, but may lie more in developing control over the abundant degrees of freedom in the body.
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Affiliation(s)
- A Morrison
- Sport and Exercise Science Research Institute, Ulster University, UK.
| | - D McGrath
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Ireland
| | - E S Wallace
- Sport and Exercise Science Research Institute, Ulster University, UK
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Johnston W, Purcell C, Duffy C, Casey T, Greene BR, Singleton D, McGrath D, Caulfield B. 54 Investigating normal day to day variations in postural control in a healthy young population (age 18–40) using wii balance boards. Br J Sports Med 2015. [DOI: 10.1136/bjsports-2015-095573.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Coffey JC, Sehgal R, Culligan K, Dunne C, McGrath D, Lawes N, Walsh D. Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy. Tech Coloproctol 2014; 18:789-94. [DOI: 10.1007/s10151-014-1184-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/09/2014] [Indexed: 12/12/2022]
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Lane G, Dunne C, English A, Finucane P, O'Connor R, Griffin M, O'Sullivan B, Hanrahan C, McGrath D, O'Donovan N, Cullen W. General practice career intentions among graduate-entry students: a cross-sectional study at Ireland's newest medical school. Ir Med J 2014; 107:55-57. [PMID: 24654489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Increased care provision and clinical activity in General Practice in Ireland will have important manpower implications. Recent developments in medical education policy including the introduction of graduate-entry medical degree programmes may help address this issue. The aim of this study was to determine GP career intentions among students on an Irish graduate-entry medical degree programme and to identify factors that influence these. An electronic cross-sectional study of students at University of Limerick Graduate-Entry Medical School (UL-GEMS) was undertaken. We received 139 replies (78% response rate). 41 (29%) reported GP was their current preferred career choice, while 29 (19%) reported it was their preferred career choice on entry to medical school. This first study to present data on GP career intentions among graduate-entry students in Ireland highlights the specialty as a popular preferred career choice among students, both on entry to, and during medical school. The study also identifies factors which are likely to be important in determining career intentions. Further research to examine this issue at other graduate-entry medical schools in Ireland and to determine whether our findings are pursued over time amongst graduates is a priority.
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Haynes PS, Brophy D, McGrath D. The timing of early life events and growth rate estimates of age-0 year group brill Scophthalmus rhombus along the west coast of Ireland. J Fish Biol 2014; 84:225-230. [PMID: 24383806 DOI: 10.1111/jfb.12234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 08/14/2013] [Indexed: 06/03/2023]
Abstract
The timing of spawning and hatching, larval durations and growth exhibited by juvenile brill Scophthalmus rhombus captured along the Irish west coast were estimated using otolith microstructure analysis. Scophthalmus rhombus were estimated to have hatched between February and May, with fish settling onto nursery grounds between March and June. Fish collected later on in the season exhibited higher otolith growth rates in comparison to earlier collected fish. This is the first study to describe the early life history of a commercially valuable but understudied flatfish species.
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Affiliation(s)
- P S Haynes
- Marine and Freshwater Research Centre, Department of Life Sciences, Galway-Mayo Institute of Technology, Dublin Road, Galway, Ireland
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O'Gorman CS, Macken AP, Coyle O, Cullen W, McGrath D, Higgins MF. How to teach practical skills in medicine: bridging the gap from the course to the patient, and teaching on the job. Ir Med J 2013; 106:18-19. [PMID: 24273842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- C S O'Gorman
- Graduate Entry Medical School, University of Limerick.
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Higgins MF, Macken AP, Coyle O, Cullen W, McGrath D, O'Gorman CS. How to teach practical skills in medicine: out of hospital training. Ir Med J 2013; 106:17-18. [PMID: 24273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- M F Higgins
- Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto
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O'Regan A, Culhane A, Dunne C, Griffin M, Meagher D, McGrath D, O'Dwyer P, Cullen W. Towards vertical integration in general practice education: literature review and discussion paper. Ir J Med Sci 2012; 182:319-24. [PMID: 23266908 DOI: 10.1007/s11845-012-0893-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development. AIMS To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges. METHODS We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches. RESULTS The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures. CONCLUSIONS Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.
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Affiliation(s)
- A O'Regan
- Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
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Haynes PS, Brophy D, De Raedemaecker F, McGrath D. The feeding ecology of 0 year-group turbot Scophthalmus maximus and brill Scophthalmus rhombus on Irish west coast nursery grounds. J Fish Biol 2011; 79:1866-1882. [PMID: 22141892 DOI: 10.1111/j.1095-8649.2011.03128.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
On sandy beach nursery grounds along the west coast of Ireland, 0 year-group turbot Scophthalmus maximus were found to consume six types of crustaceans, in addition to polychaetes. The 0 year-group brill Scophthalmus rhombus fed almost exclusively on mysids, even though nine taxonomic prey groups were identified in the sediment across the investigated beaches. Both species avoided non-motile organisms such as gastropods and bivalves, which were present in high abundances in the sediment and their growth and condition was not significantly related to the quantity or type of prey consumed, temperature or salinity. A high incidence of feeding was detected for both species over the duration of the study, suggesting that food was not limiting on west of Ireland nursery grounds. Temporal partitioning of settlement was detected between S. maximus and S. rhombus, indicating that inter-specific competition for food does not occur between these two flatfish species on west of Ireland nursery grounds.
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Affiliation(s)
- P S Haynes
- Commercial Fisheries Research Group, Department of Life Sciences, Galway-Mayo Institute of Technology, Galway, Ireland.
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Zhu L, Liao S, Child M, Zhang J, Persson A, Sevinsky H, Eley T, Xu X, Krystal M, Farajallah A, McGrath D, Molina JM, Bertz R. Pharmacokinetics and inhibitory quotient of atazanavir/ritonavir versus lopinavir/ritonavir in HIV-infected, treatment-naive patients who participated in the CASTLE Study. J Antimicrob Chemother 2011; 67:465-8. [DOI: 10.1093/jac/dkr490] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Samavati N, McGrath D, Lee J, VanderKwast T, Ménard C, Brock K. TU-C-211-08: Optimization of a Deformable Registration Algorithm for Matching MRI with Histology for Clinical Prostatectomy. Med Phys 2011. [DOI: 10.1118/1.3613155] [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: 11/07/2022] Open
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Abstract
INTRODUCTION AND AIMS Alcohol use has consistently been associated with smoking among nondaily smokers. However, this may not be an inevitable relationship that extends across all drinking sessions and/or all nondaily smokers. Recently, distinct subgroups of nondaily smokers have been identified, with one subgroup maintaining a stable pattern of nondaily smoking (long-term occasional smokers; LOS), and others transitioning to nondaily smoking either from a non-smoking status (early occasional smokers; EOS) or from a daily smoking status (former daily smokers; FDS). However, little is known about the extent to which these subgroups differ in their alcohol-tobacco co-administration patterns. DESIGN AND METHODS 183 nondaily smokers (74 LOS; 55 EOS; 54 FDS) completed face-to-face interviews during which they provided details about their lifetime and past-week tobacco and alcohol administration patterns. RESULTS EOS were more likely to report having used alcohol at the time of their first-ever cigarette relative to the other subgroups (P ≤ 0.001), but there were no differences in past-week co-administration patterns between the subgroups. Overall, less than one-third of all smoking sessions occurred when drinking, but these accounted for more than half of all cigarettes consumed during the previous week. Moreover, while only 42% of drinking sessions involved tobacco co-administration, when drinking and smoking did co-occur, significantly greater amounts of alcohol were consumed relative to drinking sessions where no tobacco was used (P < 0.01). DISCUSSION AND CONCLUSIONS Findings suggest that alcohol use is not invariably related to smoking in EOS, FDS or LOS, but when it is, across all subgroups co-administration is associated with mutual dose escalation.
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Conradie F, Zorrilla C, Josipovic D, Botes M, Osiyemi O, Vandeloise E, Eley T, Child M, Bertz R, Hu W, Wirtz V, McGrath D. Safety and exposure of once-daily ritonavir-boosted atazanavir in HIV-infected pregnant women. HIV Med 2011; 12:570-9. [DOI: 10.1111/j.1468-1293.2011.00927.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Absalon J, Thal G, Thiry A, Yang R, Mancini MD, McGrath D. Atazanavir is safe and efficacious in HBV and HCV co-infected patients: results of AI424138 (CASTLE). J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Uy J, Yang R, Thiry A, Absalon J, Farajallah A, Maa JF, McGrath D. Efficacy and safety by baseline HIV-RNA and CD4 count in treatment-naive patients treated With atazanavir/r and lopinavir/r in the CASTLE study. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lataillade M, Yang R, Mancini MD, McGrath D. Impact of HIV viral diversity and baseline resistance on treatment outcomes and the emergence of resistance: the CASTLE study 48-week results. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Uy J, Lataillade M, Thiry A, McGrath D, Seekins D, Hanna G. Impact of the HIV-1 protease N88S substitution on protease inhibitor susceptibility and clinical response. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p185] [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: 11/10/2022] Open
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Garland S, Sharman M, Persley D, McGrath D. The development of an improved PCR-based marker system for Sw-5, an important TSWV resistance gene of tomato. ACTA ACUST UNITED AC 2005. [DOI: 10.1071/ar04140] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Sw-5 is an important disease resistance gene of tomato, providing broad resistance to Tomato spotted wilt virus (TSWV). A cleaved amplified polymorphic sequence (CAPS) marker, closely linked to the gene, has been reported. Although the Sw-5 locus has been characterised, a gene-specific marker has not been developed. This paper presents a PCR-based marker-system that consists of the co-amplification of a dominant marker representing the Sw-5 gene sequence, and the modified CAPS marker as a positive control and indicator of genotype.
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Abstract
Sarcoidosis is a granulomatous disease that has the immunopathological features of being antigen-driven. It is a complex disease that appears to arise from the interaction of one or more triggers with an immunologically predisposed host. Previous reports of familial clustering and varying prevalence of sarcoidosis in different populations could reflect differences in ethnic predisposition or differences in local environmental exposures. This review focuses specifically on these areas that have been the subjects of intensive investigation recently. Specific focus is provided on the issue of an infective trigger and highlights popular candidates. It is concluded that microbes are a likely trigger (but not as an infection) in a genetically predisposed individual and that this initial event culminates in the sarcoidosis granulomatous response.
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Affiliation(s)
- R M du Bois
- Clinical Genomics Group, Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College, London, UK.
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Larson K, Vaknin D, Villavicencio O, McGrath D, Tsukruk VV. Molecular Packing of Amphiphiles with Crown Polar Heads at the Air−Water Interface. J Phys Chem B 2002. [DOI: 10.1021/jp015579h] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Larson
- Department of Materials Science and Engineering, Iowa State University, Ames, Iowa 50011, Ames Laboratory and Department of Physics and Astronomy, Iowa State University, Ames, Iowa 50011, and Department of Chemistry, University of Arizona, P.O. Box 210041, Tucson, Arizona 85721
| | - D. Vaknin
- Department of Materials Science and Engineering, Iowa State University, Ames, Iowa 50011, Ames Laboratory and Department of Physics and Astronomy, Iowa State University, Ames, Iowa 50011, and Department of Chemistry, University of Arizona, P.O. Box 210041, Tucson, Arizona 85721
| | - O. Villavicencio
- Department of Materials Science and Engineering, Iowa State University, Ames, Iowa 50011, Ames Laboratory and Department of Physics and Astronomy, Iowa State University, Ames, Iowa 50011, and Department of Chemistry, University of Arizona, P.O. Box 210041, Tucson, Arizona 85721
| | - D. McGrath
- Department of Materials Science and Engineering, Iowa State University, Ames, Iowa 50011, Ames Laboratory and Department of Physics and Astronomy, Iowa State University, Ames, Iowa 50011, and Department of Chemistry, University of Arizona, P.O. Box 210041, Tucson, Arizona 85721
| | - V. V. Tsukruk
- Department of Materials Science and Engineering, Iowa State University, Ames, Iowa 50011, Ames Laboratory and Department of Physics and Astronomy, Iowa State University, Ames, Iowa 50011, and Department of Chemistry, University of Arizona, P.O. Box 210041, Tucson, Arizona 85721
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Affiliation(s)
- D Nepstad
- Woods Hole Research Center (WHRC), Woods Hole, MA 02543-0296, USA.
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Maier LA, Sawyer RT, Bauer RA, Kittle LA, Lympany P, McGrath D, Dubois R, Daniloff E, Rose CS, Newman LS. High beryllium-stimulated TNF-alpha is associated with the -308 TNF-alpha promoter polymorphism and with clinical severity in chronic beryllium disease. Am J Respir Crit Care Med 2001; 164:1192-9. [PMID: 11673208 DOI: 10.1164/ajrccm.164.7.2012123] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Beryllium (Be)-antigen stimulates tumor necrosis factor-alpha (TNF-alpha) from bronchoalveolar lavage (BAL) cells in chronic beryllium disease (CBD). This study tested the hypothesis that high concentrations of Be-stimulated TNF-alpha are related to polymorphisms in the TNF-alpha promoter and clinical markers of disease severity in CBD. Demographic and clinical information was obtained from patients with CBD (n = 20). TNF-alpha concentrations were measured in BAL cell culture supernatant by ELISA. A priori, we categorized CBD subjects as either high or low TNF-alpha producers using a cutoff of 1,500 pg/ml. The TNF-alpha promoter sequence, +64 to -1045, was determined by direct sequencing. Human leukocyte-associated antigen (HLA)-DPB1 and -DRB1 genotyping was determined by polymerase chain reaction (PCR). High Be-stimulated TNF-alpha was associated with TNF2 alleles, Hispanic ethnicity, presence of HLA-DPB1 Glu69, and absence of HLA-DR4. Be-stimulated TNF-alpha concentrations correlated with markers of disease severity, including chest radiograph, beryllium lymphocyte proliferation, and spirometry. We found no novel TNF-alpha promoter polymorphisms. These data suggest that the TNF2 A allele at -308 in the TNF-alpha promoter region is a functional polymorphism, associated with a high level of Be-antigen-stimulated TNF-alpha and that these high TNF-alpha levels indicate disease severity in CBD.
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Affiliation(s)
- L A Maier
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
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