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Jimenez BS, Sterling T, Brown A, Modica B, Gibson K, Collins H, Koch C, Schwarz T, Dye KN. Protocol to longitudinally quantify SARS-CoV-2 RNA in wastewater using RT-qPCR and pepper mild mottle virus normalization. STAR Protoc 2024; 5:103001. [PMID: 38598332 PMCID: PMC11011218 DOI: 10.1016/j.xpro.2024.103001] [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: 01/10/2024] [Revised: 02/06/2024] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Wastewater surveillance allows severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection levels to be tracked in a community. Here, we present a protocol to longitudinally quantify SARS-CoV-2 RNA in wastewater using quantitative reverse-transcription PCR (RT-qPCR) and pepper mild mottle virus (PMMoV) normalization. We describe steps for the pasteurization of wastewater samples, solids separation, supernatant filtration, viral precipitation and concentration, and RNA extraction. We then detail procedures for RT-qPCR, viral concentration extrapolation, PMMoV normalization, and longitudinal analysis. This protocol has the potential to be used for surveillance of other microorganisms. For complete details on the use and execution of this protocol, please refer to Sanchez Jimenez et al.1.
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Affiliation(s)
- Bryan Sanchez Jimenez
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA; Department of Microbiology and Immunology, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595, USA.
| | - Trinity Sterling
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Austin Brown
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Brian Modica
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Kaylee Gibson
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Hannah Collins
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Carolyn Koch
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Tyler Schwarz
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA
| | - Kristine N Dye
- Department of Health Sciences, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA; Department of Biology, Stetson University, 421 N Woodland Boulevard, DeLand, FL 32723, USA.
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2
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Bethurum AJ, Zeng K, Puzdrakiewicz T, Goenka P, Collins H, Burns JB, Roche K. Antithrombotics in the Fall Patient: Appropriateness and Risk-Benefit Analysis. Am Surg 2024:31348241241733. [PMID: 38532271 DOI: 10.1177/00031348241241733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Falls are the leading cause of hospitalizations following trauma nationwide, resulting in over 3 million admissions in 2020. This population is typically aged, and many are prescribed antithrombotic (AT) therapy. In this prospective study, we aimed to analyze fall history while assessing appropriateness of AT regimen relative to fall risk. Patients presenting following ground level fall (GLF) and meeting inclusion criteria during the study period were enrolled. Primary outcome was the relationship between AT therapy necessity (CHA2DS2-VASc) and fall risk (Morse Fall Risk). The cohort of 30 patients had an average age of 77. CHA2DS2-VASc and Morse Fall Risk showed a moderate-positive correlation (r = 0.47; P = 0.012); however, 17% of patients categorized as high fall risk had a <5% 1-year risk of VTE. This study demonstrates that risks of hemorrhage may outweigh thromboembolism prophylaxis in a significant number of patients and sheds light on the astonishing fall volume in this population.
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Affiliation(s)
- A J Bethurum
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Kevin Zeng
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | | | - Parth Goenka
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hannah Collins
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - J Bracken Burns
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Keelin Roche
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Phelps TB, Archer AD, Leonard M, Collins H, Burns JB. Outcome of Seatbelt Education and Safety Program Among Teenagers. Am Surg 2024:31348241241744. [PMID: 38523078 DOI: 10.1177/00031348241241744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Despite the effectiveness of seatbelts, concerns persist about compliance, especially among teenagers. Survey data from a local high school and registry data from a level 1 trauma center were used to observe seatbelt and motor vehicle accident trends. The survey data was analyzed to gauge student's sentiments on seatbelt education. The trauma center data was analyzed to identify characteristics and trends among teenage motor vehicle accidents. Social media was the most common strategy selected for seatbelt safety awareness. Random seatbelt checks performed over 4 months revealed seatbelt compliance rates of 90%, 93.55%, and 96.94% after education intervention. Trauma center data showed that lack of seatbelt usage resulted in greater morbidity. These findings emphasize the need for targeted interventions. This study provides insights into creating effective education campaigns that can be used to enhance safety belt compliance and potentially reduce injury.
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Affiliation(s)
- Trevor B Phelps
- Department of Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
| | - Allen D Archer
- Department of Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
| | | | | | - J Bracken Burns
- Department of Surgery, East Tennessee State University, Quillen College of Medicine, Johnson City, TN, USA
- Ballad Health, Johnson City, TN, USA
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Landis RM, Mannino EA, Leonard M, Collins H, Burns JB. The Predictive Value of Shock Index in Rural Trauma Triage, Morbidity, and Mortality. Am Surg 2024; 90:465-467. [PMID: 37983069 DOI: 10.1177/00031348231216486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Ryan M Landis
- Department of Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- Department of Trauma, Ballad Health Trauma Services, Johnson City, TN, USA
| | - Elizabeth A Mannino
- Department of Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Matthew Leonard
- Department of Trauma, Ballad Health Trauma Services, Johnson City, TN, USA
| | - Hannah Collins
- Department of Trauma, Ballad Health Trauma Services, Johnson City, TN, USA
| | - James B Burns
- Department of Surgery, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- Department of Trauma, Ballad Health Trauma Services, Johnson City, TN, USA
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Lalonde CS, Switchenko JM, Behera M, Bilen MA, Owonikoko TK, Kaufman JL, Nooka AK, Lewis CM, Hitron E, Collins H, Judson EC, Alese OB, Donald Harvey R, Carlisle JW. Shifting Sociodemographic Characteristics of a Phase I Clinical Trial Population at an NCI-Designated Comprehensive Cancer Center in the Southeast. Oncologist 2023; 28:1055-1063. [PMID: 37418599 PMCID: PMC10712723 DOI: 10.1093/oncolo/oyad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 07/09/2023] Open
Abstract
Racial and ethnic minority populations are consistently under-represented in oncology clinical trials despite comprising a disproportionate share of a cancer burden. Phase I oncology clinical trials pose a unique challenge and opportunity for minority inclusion. Here we compared the sociodemographic characteristics of patients participating in phase 1 clinical trials a National Cancer Institute ( NCI)-designated comprehensive center to all patients at the center, patients with new cancer diagnosis in metropolitan Atlanta and patients with new cancer diagnoses in the state of Georgia. From 2015 to 2020, 2325 patients (43.4% female, 56.6% male) consented to participate in a phase I trial. Grouped self-reported race distribution was 70.3% White, 26.2% Black, and 3.5% other. Of new patient registrations at Winship Cancer Institute (N = 107 497) (50% F, 50% M), grouped race distribution was 63.3% White, 32.0% Black, and 4.7% other. Patients with new cancer diagnoses in metro Atlanta from 2015 to 2016 (N = 31101) were 58.4% White, 37.2% Black, and 4.3% other. Race and sex distribution of phase I patients was significantly different than Winship patients (P < .001). Over time, percent of White patients decreased in both phase I and Winship groups (P = .009 and P < .001, respectively); percentage of females did not change in either group (P = .54 phase I, P = .063 Winship). Although phase I patients were more likely to be White, male, and privately ensured than the Winship cohort, from 2015 to 2020 the percentage of White patients in phase I trials and among all new patients treated at Winship decreased. The intent of characterizing existing disparities is to improve the representation of patients from racial and ethnic minority backgrounds in phase I clinical trials.
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Affiliation(s)
- Chloe S Lalonde
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan L Kaufman
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Ajay K Nooka
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Hannah Collins
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Emma C Judson
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Olatunji B Alese
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - R Donald Harvey
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Sanchez Jimenez B, Sterling T, Brown A, Modica B, Gibson K, Collins H, Koch C, Schwarz T, Dye KN. Wastewater surveillance in the COVID-19 post-emergency pandemic period: A promising approach to monitor and predict SARS-CoV-2 surges and evolution. Heliyon 2023; 9:e22356. [PMID: 38045160 PMCID: PMC10689941 DOI: 10.1016/j.heliyon.2023.e22356] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/17/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
On May 24, 2023, approximately 3.5 years into the pandemic, the World Health Organization (WHO) declared the end of the COVID-19 global health emergency. However, as there are still ∼3000 COVID-19 deaths per day in May 2023, robust surveillance systems are still warranted to return to normalcy in times of low risk and respond appropriately in times of high risk. The different phases of the pandemic have been defined by infection numbers and variants, both of which have been determined through clinical tests that are subject to many biases. Unfortunately, the end of the COVID-19 emergency threatens to exasperate these biases, thereby warranting alternative tracking methods. We hypothesized that wastewater surveillance could be used as a more accurate and comprehensive method to track SARS-CoV-2 in the post-emergency pandemic period (PEPP). SARS-CoV-2 was quantified and sequenced from wastewater between June 2022 and March 2023 to research the anticipated 2022/23 winter surge. However, in the 2022/23 winter, there was lower-than-expected SARS-CoV-2 circulation, which was hypothesized to be due to diagnostic testing biases but was confirmed by our wastewater analysis, thereby emphasizing the unpredictable nature of SARS-CoV-2 surges while also questioning its winter seasonality. Even in times of low baseline circulation, we found wastewater surveillance to be sensitive enough to detect minor changes in circulation levels ∼30-46 days prior to diagnostic tests, suggesting that wastewater surveillance may be a more appropriate early warning system to prepare for unpredictable surges in the PEPP. Furthermore, sequencing of wastewater detected variants of concern that were positively correlated with clinical samples and also provided a method to identify mutations with a high likelihood of appearing in future variants, necessary for updating vaccines and therapeutics prior to novel variant circulation. Together, these data highlight the effectiveness of wastewater surveillance in the PEPP to limit the global health burden of SARS-CoV-2 due to increases in circulation and/or viral evolution.
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Affiliation(s)
| | - Trinity Sterling
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Austin Brown
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Brian Modica
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Kaylee Gibson
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Hannah Collins
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Carolyn Koch
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Tyler Schwarz
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
| | - Kristine N. Dye
- Department of Health Sciences, Stetson University, DeLand, FL, 32723, USA
- Department of Biology, Stetson University, DeLand, FL, 32723, USA
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7
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Richards T, Miles LF, Clevenger B, Keegan A, Abeysiri S, Rao Baikady R, Besser MW, Browne JP, Klein AA, Macdougall IC, Murphy GJ, Anker SD, Dahly D, Besser M, Browne J, Clevenger B, Kegan A, Klein A, Miles L, MacDougall I, Baikady RR, Dahly D, Bradbury A, Richards T, Burley T, Van Loen S, Anker S, Klein A, MacDougall I, Murphy G, Besser M, Unsworth I, Clayton T, Collier T, Potter K, Abeysiri S, Evans R, Knight R, Swinson R, Van Dyck L, Keidan J, Williamson L, Crook A, Pepper J, Dobson J, Newsome S, Godec T, Dodd M, Richards T, Van Dyck L, Evans R, Abeysiri S, Clevenger B, Butcher A, Swinson R, Collier T, Potter K, Anker S, Kelly J, Morris S, Browne J, Keidan J, Grocott M, Chau M, Knight R, Collier T, Baikady RR, Black E, Lawrence H, Kouthra M, Horner K, Jhanji S, Todman E, Keon‐Cohen Z, Rooms M, Tomlinson J, Bailes I, Walker S, Pirie K, Gerstman M, Kasivisvanathan R, Uren S, Magee D, Eeles A, Anker R, McCanny J, O'Mahony M, Reynolds T, Batley S, Hegarty A, Trundle S, Mazzola F, Tatham K, Balint A, Morrison B, Evans M, Pang CL, Smith L, Wilson C, Sjorin V, Khatri P, Wilson M, Parkinson D, Crosbie J, Dawas K, Smyth D, Bercades G, Ryu J, Reyes A, Martir G, Gallego L, Macklin A, Rocha M, Tam DK, Brealey DD, Dhesi J, Morrison C, Hardwick J, Partridge J, Braude P, Rogerson A, Jahangir N, Thomson C, Biswell L, Cross J, Pritchard F, Mohammed A, Wallace D, Galat MG, Okello J, Symes R, Leon J, Gibbs C, Sanghera S, Dennis A, Kibutu F, Fofie J, Bird S, Alli A, Jackson Y, Albuheissi S, Brain C, Shiridzinomwa C, Ralph C, Wroath B, Hammonds F, Adams B, Faulds J, Staddon S, Hughes T, Saha S, Finney C, Harris C, Mellis C, Johnson L, Riozzi P, Yarnold A, Buchanan F, Hopkins P, Greig L, Noble H, Edwards M, Grocott M, Plumb J, Harvie D, Dushianthan A, Wakatsuki M, Leggett S, Salmon K, Bolger C, Burnish R, Otto J, Rayat G, Golder K, Bartlett P, Bali S, Seaward L, Wadams B, Tyrell B, Collins H, Tantony N, Geale R, Wilson A, Ball D, Lindsey I, Barker D, Thyseen M, Chiam P, Hannaway C, Colling K, Messer C, Verma N, Nasseri M, Poonawala G, Sellars A, Mainali P, Hammond T, Hughes A, O'Hara D, McNeela F, Shillito L, Kotze A, Moriarty C, Wilson J, Davies S, Yates D, Carter J, Redman J, Ma S, Howard K, Redfearn H, Wilcock D, Lowe J, Alexander T, Jose J, Hornzee G, Akbar F, Rey S, Patel A, Coulson S, Saini R, Santipillai J, McCretton T, McCanny J, Chima K, Collins K, Pathmanathan B, Chattersingh A, McLeavy L, Al‐Saadi Z, Patel M, Skampardoni S, Chinnadurai R, Thomas V, Keen A, Pagett K, Keatley C, Howard J, Greenhalgh M, Jenkins S, Gidda R, Watts A, Breaton C, Parker J, Mallett S, James S, Penny L, Chan K, Reeves T, Catterall M, Williams S, Birch J, Hammerton K, Williamson N, Thomas A, Evans M, Mercer L, Horsfield G, Hughes C, Cupitt J, Stoddard E, McNamara H, Birt C, Hardy A, Dennis R, Butcher D, O'Sullivan S, Pope A, Elhanash S, Preston S, Officer H, Stoker A, Moss S, Walker A, Gipson A, Melville J, Bradley‐Potts J, McCormac R, Benson V, Melia K, Fielding J, Guest W, Ford S, Murdoch H, Beames S, Townshend P, Collins K, Glass J, Cartwright B, Altemimi B, Berresford L, Jones C, Kelliher L, de Silva S, Blightman K, Pendry K, Pinto L, Allard S, Taylor L, Chishti A, Scott J, O'Hare D, Lewis M, Hussain Z, Hallett K, Dermody S, Corbett C, Morby L, Hough M, Williams S, Williams P, Horton S, Ashcroft P, Homer A, Lang A, Dawson H, Harrison E, Thompson J, Hariharan V, Goss V, Ravi R, Butt G, Vertue M, Acheson A, Ng O, Bush D, Dickson E, Ward A, Morris S, Taylor A, Casey R, Wilson L, Vimalachandran D, Faulkner M, Jeffrey H, Gabrielle C, Martin S, Bracewell A, Ritzema J, Sproates D, Alexander‐Sefre F, Kubitzek C, Humphreys S, Curtis J, Oats P, Swann S, Holden A, Adam C, Flintoff L, Paoloni C, Bobruk K. The association between iron deficiency and outcomes: a secondary analysis of the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial. Anaesthesia 2023; 78:320-329. [PMID: 36477695 PMCID: PMC10107684 DOI: 10.1111/anae.15926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
In the intravenous iron therapy to treat iron deficiency anaemia in patients undergoing major abdominal surgery (PREVENTT) trial, the use of intravenous iron did not reduce the need for blood transfusion or reduce patient complications or length of hospital stay. As part of the trial protocol, serum was collected at randomisation and on the day of surgery. These samples were analysed in a central laboratory for markers of iron deficiency. We performed a secondary analysis to explore the potential interactions between pre-operative markers of iron deficiency and intervention status on the trial outcome measures. Absolute iron deficiency was defined as ferritin <30 μg.l-1 ; functional iron deficiency as ferritin 30-100 μg.l-1 or transferrin saturation < 20%; and the remainder as non-iron deficient. Interactions were estimated using generalised linear models that included different subgroup indicators of baseline iron status. Co-primary endpoints were blood transfusion or death and number of blood transfusions, from randomisation to 30 days postoperatively. Secondary endpoints included peri-operative change in haemoglobin, postoperative complications and length of hospital stay. Most patients had iron deficiency (369/452 [82%]) at randomisation; one-third had absolute iron deficiency (144/452 [32%]) and half had functional iron deficiency (225/452 [50%]). The change in pre-operative haemoglobin with intravenous iron compared with placebo was greatest in patients with absolute iron deficiency, mean difference 8.9 g.l-1 , 95%CI 5.3-12.5; moderate in functional iron deficiency, mean difference 2.8 g.l-1 , 95%CI -0.1 to 5.7; and with little change seen in those patients who were non-iron deficient. Subgroup analyses did not suggest that intravenous iron compared with placebo reduced the likelihood of death or blood transfusion at 30 days differentially across subgroups according to baseline ferritin (p = 0.33 for interaction), transferrin saturation (p = 0.13) or in combination (p = 0.45), or for the number of blood transfusions (p = 0.06, 0.29, and 0.39, respectively). There was no beneficial effect of the use of intravenous iron compared with placebo, regardless of the metrics to diagnose iron deficiency, on postoperative complications or length of hospital stay.
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Affiliation(s)
- T Richards
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia.,Institute of Clinical Trials and Methodology and Division of Surgery, University College London, UK
| | - L F Miles
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, VIC, Australia.,Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia
| | - B Clevenger
- Department of Anaesthesia, Royal National Orthopaedic Hospital, Stanmore, UK
| | - A Keegan
- Department of Haematology, PathWest Laboratory Medicine, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - S Abeysiri
- Division of Surgery, University of Western Australia, Perkins South Building, Fiona Stanley Hospital, Murdoch, Perth, WA, Australia
| | - R Rao Baikady
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - M W Besser
- Department of Haematology, Addenbrooke's Hospital, Cambridge, UK
| | - J P Browne
- School of Public Health, University College Cork, Ireland
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - I C Macdougall
- Department of Renal Medicine, King's College Hospital, London, UK
| | - G J Murphy
- Department of Cardiovascular Sciences, University of Leicester, UK
| | - S D Anker
- Department of Cardiology, Berlin Institute of Health Centre for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - D Dahly
- School of Public Health, University College Cork, Ireland.,Health Research Board Clinical Research Facility, University College Cork, Ireland
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Lawless C, Sibley C, AbiKheir C, Collins H, Campbell C. Emergency simulation in the outpatient world. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Drury J, Stancombe J, Williams R, Collins H, Lagan L, Barrett A, French P, Chitsabesan P. Survivors' experiences of informal social support in coping and recovering after the 2017 Manchester Arena bombing. BJPsych Open 2022; 8:e124. [PMID: 35781122 PMCID: PMC9301776 DOI: 10.1192/bjo.2022.528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors. AIMS We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery? METHOD Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed. RESULTS Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth. CONCLUSIONS We recommend that people who respond to survivors' psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.
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Affiliation(s)
- John Drury
- School of Psychology, University of Sussex, UK
| | - John Stancombe
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, UK
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, UK
| | - Hannah Collins
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Trust, UK
| | | | - Alan Barrett
- Manchester Resilience Hub, Pennine Care NHS Foundation Trust, UK; and School of Health Sciences, University of Salford, UK
| | - Paul French
- Research and Innovation Department, Pennine Care NHS Foundation Trust, UK; and Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | - Prathiba Chitsabesan
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, UK; and Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
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Lalonde CS, Switchenko JM, Behera M, Bilen MA, Owonikoko TK, Lewis CM, Hitron E, Collins H, Goodale T, Judson EC, Harvey RD, Carlisle JW. Comparison of sociodemographic characteristics of a phase 1 clinical trial population at an NCI-designated comprehensive cancer center in the Southeast to catchment area. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18591] [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: 11/20/2022] Open
Abstract
e18591 Background: Racial and ethnic minority populations are consistently under-represented in oncology clinical trials despite comprising a disproportionate share of cancer burden. Due in part to difficulties associated with participation, phase 1 trials pose a unique challenge and opportunity for minority inclusion. Here we examine the sociodemographics of phase 1 clinical trial patients at an NCI-designated Comprehensive Cancer Center compared to all patients treated at the center, patients with new cancer diagnoses in metropolitan Atlanta, and the state of Georgia (GA). Methods: Patients enrolled on phase 1 trials at the Winship Cancer Institute (WCI) from 2015-2020, identified from a data warehouse, were compared to new patient registrations at WCI from 2015-2019. Patients with cancer in metro Atlanta and GA were identified from the Surveillance, Epidemiology, and End Results (SEER) Program: Nov 2018 Submission. Covariates for the phase 1 and institutional cohort included sex, race, ECOG PS, insurance, and age at consent. Covariates for SEER patients included sex, race, and age at diagnosis. Summary statistics are reported for categorical variables using frequencies and percentages, and for continuous variables using mean, median, standard deviation, and range. One-sample proportion tests were utilized to compare observed demographic proportions on phase 1 trials with proportions calculated from new patient registrations at WCI and from SEER case data. Results: From 2015-2020, 2325 patients (43.4% F, 56.6% M) signed consent for phase 1 trials. Grouped race distribution was 70.3% White, 26.2% Black, 3.5% Other. Insurance distribution was 42.9% private, 48% government, 9.1% uninsured/other. Mean age at consent was 61.7 years (MD 63, ran 19-92). Of new patient registrations at WCI in 2015 ( N= 12358) (49.7% F, 50.3% M), grouped race distribution was 64.0% W, 28.2% B, 8% O. Atlanta 2015 SEER patients ( N= 31101) (50.3%F, 49.7%M) showed grouped race distribution 58.4% W, 37.2% B, 4.3% O. Mean age at diagnosis was 62.9. GA 2015 SEER patients ( N= 99487) (48.6%F, 51.4%M) showed grouped race distribution 71.2% W, 26.7% B, 2.1% O. Mean age at diagnosis was 64.2. The race and sex distribution of phase 1 patients was significantly different than proportions calculated from new patient registrations at WCI and SEER data from patients in Atlanta ( p< 0.001). Sex distribution was significantly different than GA SEER patients. Conclusions: Phase 1 patients were significantly more likely to be white and male, compared with patients treated at the cancer center, as well as patients with cancer in Atlanta. Race distribution was not significantly different from patients with cancer in GA. Our intent is to characterize existing disparities in order to increase representation of patients from racial and ethnic minority backgrounds in phase 1 clinical trials.
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Affiliation(s)
| | | | | | - Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | | | | | - Elise Hitron
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hannah Collins
- Winship Cancer Institute of Emory University, Atlanta, GA
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11
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Collins H, Forbes G, Roebuck EM. A dentist's dilemma: sharing wellbeing concerns to safeguard Scotland's children. Br Dent J 2022:10.1038/s41415-022-4088-y. [PMID: 35304590 DOI: 10.1038/s41415-022-4088-y] [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] [Received: 02/20/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022]
Abstract
Introduction Over a decade ago, Getting it right for every child (GIRFEC) introduced the 'Named Person' as a central contact with whom professionals could share 'wellbeing' concerns in Scotland, aiming to promote inter-agency working to avoid potential child protection issues. The mandatory 'Named Person' scheme has since been repealed but the professional's responsibility to share concerns at wellbeing level remains.Aims To explore general dental practitioners' (GDPs') understanding of a child's 'wellbeing', along with the investigation of influencing factors on behaviour when sharing concerns at wellbeing level.Methods Qualitative one-to-one semi-structured telephone interviews with GDPs. Themes arising from transcriptions were organised into the Theoretical Domains Framework.Results In total, 11 dentists (five men and six women) participated. Risks to wellbeing included only attending in pain and dental neglect. There was good awareness of the 'Named Person' and triggers to sharing suspicions were identified, which were concern severity, multiple concerns and own intuition. Multiple barriers (eg poor knowledge, fear of consequences, environment) and enablers (eg professional responsibility and influences, positive consequences) influenced decisions to refer. GDPs struggled to differentiate between wellbeing and child protection.Conclusion Barriers and facilitators to sharing wellbeing suspicions are similar to child protection. GDPs may benefit from further training when safeguarding at a wellbeing level.
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Affiliation(s)
- Hannah Collins
- Speciality Registrar in Paediatric Dentistry, Edinburgh Dental Institute, Edinburgh, UK.
| | - Gillian Forbes
- Research Fellow in Implementation Science, University College London, UK
| | - Elizabeth M Roebuck
- Consultant in Paediatric Dentistry, Edinburgh Dental Institute, Edinburgh, UK
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12
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Stancombe J, Williams R, Drury J, Collins H, Lagan L, Barrett A, French P, Chitsabesan P. People's experiences of distress and psychosocial care following a terrorist attack: interviews with survivors of the Manchester Arena bombing in 2017. BJPsych Open 2022; 8:e41. [PMID: 35109959 PMCID: PMC8867861 DOI: 10.1192/bjo.2022.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Distress after major incidents is widespread among survivors. The great majority do not meet the criteria for mental health disorders and rely on psychosocial care provided by their informal networks and official response services. There is a need to better understand their experiences of distress and psychosocial care needs. AIMS The aims of our study were to enhance understanding of the experience of distress among people present at the Manchester Arena bombing in 2017, identify their experiences of psychosocial care after the incident and learn how to better deliver and target effective psychosocial care following major incidents. METHOD We conducted a thematic analysis of semi-structured interviews with 18 physically non-injured survivors of the Manchester Arena attack, who registered with the NHS Manchester Resilience Hub. RESULTS Distress was ubiquitous, with long-lasting health and social consequences. Initial reluctance to seek help from services was also common. Early and open access to authoritative sources of information and emotional support, and organised events for survivors, were viewed as helpful interventions. Inappropriate forms of psychosocial and mental healthcare were common and potent stressors that affected coping and recovery. CONCLUSIONS This paper extends our understanding of how people react to major events. Provision for the large group of people who are distressed and require psychosocial care may be inadequate after many incidents. There is a substantial agenda for developing awareness of people's needs for psychosocial interventions, and training practitioners to deliver them. The findings have substantial implications for policy and service design.
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Affiliation(s)
- John Stancombe
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, UK
| | - Richard Williams
- Welsh Institute for Health and Social Care, University of South Wales, UK
| | - John Drury
- School of Psychology, University of Sussex, UK
| | - Hannah Collins
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Trust, UK
| | | | - Alan Barrett
- Manchester Resilience Hub, Pennine Care NHS Foundation Trust, UK; and School of Health Sciences, University of Salford, UK
| | - Paul French
- Research and Innovation Department, Pennine Care NHS Foundation Trust, UK; and Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | - Prathiba Chitsabesan
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust, UK; and Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
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Morice D, Elhassan HA, Myint-Wilks L, Barnett RE, Rasheed A, Collins H, Owen A, Hughes K, Mcleod R. Laryngopharyngeal reflux: is laparoscopic fundoplication an effective treatment? Ann R Coll Surg Engl 2022; 104:79-87. [PMID: 35100850 DOI: 10.1308/rcsann.2021.0613] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). METHODS PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. FINDINGS Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case-control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). CONCLUSION Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.
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Affiliation(s)
| | - H A Elhassan
- Homerton University Hospital NHS Foundation Trust, UK
| | | | - R E Barnett
- Cardiff and Vale University Health Board, UK
| | - A Rasheed
- Aneurin Bevan University Health Board, UK
| | - H Collins
- Aneurin Bevan University Health Board, UK
| | - A Owen
- Aneurin Bevan University Health Board, UK
| | - K Hughes
- Swansea Bay University Health Board, UK
| | - R Mcleod
- Aneurin Bevan University Health Board, UK
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14
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Morice D, Elhassan HA, Myint-Wilks L, Barnett RE, Rasheed A, Collins H, Owen A, Hughes K, Mcleod R. Laryngopharyngeal reflux: is laparoscopic fundoplication an effective treatment? Ann R Coll Surg Engl 2021; 104:79-87. [PMID: 34482754 DOI: 10.1308/rcsann.2021.0046] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). METHODS PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. FINDINGS Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case-control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). CONCLUSION Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.
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Affiliation(s)
| | - H A Elhassan
- Homerton University Hospital NHS Foundation Trust, UK
| | | | - R E Barnett
- Cardiff and Vale University Health Board, UK
| | - A Rasheed
- Aneurin Bevan University Health Board, UK
| | - H Collins
- Aneurin Bevan University Health Board, UK
| | - A Owen
- Aneurin Bevan University Health Board, UK
| | - K Hughes
- Swansea Bay University Health Board, UK
| | - R Mcleod
- Aneurin Bevan University Health Board, UK
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15
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Selvan M, Collins H, Griffiths W, Gelson W, Herre J. Case Report: Indwelling Pleural Catheter Based Management of Refractory Hepatic Hydrothorax as a Bridge to Liver Transplantation. Front Med (Lausanne) 2021; 8:695977. [PMID: 34322505 PMCID: PMC8311019 DOI: 10.3389/fmed.2021.695977] [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: 04/15/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Liver transplantation is the treatment of choice for decompensated liver disease, and by extension for hepatic hydrothorax. Persistent pleural effusions make it challenging for patients to maintain physiological fitness for transplantation. Indwelling pleural catheters (IPCs) provide controlled pleural fluid removal, including peri-operatively. The immune dysfunction of cirrhosis heightens susceptibility to bacterial infection and concerns exist regarding the sepsis potential from a tunnelled drain. Method: Six patients were identified who underwent IPC insertion for hepatic hydrothorax before successful liver transplantation, between November 2016 and November 2017. Results: All patients had recurrent transudative right sided pleural effusions. Mean age was 49 years (range 24–64) and mean United Kingdom Model for End-Stage Liver Disease score was 58. Four patients required correction of coagulopathy before insertion. There were no complications secondary to bleeding. Three patients were taught self-drainage at home of up to 1 litre (L) daily. A protocol was developed to ensure weekly review, pleural fluid culture and drainage of larger volumes in hospital. For every 2–3 L of pleural fluid drained, 100 mls of 20% Human Albumin Solution (HAS) was administered. On average an IPC was in situ for 58 days before surgery and drained 19 L of fluid in hospital. There was a small increase in average BMI (0.2) and serum albumin (2.1 g/L) at transplantation. There was one episode of stage one acute kidney injury secondary to high volume drainage. No further ascitic or pleural procedures were needed while an IPC was in situ. One thoracentesis was required after IPC removal. On average IPCs remained in situ for 7 days post transplantation and drained a further 2 L of fluid. Pleural fluid sampling was acquired on 92% of drainages in hospital. Of 44 fluid cultures, 2 cultured bacteria. Two patients had their IPCs and all other lines removed post transplantation due to suspected infection. Conclusion: Our case series describes a novel protocol and successful use of IPCs in the management of refractory hepatic hydrothorax as a bridge to liver transplantation. The protocol includes albumin replacement during pleural drainage, regular clinical review and culture of pleural fluid, with the option of self-drainage at home.
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Affiliation(s)
- Mayurun Selvan
- Respiratory Medicine, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Hannah Collins
- Respiratory Medicine, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - William Griffiths
- Cambridge Liver Unit, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - William Gelson
- Cambridge Liver Unit, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Jurgen Herre
- Respiratory Medicine, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
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16
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Collins H, Eley C, Kohler G, Morgan H. Foundation rotations in medical training: is it love at first sight? Postgrad Med J 2021; 98:689-693. [PMID: 37062978 DOI: 10.1136/postgradmedj-2021-140198] [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] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE OF STUDY Factors influencing physician specialty choice is a prominent topic given the recruitment challenges faced by various specialties. We aimed to assess whether specialty exposure in the first foundation year was a positive predictive factor for permanent career choice. STUDY DESIGN A questionnaire-based study was distributed online using a survey tool. Questions recorded the foundation rotations of participants as well as their chosen medical specialty. RESULTS 1181 responses were included in the analysis. 23% of respondents had undertaken a Foundation Year 1 (F1) rotation in their career specialty. Having undertaken a foundation rotation in anaesthetics, cardiology, emergency medicine, endocrinology, gastroenterology, genito-urinary medicine, intensive care, obstetrics and gynaecology, oncology, paediatrics, palliative care, psychiatry, radiology, respiratory and rheumatology was found to be statistically significantly linked to choosing that specialty as a career (p<0.01). There was a significant correlation between the second foundation rotation and career choice (p=0.02). CONCLUSIONS For many specialties, direct experience within foundation training has a positive effect on later career choice.
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Affiliation(s)
| | - Catherine Eley
- General Surgery, Merthyr Tydfil Local Health Board, Abercynon, Rhondda Cynon Taf, UK
| | - George Kohler
- Intensive Care Medicine, Cwm Taf Health Board, Abercynon, Rhondda Cynon Taf, UK
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17
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Morgan H, Collins H, Moore S, Eley C. Written in the stars: did your specialty choose you? Postgrad Med J 2021; 98:205-211. [PMID: 33414176 DOI: 10.1136/postgradmedj-2020-139058] [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: 09/20/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE OF THE STUDY Established over 2000 years ago, horoscopes remain a regular feature in contemporary society. We aimed to assess whether there could be a link between zodiac sign and medical occupation, asking the question-did your specialty choose you? STUDY DESIGN A questionnaire-based study was distributed using an online survey tool. Questions explored the zodiac sign, specialty preferences and personality features of physicians. RESULTS 1923 physicians responded between February and March 2020. Variations in personality types between different medical specialties were observed, introverts being highly represented in oncology (71.4%) and rheumatology (65.4%), and extroverts in sexual health (55%), gastroenterology (44.4%) and obstetrics and gynaecology (44.2%) (p<0.01). Proportions of zodiac signs in each specialty also varied; for example, cardiologists were more likely to be Leo compared with Aries (14.4% vs 3.9%, p=0.047), medical physicians more likely Capricorn than Aquarius (10.4% vs 6.7%, p=0.02) and obstetricians and gynaecologists more likely Pisces than Sagittarius (17.5% vs 0%, p=0.036). Intensive care was the most commonly reported second choice career, but this also varied between zodiac signs and specialties. Fountain pen use was associated with extroversion (p=0.049) and gastroenterology (p<0.01). CONCLUSIONS Personality types vary in different specialties. There may be links to zodiac signs which warrant further investigation.
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Affiliation(s)
- Holly Morgan
- Cardiology Department, Royal Gwent Hospital, Newport, UK
| | - Hannah Collins
- Surgical Department, University Hospital of Wales Healthcare NHS Trust, Cardiff, Cardiff, UK
| | - Sacha Moore
- Cardiology Department, Royal Gwent Hospital, Newport, UK
| | - Catherine Eley
- Surgical Department, University Hospital of Wales Healthcare NHS Trust, Cardiff, Cardiff, UK
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18
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Collins H, Beban G, Windsor J, Ram R, Orr D, Evennett N, Loveday B. Safety and Utility of Liver Biopsy During Bariatric Surgery in the New Zealand Setting. Obes Surg 2020; 30:313-318. [PMID: 31482482 DOI: 10.1007/s11695-019-04161-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Asymptomatic liver disease is common in bariatric patients and can be diagnosed with intraoperative biopsy. This study aimed to establish the risk-benefit profile of routine liver biopsy, prevalence of clinically significant liver disease, relationship between liver pathology and body mass index, and compare outcomes between ethnic groups. METHODS This retrospective cohort study included all patients who had index bariatric surgery at Auckland City Hospital between 2009 and 2016. Diagnosis of liver disease was based on intraoperative biopsy histology. Outcomes included safety (biopsy-related complication) and utility (liver pathology meeting criteria for referral). Liver pathology and referral rates were compared between ethnic groups. RESULTS Of 335 bariatric surgery patients, 234 (70%) underwent intraoperative liver biopsy. There were no biopsy-related complications. Histological findings were as follows: normal 25/234 (11%), non-alcoholic fatty liver disease (NAFLD) 207/234 (88%), and other pathological findings in 35/234 (15%). Histological finding meeting referral criteria was present in 22/234 (9%). Of these, 12/22 (55%) were referred. Number needed to biopsy to identify histology meeting referral criteria: n = 11. Māori had a similar NAFLD rate to non-Māori [51/56 versus 156/178, p = 0.48]. Pasifika patients had a higher rate than non-Pasifika [39/40 versus 168/194, p = 0.049]. Māori and Pasifika patients had similar referral rates to non-Māori and non-Pasifika [2/3 versus 5/9, p = 0.73; 2/2 versus 5/10, p = 0.19]. CONCLUSIONS Intraoperative liver biopsy during bariatric surgery is safe and identified liver disease in 89%, with 9% meeting referral criteria. Pasifika patients have a higher rate of NAFLD than non-Pasifika.
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Affiliation(s)
- Hannah Collins
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand.
| | - Grant Beban
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | | | - Rishi Ram
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - David Orr
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
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Ingram J, Collins H, Atkinson M, Brooks C. The prevalence of hidradenitis suppurativa is shown by the Secure Anonymised Information Linkage (
SAIL
) Databank to be one per cent of the population of Wales. Br J Dermatol 2020; 183:950-952. [DOI: 10.1111/bjd.19210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J.R. Ingram
- Department of Dermatology Division of Infection and Immunity Cardiff University Cardiff UK
| | - H. Collins
- SAIL Databank Population Data Science Data Science Building Swansea University Medical School Singleton Park Swansea UK
| | - M.D. Atkinson
- Data Science Building Swansea University School of Medicine Swansea University Swansea UK
| | - C.J. Brooks
- SAIL Databank Population Data Science Data Science Building Swansea University Medical School Singleton Park Swansea UK
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Barandov A, Ghosh S, Li N, Bartelle BB, Daher JI, Pegis ML, Collins H, Jasanoff A. Molecular Magnetic Resonance Imaging of Nitric Oxide in Biological Systems. ACS Sens 2020; 5:1674-1682. [PMID: 32436387 DOI: 10.1021/acssensors.0c00322] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Detection of nitric oxide (NO) in biological systems is challenging due to both physicochemical properties of NO and limitations of current imaging modalities and probes. Magnetic resonance imaging (MRI) could be applied for studying NO in living tissue with high spatiotemporal resolution, but there is still a need for chemical agents that effectively sensitize MRI to biological NO production. To develop a suitable probe, we studied the interactions between NO and a library of manganese complexes with various oxidation states and molecular structures. Among this set, the manganese(III) complex with N,N'-(1,2-phenylene)bis(5-fluoro-2-hydroxybenzamide) showed favorable changes in longitudinal relaxivity upon addition of NO-releasing chemicals in vitro while also maintaining selectivity against other biologically relevant reactive nitrogen and oxygen species, making it a suitable NO-responsive contrast agent for T1-weighted MRI. When loaded with this compound, cells ectopically expressing nitric oxide synthase (NOS) isoforms showed MRI signal decreases of over 20% compared to control cells and were also responsive to NOS inhibition or calcium-dependent activation. The sensor could also detect endogenous NOS activity in antigen-stimulated macrophages and in a rat model of neuroinflammation in vivo. Given the key role of NO and associated reactive nitrogen species in numerous physiological and pathological processes, MRI approaches based on the new probe could be broadly beneficial for studies of NO-related signaling in living subjects.
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Affiliation(s)
- Ali Barandov
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Souparno Ghosh
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Nan Li
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Benjamin B. Bartelle
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Jade I. Daher
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Michael L. Pegis
- Department of Chemistry, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Hannah Collins
- Department of Chemistry, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
| | - Alan Jasanoff
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
- Department of Brain & Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
- Department of Nuclear Science & Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue Rm. 16-561, Cambridge, Massachusetts 02139, United States
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Collins H, Allsopp K, Arvanitis K, Chitsabesan P, French P. Psychological impact of spontaneous memorials: A narrative review. Psychol Trauma 2020; 14:1230-1236. [PMID: 32191057 DOI: 10.1037/tra0000565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The creation of spontaneous memorials has become an increasingly common response following a traumatic event, such as the Manchester Arena attack, the 2016 Paris attacks, and September 11, 2001, in New York. In many cases, spontaneous memorials are collected and archived. This article is the 1st to date to review the research literature on the potential psychological and therapeutic impact of such archives. METHOD This study presents a literature review of 35 articles (including empirical research, discussion papers and gray literature) that explore the psychological functions of spontaneous memorials and why they may have been created. RESULTS Research has indicated that therapeutic impact is 1 of the main intended or assumed outcomes of such memorials and archives when it comes to those directly affected and the broader public. However, it has also been suggested that working with these materials can have a detrimental psychological impact on cultural professionals such as archivists, and research has recommended that mental health support should be in place for those working with the materials. This review indicates that there is limited research within this area and demonstrates a clear need to explore the impact of spontaneous memorials and their archives further, including avenues of support that may be helpful for professionals. CONCLUSION Because spontaneous memorials are becoming an ever-increasing phenomenon, it is important to address this evidence gap to help guide cultural, health care, and other professionals in how best to present and potentially use these archives therapeutically in the future. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Hannah Collins
- Manchester Resilience Hub, Pennine Care NHS Foundation Trust
| | - Kate Allsopp
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust
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Kistin CJ, Touw S, Collins H, Sporn N, Finnegan KE. Impact of a community-delivered parenting curriculum on perceived parenting stress and parent-reported outcomes in a low-income diverse population. ACTA ACUST UNITED AC 2020; 38:57-73. [DOI: 10.1037/fsh0000460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lyubchenko T, Collins H, Vang K, Leung D. Th2 cytokines (IL-4/IL-13) and SMOC1 regulate keratinocytes sensitivity to microenviromental Ca2+ changes that initiate differentiation signals leading to skin barrier alterations. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Bilen MA, Martini DJ, Liu Y, Shabto JM, Brown JT, Williams M, Khan AI, Speak A, Lewis C, Collins H, Kissick HT, Carthon BC, Akce M, Shaib WL, Alese OB, Pillai RN, Steuer CE, Wu CS, Lawson DH, Kudchadkar RR, El‐Rayes BF, Ramalingam SS, Owonikoko TK, Harvey RD, Master VA. Combined Effect of Sarcopenia and Systemic Inflammation on Survival in Patients with Advanced Stage Cancer Treated with Immunotherapy. Oncologist 2019; 25:e528-e535. [PMID: 32162807 PMCID: PMC7066707 DOI: 10.1634/theoncologist.2019-0751] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/31/2019] [Indexed: 12/27/2022] Open
Abstract
Background Sarcopenia and inflammation have been associated with poor survival in patients with cancer. We explored the combined effects of these variables on survival in patients with cancer treated with immunotherapy. Methods We performed a retrospective review of 90 patients enrolled on immunotherapy‐based phase I clinical trials at Emory University from 2009 to 2017. Baseline neutrophil‐to‐lymphocyte ratio, monocyte‐to‐lymphocyte ratio, and platelet‐to‐lymphocyte ratio (PLR) were used as surrogates of inflammation. The skeletal muscle index (SMI) was derived from the skeletal muscle density calculated from baseline abdominal computed tomography images. Optimal cutoffs for continuous inflammation biomarkers and SMI were determined by bias‐adjusted log‐rank test. A four‐level risk stratification was used to create low‐risk (PLR <242 and nonsarcopenic), intermediate‐risk (PLR <242 and sarcopenic), high‐risk (PLR ≥242 and nonsarcopenic), and very‐high‐risk (PLR ≥242 and sarcopenic) groups with subsequent association with survival. Results Most patients (59%) were male, and the most common cancers were melanoma (33%) and gastrointestinal (22%). Very high‐risk, high‐risk, and intermediate‐risk patients had significantly shorter overall survival (hazard ratio [HR], 8.46; 95% confidence interval [CI], 2.65–27.01; p < .001; HR, 5.32; CI, 1.96–14.43; p = .001; and HR, 4.01; CI, 1.66–9.68; p = .002, respectively) and progression‐free survival (HR, 12.29; CI, 5.15–29.32; p < .001; HR, 3.51; CI, 1.37–9.02; p = .009; and HR, 2.14; CI, 1.12–4.10; p = .022, respectively) compared with low‐risk patients. Conclusion Baseline sarcopenia and elevated inflammatory biomarkers may have a combined effect on decreasing survival in immunotherapy‐treated patients in phase I trials. These data may be immediately applicable for medical oncologists for the risk stratification of patients beginning immunotherapeutic agents. Implications for Practice Sarcopenia and inflammation have been associated with poor survival in patients with cancer, but it is unclear how to apply this information to patient care. The authors created a risk‐stratification system that combined sarcopenia and platelet‐to‐lymphocyte ratio as a marker of systemic inflammation. The presence of sarcopenia and systemic inflammation decreased progression‐free survival and overall survival in our cohort of 90 patients who received immunotherapy in phase I clinical trials. The data presented in this study may be immediately applicable for medical oncologists as a way to risk‐stratify patients who are beginning treatment with immunotherapy. The interaction between chronic inflammation and body composition is particularly important in the era of immunotherapy, considering that immune checkpoint inhibitors rely on the host immune system for their efficacy. This article reports on the combined effects of inflammation and sarcopenia on clinical outcomes in patients with solid tumors treated with immunotherapy‐based regimens.
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Affiliation(s)
- Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Dylan J. Martini
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory UniversityAtlantaGeorgiaUSA
| | - Julie M. Shabto
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Jacqueline T. Brown
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Milton Williams
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Amir I. Khan
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Alexandra Speak
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Colleen Lewis
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Hannah Collins
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Haydn T. Kissick
- Department of Urology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Mehmet Akce
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Walid L. Shaib
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Olatunji B. Alese
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Rathi N. Pillai
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Conor E. Steuer
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Christina S. Wu
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - David H. Lawson
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Ragini R. Kudchadkar
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Bassel F. El‐Rayes
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Suresh S. Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Taofeek K. Owonikoko
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - R. Donald Harvey
- Department of Hematology and Medical Oncology, Emory University School of MedicineAtlantaGeorgiaUSA
- Department of Pharmacology, Emory University School of MedicineAtlantaGeorgiaUSA
- Winship Cancer Institute of Emory UniversityAtlantaGeorgiaUSA
| | - Viraj A. Master
- Department of Urology, Emory University School of MedicineAtlantaGeorgiaUSA
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Martini DJ, Kline MR, Liu Y, Shabto JM, Williams MA, Khan AI, Lewis C, Collins H, Akce M, Kissick HT, Carthon BC, Shaib WL, Alese OB, Pillai RN, Steuer CE, Wu CS, Lawson DH, Kudchadkar RR, El‐Rayes BF, Ramalingam SS, Owonikoko TK, Harvey RD, Master VA, Bilen MA. Adiposity may predict survival in patients with advanced stage cancer treated with immunotherapy in phase 1 clinical trials. Cancer 2019; 126:575-582. [DOI: 10.1002/cncr.32576] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/27/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022]
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Khan AR, Reichmann LG, Ibal JC, Shin JH, Liu Y, Collins H, LePage B, Terry N. Variation in pickleweed root-associated microbial communities at different locations of a saline solid waste management unit contaminated with petroleum hydrocarbons. PLoS One 2019; 14:e0222901. [PMID: 31581244 PMCID: PMC6776359 DOI: 10.1371/journal.pone.0222901] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/10/2019] [Indexed: 12/03/2022] Open
Abstract
The main purpose of this study was to explore the potential influences of pickleweed vegetation on the abundance, diversity and metabolic activities of microbial communities in four distinct areas of a petroleum-contaminated solid waste management unit (SWMU) located in Contra Costa County, northern California. The four areas sampled include two central areas, one of which is central vegetated (CV) and one unvegetated (UV), and two peripheral vegetated areas, one of which is located to the west side of the SWMU (V-West) and one located to the east side (V-East). Measurements were made of total petroleum hydrocarbons (TPH), polyaromatic hydrocarbons (PAH), soil physicochemical properties, and various aspects of microbial communities including metabolic activities, microbial abundances (PLFAs), diversity and composition based on amplicon sequencing. The peripheral V-East and V-West sites had 10-times lower electrical conductivity (EC) than that of the CV and UV sites. The high salinity levels of the CV and UV sites were associated with significant reductions in bacterial and fungal abundances (PLFA) when compared to V-East but not when compared to V-West. TPH levels of CV and UV were not significantly different from those of V-West but were substantially lower than V-East TPH (19,311 mg/kg of dry soil), the high value of which may have been associated with a pipeline that ran through the area. Microbial activities (in terms of soil respiration and the activities of three soil enzymes, i.e., urease, lipase, and phosphatase) were greatest in the vegetated sites compared to the UV site. The prokaryotic community was not diverse as revealed by the Shannon index with no significant variation among the four groups of samples. However, the fungal community of the peripheral sites, V-East and V-West had significantly higher OTU richness and Shannon index. Structure of prokaryotic communities inhabiting the rhizosphere of pickleweed plants at the three sites differed significantly and were also different from those found in the UV region of the central site according to pairwise, global PERMANOVA and ANOSIM analyses. The differences in OTU-based rhizosphere-associated bacterial and fungal communities’ composition were explained mainly by the changes in soil EC and pH. The results suggest that saline TPH-contaminated areas that are vegetated with pickleweed are likely to have increased abundances, diversity and metabolic activities in the rhizosphere compared to unvegetated areas, even in the presence of high salinity.
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Affiliation(s)
- Abdur Rahim Khan
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, United States of America
- * E-mail: (NT); , (ARK)
| | - L. G. Reichmann
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, United States of America
| | - J. C. Ibal
- School of Applied Biosciences, College of Agriculture and Life Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - J. H. Shin
- School of Applied Biosciences, College of Agriculture and Life Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Y. Liu
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, United States of America
| | - H. Collins
- USDA-ARS Grassland Soil and Water Research Laboratory, Temple, TX, United States of America
| | - B. LePage
- Pacific Gas and Electric Company, San Ramon, CA, United States of America
- The Academy of Natural Science, Philadelphia, PA, United States of America
| | - N. Terry
- Department of Plant and Microbial Biology, University of California, Berkeley, CA, United States of America
- * E-mail: (NT); , (ARK)
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27
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Bilen MA, Shabto JM, Martini DJ, Liu Y, Lewis C, Collins H, Akce M, Kissick H, Carthon BC, Shaib WL, Alese OB, Steuer CE, Wu C, Lawson DH, Kudchadkar R, Master VA, El-Rayes B, Ramalingam SS, Owonikoko TK, Harvey RD. Sites of metastasis and association with clinical outcome in advanced stage cancer patients treated with immunotherapy. BMC Cancer 2019; 19:857. [PMID: 31464611 PMCID: PMC6716879 DOI: 10.1186/s12885-019-6073-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 09/22/2018] [Accepted: 08/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background Selecting the appropriate patients to receive immunotherapy (IO) remains a challenge due to the lack of optimal biomarkers. The presence of liver metastases has been implicated as a poor prognostic factor in patients with metastatic cancer. We investigated the association between sites of metastatic disease and clinical outcomes in patients receiving IO. Methods We conducted a retrospective review of 90 patients treated on IO-based phase 1 clinical trials at Winship Cancer Institute of Emory University between 2009 and 2017. Overall survival (OS) and progression-free survival (PFS) were measured from the first dose of IO to date of death or hospice referral and clinical or radiographic progression, respectively. Clinical benefit (CB) was defined as a best response of complete response (CR), partial response (PR), or stable disease (SD). Univariate analysis (UVA) and Multivariate analysis (MVA) were carried out using Cox proportional hazard model or logistic regression model. Covariates included age, whether IO is indicated for the patient’s histology, ECOG performance status, Royal Marsden Hospital (RMH) risk group, number of metastatic sites, and histology. Results The median age was 63 years and 53% of patients were men. The most common histologies were melanoma (33%) and gastrointestinal cancers (22%). Most patients (73.3%) had more than one site of distant metastasis. Sites of metastasis collected were lymph node (n = 58), liver (n = 40), lung (n = 37), bone (n = 24), and brain (n = 8). Most patients (80.7%) were RMH good risk. Most patients (n = 62) had received 2+ prior lines of systemic treatment before receiving IO on trial; 27 patients (30.0%) received prior ICB. Liver metastases were associated with significantly shorter OS (HR: 0.38, CI: 0.17–0.84, p = 0.017). Patients with liver metastasis also trended towards having shorter PFS (HR: 0.70, CI: 0.41–1.19, p = 0.188). The median OS was substantially longer for patients without liver metastases (21.9 vs. 8.1 months, p = 0.0048). Conclusions Liver metastases may be a poor prognostic factor in patients receiving IO on phase 1 clinical trials. The presence of liver metastases may warrant consideration in updated prognostic models if these findings are validated in a larger prospective cohort.
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Affiliation(s)
- Mehmet Asim Bilen
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA.
| | - Julie M Shabto
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Rd, Atlanta, GA, USA
| | - Colleen Lewis
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Hannah Collins
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Mehmet Akce
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Haydn Kissick
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA.,Department of Urology, Emory University, 5673 Peachtree, Dunwoody Rd, Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Walid L Shaib
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Olatunji B Alese
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Conor E Steuer
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Christina Wu
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - David H Lawson
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Ragini Kudchadkar
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University, 5673 Peachtree, Dunwoody Rd, Atlanta, GA, USA
| | - Bassel El-Rayes
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA
| | - R Donald Harvey
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd, Atlanta, GA, USA.,Department of Pharmacology, Emory University School of Medicine, 1365 Clifton Rd, Atlanta, GA, USA
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28
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Bilen M, Martini D, Liu Y, Lewis C, Collins H, Shabto J, Akce M, Kissick H, Carthon B, Shaib W, Alese O, Pillai R, Steuer C, Wu C, Lawson D, Kudchadkar R, El-Rayes B, Master V, Ramalingam S, Owonikoko T, Harvey RD. Abstract B176: Sequential immunotherapy and association with clinical outcomes in advanced-stage cancer patients. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-b176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There are now six approved immune checkpoint inhibitors for several different malignancies including melanoma, head and neck cancer, lung cancer, and renal cell carcinoma. Given the increased number of available immunotherapeutic agents, more patients are presenting in clinic as candidates for sequential immunotherapy. However, the efficacy of sequential immunotherapy in a trial setting is unknown. We investigated the association between prior treatment with immune checkpoint inhibitors and clinical outcomes in patients treated with subsequent immunotherapy in a phase 1 clinical trial. Methods: We conducted a retrospective review of 90 advanced stage cancer patients treated on immunotherapy-based phase 1 clinical trials at Winship Cancer Institute between 2009 and 2017. We included 49 patients with an immune checkpoint-indicated histology (melanoma, lung cancer, head and neck cancer, and bladder cancer). Patients were then analyzed based on whether they had received at least one immune checkpoint inhibitor prior to enrollment. Overall survival (OS) and progression-free survival (PFS) were calculated in months from immunotherapy initiation on trial to date of death and clinical or radiographic progression, respectively. Clinical benefit (CB) was defined as a best response of complete response (CR), partial response (PR), or stable disease (SD). Univariate analysis (UVA) and multivariate analysis (MVA) were carried out using Cox proportional hazard or logistic regression model. Covariates included age, presence of liver metastases, number of prior lines of systemic therapy, histology, and Royal Marsden Hospital (RMH) risk group. Results: The median age was 67 years and most patients (78%) were men. The most common histologies were melanoma (61%) and lung/head and neck cancers (37%). The majority (81%) of patients were RMH good risk. More than half of patients (n=27, 55%) had received at least one immune checkpoint inhibitor prior to trial enrollment: ten received anti-PD-1, two received anti-CTLA-4, five received anti-PD-1/CTLA-4 combination therapy, and ten received multiple immune checkpoint inhibitors. In MVA, patients who had not received a prior immune checkpoint inhibitor had significantly longer OS (HR: 0.22, CI: 0.07-0.70, p=0.010). These patients also trended towards longer PFS (HR: 0.86, CI: 0.39-1.87, p=0.699) and higher chance of CB (HR: 2.52, CI: 0.49-12.97, p=0.268). Immunotherapy-naïve patients had substantially longer OS (24.3 vs 10.9 months) and PFS (5.1 vs. 2.8 months) than patients who had prior immunotherapy per Kaplan-Meier estimation. Conclusion: Optimal treatment options for oncology patients who progress on immune checkpoint inhibitors are lacking. In this study, patients who received at least one prior immune checkpoint inhibitor had worse clinical outcomes on immunotherapy-based phase 1 clinical trials than immune checkpoint-naïve patients. This suggests that further development of immunotherapy combination therapies is needed to improve clinical outcomes of these patients. The results from this study should be validated in a larger, prospective study.
Citation Format: Mehmet Bilen, Dylan Martini, Yuan Liu, Colleen Lewis, Hannah Collins, Julie Shabto, Mehmet Akce, Haydn Kissick, Bradley Carthon, Walid Shaib, Olatunji Alese, Rathi Pillai, Conor Steuer, Christina Wu, David Lawson, Ragini Kudchadkar, Bassel El-Rayes, Viraj Master, Suresh Ramalingam, Taofeek Owonikoko, R. Donald Harvey. Sequential immunotherapy and association with clinical outcomes in advanced-stage cancer patients [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B176.
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Affiliation(s)
- Mehmet Bilen
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Dylan Martini
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Yuan Liu
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Colleen Lewis
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hannah Collins
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Julie Shabto
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mehmet Akce
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Haydn Kissick
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Bradley Carthon
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Walid Shaib
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Olatunji Alese
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Rathi Pillai
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Conor Steuer
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Christina Wu
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - David Lawson
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Ragini Kudchadkar
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Bassel El-Rayes
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Viraj Master
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Suresh Ramalingam
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Taofeek Owonikoko
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - R. Donald Harvey
- Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
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Finnegan S, Nichols V, Sheehan B, Atherton N, Collins H, Mistry D, Dosanjh S, Slowther AM, Khan I, Petrou S, Lall R, Lamb S. A randomised controlled trial of moderate to high intensity exercise training for people with dementia: Dementia And Physical Activity (DAPA). Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.082] [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: 11/28/2022]
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Haney MS, Bohlen CJ, Morgens DW, Ousey JA, Barkal AA, Tsui CK, Ego BK, Levin R, Kamber RA, Collins H, Tucker A, Li A, Vorselen D, Labitigan L, Crane E, Boyle E, Jiang L, Chan J, Rincón E, Greenleaf WJ, Li B, Snyder MP, Weissman IL, Theriot JA, Collins SR, Barres BA, Bassik MC. Identification of phagocytosis regulators using magnetic genome-wide CRISPR screens. Nat Genet 2018; 50:1716-1727. [PMID: 30397336 DOI: 10.1038/s41588-018-0254-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/11/2018] [Indexed: 01/09/2023]
Abstract
Phagocytosis is required for a broad range of physiological functions, from pathogen defense to tissue homeostasis, but the mechanisms required for phagocytosis of diverse substrates remain incompletely understood. Here, we developed a rapid magnet-based phenotypic screening strategy, and performed eight genome-wide CRISPR screens in human cells to identify genes regulating phagocytosis of distinct substrates. After validating select hits in focused miniscreens, orthogonal assays and primary human macrophages, we show that (1) the previously uncharacterized gene NHLRC2 is a central player in phagocytosis, regulating RhoA-Rac1 signaling cascades that control actin polymerization and filopodia formation, (2) very-long-chain fatty acids are essential for efficient phagocytosis of certain substrates and (3) the previously uncharacterized Alzheimer's disease-associated gene TM2D3 can preferentially influence uptake of amyloid-β aggregates. These findings illuminate new regulators and core principles of phagocytosis, and more generally establish an efficient method for unbiased identification of cellular uptake mechanisms across diverse physiological and pathological contexts.
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Affiliation(s)
- Michael S Haney
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Christopher J Bohlen
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, USA. .,Department of Neuroscience, Genentech, South San Francisco, CA, USA.
| | - David W Morgens
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - James A Ousey
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Amira A Barkal
- Institute for Stem Cell Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - C Kimberly Tsui
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Braeden K Ego
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Roni Levin
- Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
| | - Roarke A Kamber
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Hannah Collins
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrew Tucker
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy Li
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Daan Vorselen
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
| | - Lorenzo Labitigan
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
| | - Emily Crane
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Evan Boyle
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Lihua Jiang
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Joanne Chan
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Esther Rincón
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - William J Greenleaf
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Billy Li
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Michael P Snyder
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA
| | - Irving L Weissman
- Institute for Stem Cell Biology, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie A Theriot
- Department of Biochemistry, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean R Collins
- Department of Microbiology and Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Ben A Barres
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael C Bassik
- Department of Genetics and Stanford University Chemistry, Engineering and Medicine for Human Health (ChEM-H), Stanford University School of Medicine, Stanford, CA, USA.
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Martini DJ, Liu Y, Lewis C, Collins H, Akce M, Kissick H, Carthon BC, Shaib WL, Alese OB, Pillai R, Steuer CE, Wu C, Lawson DH, Kudchadkar R, El-Rayes B, Master VA, Ramalingam S, Owonikoko TK, Harvey RD, Bilen MA. Abstract 2607: Blood based biomarkers and association with clinical outcome (CO) in advanced stage patients (pts) treated with immunotherapy (IO). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Optimal biomarkers for cancer pts treated with IO are currently lacking. Markers of inflammation, such as neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) are readily available and associated with poor outcomes. We investigated the association between these markers and CO in pts treated with IO.
Methods: We conducted a retrospective review of 90 pts with advanced cancer treated on IO-based phase I trials at the Winship Cancer Institute of Emory University between 2009-2017. Baseline NLR, MLR, and PLR were treated as continuous variables and rescaled by their own standard deviation. Overall survival (OS) was measured from the first dose of IO to date of death or hospice referral. Progression-free survival (PFS) was determined from first dose of IO to clinical or radiographic progression or death. We defined clinical benefit (CB) as complete response, partial response, or stable disease. Univariate association (UVA) and multivariable analysis (MVA) were carried out using Cox proportional hazard model or logistic regression model. Baseline covariates included race, gender, ECOG PS, # of prior therapies, Royal Marsden Hospital (RMH) risk group, IO indication, and # of metastatic sites.
Results: The median pt age was 63 years and most (59%) were men. The most common histologies were melanoma (33%) and GI cancers (22%). The majority (81%) were RMH good risk. 46% of pts had CB on IO. The median NLR, MLR, and PLR was 3.63, 0.48, and 182.65, respectively. Increased NLR, MLR, and PLR were all associated with worse OS, PFS, and chance of CB (Table 1). NLR, MLR and PLR are highly correlated to each other (Pearson correlation coefficients ≥ 0.8, all p < 0.0001).
Conclusion: NLR, MLR, and PLR are strongly associated with CO in pts treated with IO. Prospective validation of these findings are warranted.
Table 1: UVA and MVA of NLR, MRL, and PLR with CO
OS PFSCBUVAMVAUVAMVAUVAMVAHR (CI)p-valueHR (CI)p-valueHR (CI)p-valueHR (CI)p-valueOR (CI)p-valueOR (CI)p-valueNLR1.37 (1.11-1.70)0.003*1.30 (1.02-1.66)0.031*1.42 (1.18-1.70)<0.001*1.32 (1.06-1.63)0.011*0.47 (0.23-0.94)0.033*0.57 (0.26-1.27)0.169MLR1.38 (1.14-1.67)<0.001*1.22 (0.98-1.52)0.071.39 (1.18-1.63)<0.001*1.26 (1.03-1.55)0.026*0.45 (0.23-0.89)0.021*0.71 (0.32-1.57)0.398PLR1.40 (1.15-1.69)<0.001*1.27 (1.03-1.56)0.027*1.40 (1.19-1.63)<0.001*1.27 (1.06-1.53)0.01*0.35 (0.17-0.74)0.006*0.28 (0.11-0.67)0.005*
*statistically significant
Citation Format: Dylan J. Martini, Yuan Liu, Colleen Lewis, Hannah Collins, Mehmet Akce, Haydn Kissick, Bradley C. Carthon, Walid L. Shaib, Olatunji B. Alese, Rathi Pillai, Conor E. Steuer, Christina Wu, David H. Lawson, Ragini Kudchadkar, Bassel El-Rayes, Viraj A. Master, Suresh Ramalingam, Taofeek K. Owonikoko, R Donald Harvey, Mehmet Asim Bilen. Blood based biomarkers and association with clinical outcome (CO) in advanced stage patients (pts) treated with immunotherapy (IO) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2607.
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Affiliation(s)
| | | | - Colleen Lewis
- 3Winship Cancer Institute of Emory University, Atlanta, GA
| | - Hannah Collins
- 3Winship Cancer Institute of Emory University, Atlanta, GA
| | - Mehmet Akce
- 3Winship Cancer Institute of Emory University, Atlanta, GA
| | | | | | - Walid L. Shaib
- 3Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Rathi Pillai
- 3Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Christina Wu
- 3Winship Cancer Institute of Emory University, Atlanta, GA
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Salomon-Estebanez M, Mohamed Z, Michaelidou M, Collins H, Rigby L, Skae M, Padidela R, Rust S, Dunne M, Cosgrove K, Banerjee I, Nicholson J. Vineland adaptive behavior scales to identify neurodevelopmental problems in children with Congenital Hyperinsulinism (CHI). Orphanet J Rare Dis 2017; 12:96. [PMID: 28532504 PMCID: PMC5440988 DOI: 10.1186/s13023-017-0648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 01/05/2017] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background Congenital Hyperinsulinism (CHI) is a disease of severe hypoglycaemia caused by excess insulin secretion and associated with adverse neurodevelopment in a third of children. The Vineland Adaptive Behavior Scales Second Edition (VABS-II) is a parent report measure of adaptive functioning that could be used as a developmental screening tool in patients with CHI. We have investigated the performance of VABS-II as a screening tool to identify developmental delay in a relatively large cohort of children with CHI. VABS-II questionnaires testing communication, daily living skills, social skills, motor skills and behaviour domains were completed by parents of 64 children with CHI, presenting both in the early neonatal period (Early-CHI, n = 48) and later in infancy (Late-CHI, n = 16). Individual and adaptive composite (Total) domain scores were converted to standard deviation scores (SDS). VABS-II scores were tested for correlation with objective developmental assessment reported separately by developmental paediatricians, clinical and educational psychologists. VABS-II scores were also investigated for correlation with the timing of hypoglycaemia, gender and phenotype of CHI. Results Median (range) total VABS-II SDS was low in CHI [-0.48 (-3.60, 4.00)] with scores < -2.0 SDS in 9 (12%) children. VABS-II Total scores correctly identified developmental delay diagnosed by objective assessment in the majority [odds ratio (OR) (95% confidence intervals, CI) 0.52 (0.38, 0.73), p < 0.001] with 95% specificity [area under curve (CI) 0.80 (0.68, 0.90), p < 0.001] for cut-off < -2.0 SDS, although with low sensitivity (26%). VABS-II Total scores were inversely correlated (adjusted R2 = 0.19, p = 0.001) with age at presentation (p = 0.024) and male gender (p = 0.036), males having lower scores than females in those with Late-CHI [-1.40 (-3.60, 0.87) v 0.20 (-1.07, 1.27), p = 0.014]. The presence of a genetic mutation representing severe CHI also predicted lower scores (R2 = 0.19, p = 0.039). Conclusions The parent report VABS-II is a reliable and specific tool to identify developmental delay in CHI patients. Male gender, later age at presentation and severity of disease are independent risk factors for lower VABS-II scores.
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Affiliation(s)
- Maria Salomon-Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK. .,Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Zainab Mohamed
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children's Hospital, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Maria Michaelidou
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Hannah Collins
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Lindsey Rigby
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Mars Skae
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Stewart Rust
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - Mark Dunne
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Karen Cosgrove
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jacqueline Nicholson
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, UK
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Collins H, Lee KM, Cheng PTY, Hulme S. Soft tissue infections from fish spike wounds: normal commensal bacteria are more common than marine pathogens. ANZ J Surg 2017; 88:E40-E44. [PMID: 28320052 DOI: 10.1111/ans.13850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/28/2016] [Accepted: 10/17/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND A fish spike injury can be sustained by anyone handling fish; during fishing, meal preparation or in retail. Case reports of fish spikes inoculating victims with virulent marine-specific pathogens and causing systemic illness led us to question whether empirical treatment of these injuries with amoxicillin and clavulanic acid is adequate. METHODS This 2-year prospective observational study was conducted at Middlemore Hospital, Auckland, New Zealand. Wound swabs and tissue samples belonging to patients presenting to the Department of Plastic and Reconstructive Surgery with an upper limb fish spike injury were sent to the laboratory (n = 60). A series of stains and cultures were performed to look specifically for marine bacteria not typically isolated in other soft tissue injuries. Patient demographic data and injury details were collected. RESULTS Of the patients with adequate microbiology samples, 12% (6/50) grew clinically relevant bacteria resistant to amoxicillin and clavulanic acid. These included methicillin-resistant Staphylococcus aureus (8%, 4/50), Enterobacter cloacae (2%, 1/50) and an anaerobic sporing bacillus (2%, 1/50). Only one patient grew a true marine-specific bacteria, Photobacterium damselae, which was susceptible to amoxicillin and clavulanic acid. CONCLUSION The authors concluded that amoxicillin and clavulanic acid is an adequate first-line antibiotic for fish spike injuries but that flucloxacillin may be more appropriate given most bacteria were from patients' own skin flora. The authors suggest that clinicians consider the presence of resistant marine-specific bacteria in cases where there is sepsis or inadequate response to initial therapy.
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Affiliation(s)
- Hannah Collins
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Kin Mun Lee
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Paul T-Y Cheng
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sarah Hulme
- Department of Plastic and Reconstructive Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
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Green JMH, Cranston GR, Sutherland WJ, Tranter HR, Bell SJ, Benton TG, Blixt E, Bowe C, Broadley S, Brown A, Brown C, Burns N, Butler D, Collins H, Crowley H, DeKoszmovszky J, Firbank LG, Fulford B, Gardner TA, Hails RS, Halvorson S, Jack M, Kerrison B, Koh LSC, Lang SC, McKenzie EJ, Monsivais P, O’Riordan T, Osborn J, Oswald S, Price Thomas E, Raffaelli D, Reyers B, Srai JS, Strassburg BBN, Webster D, Welters R, Whiteman G, Wilsdon J, Vira B. Research priorities for managing the impacts and dependencies of business upon food, energy, water and the environment. Sustain Sci 2016; 12:319-331. [PMID: 30174755 PMCID: PMC6106109 DOI: 10.1007/s11625-016-0402-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 09/15/2016] [Indexed: 05/04/2023]
Abstract
Delivering access to sufficient food, energy and water resources to ensure human wellbeing is a major concern for governments worldwide. However, it is crucial to account for the 'nexus' of interactions between these natural resources and the consequent implications for human wellbeing. The private sector has a critical role in driving positive change towards more sustainable nexus management and could reap considerable benefits from collaboration with researchers to devise solutions to some of the foremost sustainability challenges of today. Yet opportunities are missed because the private sector is rarely involved in the formulation of deliverable research priorities. We convened senior research scientists and influential business leaders to collaboratively identify the top forty questions that, if answered, would best help companies understand and manage their food-energy-water-environment nexus dependencies and impacts. Codification of the top order nexus themes highlighted research priorities around development of pragmatic yet credible tools that allow businesses to incorporate nexus interactions into their decision-making; demonstration of the business case for more sustainable nexus management; identification of the most effective levers for behaviour change; and understanding incentives or circumstances that allow individuals and businesses to take a leadership stance. Greater investment in the complex but productive relations between the private sector and research community will create deeper and more meaningful collaboration and cooperation.
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Affiliation(s)
- Jonathan M. H. Green
- Department of Geography and University of Cambridge Conservation Research Institute, Downing Site, Cambridge, CB2 3EN UK
- University of Cambridge Institute for Sustainability Leadership, 1 Trumpington Street, Cambridge, CB2 1QA UK
- Stockholm Environment Institute, Environment Building, University of York, Wentworth Way, York, YO10 5NG UK
| | - Gemma R. Cranston
- University of Cambridge Institute for Sustainability Leadership, 1 Trumpington Street, Cambridge, CB2 1QA UK
| | - William J. Sutherland
- Conservation Science Group, Department of Zoology, University of Cambridge, The David Attenborough Building, Pembroke Street, Cambridge, CB2 3QZ UK
| | - Hannah R. Tranter
- University of Cambridge Institute for Sustainability Leadership, 1 Trumpington Street, Cambridge, CB2 1QA UK
| | - Sarah J. Bell
- Openfield, Honey Pot Lane, Colsterworth, Grantham, Lincs, NG33 5LY UK
| | - Tim G. Benton
- UK Global Food Security Programme, BBSRC, Polaris House, North Star Avenue, Swindon, SN2 1UH UK
- School of Biology, University of Leeds, Leeds, LS2 9JT UK
| | - Eva Blixt
- Swedish Steel Association (Jernkontoret), Kungsträdgårdsgatan 10, Box 1721, 111 87 Stockholm, Sweden
| | - Colm Bowe
- Environment Research Group, School of Natural Sciences and Psychology, Liverpool John Moores University, Byrom Street Campus, Byrom Street, Liverpool, L3 3AF UK
| | - Sarah Broadley
- Saint Gobain Building Distribution UK, Merchant House, Binley Business Park, Binley, Coventry, CV3 2TT UK
| | - Andrew Brown
- Anglian Water, Lancaster House, Lancaster Way, Ermine Business Park, Huntingdon, PE29 6YJ UK
| | - Chris Brown
- Asda, Asda House, Southbank, Great Wilson Street, Leeds, LS11 5AD UK
| | - Neil Burns
- Mondi Group, Building 1, 1st Floor, Aviator Park, Station Road, Addlestone, KT15 2PG UK
| | - David Butler
- Centre for Water Systems, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Harrison Building, Streatham Campus, North Park Road, Exeter, EX4 4QF UK
| | - Hannah Collins
- Economic and Social Research Council, Polaris House, North Star Avenue, Swindon, SN2 1UJ UK
| | - Helen Crowley
- Kering, 10 Avenue Hoche, 75381 Paris Cedex 08, France
| | | | - Les G. Firbank
- School of Biology, University of Leeds, Leeds, LS2 9JT UK
| | - Brett Fulford
- GlaxoSmithKline, 980 Great West Road, Brentford, TW8 9GS UK
| | - Toby A. Gardner
- Stockholm Environment Institute, Linnégatan 87D, Box 24218, 104 51 Stockholm, Sweden
| | - Rosemary S. Hails
- Centre for Ecology and Hydrology, Maclean Building, Benson Lane, Crowmarsh Gifford, Wallingford, OX10 8BB UK
| | - Sharla Halvorson
- Global Headquarters, Nestlé S.A, Avenue Nestlé 55, 1800 Vevey, Switzerland
| | - Michael Jack
- HSBC Bank, 8 Canada Square, Canary Wharf, London, E14 5HQ UK
| | - Ben Kerrison
- EDF Energy, Cardinal Place, 80 Victoria Street, London, SW1E 5JL UK
| | - Lenny S. C. Koh
- Advanced Resource Efficiency Centre and Management School, University of Sheffield, Conduit Road, Sheffield, S10 1FL UK
| | - Steven C. Lang
- Ernst and Young LLP, 1 More London Place, London, SE 2AF UK
| | - Emily J. McKenzie
- WWF and the Natural Capital Project, The Living Planet Centre, Rufford House, Brewery Road, Woking, Surrey, GU21 4LL UK
| | - Pablo Monsivais
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Timothy O’Riordan
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Jeremy Osborn
- Ernst and Young LLP, 1 More London Place, London, SE 2AF UK
| | - Stephen Oswald
- Bidvest Fresh Limited, Cedar way, Camley Street, London, N1C 4PD UK
| | - Emma Price Thomas
- ArcelorMittal, Berkeley Square House, 7th Floor, Berkeley Square, London, W1J 6DA UK
| | - David Raffaelli
- BESS Directorate, Environment, University of York, Heslington, York, YO10 5DD UK
| | - Belinda Reyers
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, SE-106 19 Stockholm, Sweden
| | - Jagjit S. Srai
- Institute for Manufacturing, Department of Engineering, University of Cambridge, Charles Babbage Road, Cambridge, CB3 0ES UK
| | - Bernardo B. N. Strassburg
- International Institute for Sustainability & Department of Geography and the Environment, Pontifical Catholic University of Rio de Janerio, Estrada Dona Castorina 124, Horto, Rio de Janeiro, Brazil
| | - David Webster
- Jordans and Ryvita, Market Garden Road, Biggleswade, SG18 8QB UK
| | - Ruth Welters
- School of Environmental Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Gail Whiteman
- Pentland Centre for Sustainability in Business, Lancaster University, Bailrigg, Lancaster, LA1 4YX UK
| | - James Wilsdon
- SPRU-Science Policy Research Unit, University of Sussex, Brighton, BN1 9SL UK
| | - Bhaskar Vira
- Department of Geography and University of Cambridge Conservation Research Institute, Downing Site, Cambridge, CB2 3EN UK
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Collins H. Evolution at Work. Midwives 2016; 19:60-61. [PMID: 30720947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Roberts DR, Chatterjee AR, Yazdani M, Marebwa B, Brown T, Collins H, Bolles G, Jenrette JM, Nietert PJ, Zhu X. Pediatric Patients Demonstrate Progressive T1-Weighted Hyperintensity in the Dentate Nucleus following Multiple Doses of Gadolinium-Based Contrast Agent. AJNR Am J Neuroradiol 2016; 37:2340-2347. [PMID: 27469211 DOI: 10.3174/ajnr.a4891] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE While there have been recent reports of brain retention of gadolinium following gadolinium-based contrast agent administration in adults, a retrospective series of pediatric patients has not previously been reported, to our knowledge. We investigated the relationship between the number of prior gadolinium-based contrast agent doses and increasing T1 signal in the dentate nucleus on unenhanced T1-weighted MR imaging. We hypothesized that despite differences in pediatric physiology and the smaller gadolinium-based contrast agent doses that pediatric patients are typically administered based on weighted-adjusted dosing, the pediatric brain would also demonstrate dose-dependent increasing T1 signal in the dentate nucleus. MATERIALS AND METHODS We included children with multiple gadolinium-based contrast agent administrations at our institution. A blinded reader placed ROIs within the dentate nucleus and adjacent cerebellar white matter. To eliminate reader bias, we also performed automated ROI delineation of the dentate nucleus, cerebellar white matter, and pons. Dentate-to-cerebellar white matter and dentate-to pons ratios were compared with the number of gadolinium-based contrast agent administrations. RESULTS During 20 years at our institution, 280 patients received at least 5 gadolinium-based contrast agent doses, with 1 patient receiving 38 doses. Sixteen patients met the inclusion/exclusion criteria for ROI analysis. Blinded reader dentate-to-cerebellar white matter ratios were significantly associated with gadolinium-based contrast agent doses (rs = 0.77, P = .001). The dentate-to-pons ratio and dentate-to-cerebellar white matter ratios based on automated ROI placement were also significantly correlated with gadolinium-based contrast agent doses (t = 4.98, P < .0001 and t = 2.73, P < .02, respectively). CONCLUSIONS In pediatric patients, the number of prior gadolinium-based contrast agent doses is significantly correlated with progressive T1-weighted dentate hyperintensity. Definitive confirmation of gadolinium deposition requires tissue analysis. Any potential clinical sequelae of gadolinium retention in the developing brain are unknown. Given this uncertainty, we suggest taking a cautious stance, including the use, in pediatric patients, of higher stability, macrocyclic agents, which in both human and animal studies have been shown to be associated with lower levels of gadolinium deposition, and detailed documentation of dosing. Most important, a patient should not be deprived of a well-indicated contrasted MR examination.
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Affiliation(s)
- D R Roberts
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.) .,Neurosciences and Neuroscience Research (D.R.R.)
| | - A R Chatterjee
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - M Yazdani
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - B Marebwa
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - T Brown
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - H Collins
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - G Bolles
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | | | - P J Nietert
- Biostatistics (P.J.N.).,Public Health Sciences (P.J.N.), Medical University of South Carolina, Charleston, South Carolina
| | - X Zhu
- Department of Psychology (X.Z.), Normal College, Shihezi University, Xinjiang, China
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Abstract
The provision of occupational therapy for stroke patients by the social services was examined in 327 patients who had been discharged from hospital. Two- thirds (64%) of the patients were referred to the social service occupational therapist (SSOT). The occupational therapist visited a median of seven days from referral, treated the patient twice and then closed the case. The SSOT provided a range of equipment and adaptations to encourage independence in the community. Half of the patients visited received a bath- board and a quarter received an extra stair-rail to assist with mobility. Patients who had been referred to the SSOT and who also received therapy from an experimental domiciliary rehabilitation team received significantly more grab handles than those who were referred to the SSOT and also treated by the hospital-based rehabilitation teams. The SSOT provided a limited service to the group of stroke patients studied, mainly delivering equipment. The equipment was relatively cheap and may have been more appropriately administered by the hospital-based occupational therapist before the patient was discharged.
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Affiliation(s)
| | | | - Jrf Gladman
- Department of Health Care of the Elderly, University Hospital, Nottingham
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Sagana R, Stuckey L, Berry J, Collins H, Heinle A, Roaden L, Stepka D, Chang A, Lin J, Chan K. Lung Transplant Recipient Survival Following Urgent Inpatient Candidacy Evaluation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.649] [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: 11/29/2022] Open
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Grossauer S, Koeck K, Kadkhodaei B, Meyers I, Leddy J, Collins H, Petritsch C. IMPS-10BRAF V600E-MUTANT IMMUNOCOMPETENT GLIOMA MODEL EXHIBITS TYPICAL HISTOPATHOLOGICAL FEATURES OF HUMAN GLIOBLASTOMA MULTIFORME. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov217.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Woods A, Patel A, Spina D, Riffo-Vasquez Y, Babin-Morgan A, de Rosales RTM, Sunassee K, Clark S, Collins H, Bruce K, Dailey LA, Forbes B. In vivo biocompatibility, clearance, and biodistribution of albumin vehicles for pulmonary drug delivery. J Control Release 2015; 210:1-9. [PMID: 25980621 PMCID: PMC4674532 DOI: 10.1016/j.jconrel.2015.05.269] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 01/31/2023]
Abstract
The development of clinically acceptable albumin-based nanoparticle formulations for use in pulmonary drug delivery has been hindered by concerns about the toxicity of nanomaterials in the lungs combined with a lack of information on albumin nanoparticle clearance kinetics and biodistribution. In this study, the in vivo biocompatibility of albumin nanoparticles was investigated following a single administration of 2, 20, and 390 μg/mouse, showing no inflammatory response (TNF-α and IL-6, cellular infiltration and protein concentration) compared to vehicle controls at the two lower doses, but elevated mononucleocytes and a mild inflammatory effect at the highest dose tested. The biodistribution and clearance of 111In labelled albumin solution and nanoparticles over 48 h following a single pulmonary administration to mice was investigated by single photon emission computed tomography and X-ray computed tomography imaging and terminal biodistribution studies. 111In labelled albumin nanoparticles were cleared more slowly from the mouse lung than 111In albumin solution (64.1 ± 8.5% vs 40.6 ± 3.3% at t = 48 h, respectively), with significantly higher (P < 0.001) levels of albumin nanoparticle-associated radioactivity located within the lung tissue (23.3 ± 4.7%) compared to the lung fluid (16.1 ± 4.4%). Low amounts of 111In activity were detected in the liver, kidneys, and intestine at time points > 24 h indicating that small amounts of activity were cleared from the lungs both by translocation across the lung mucosal barrier, as well as mucociliary clearance. This study provides important information on the fate of albumin vehicles in the lungs, which may be used to direct future formulation design of inhaled nanomedicines.
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Affiliation(s)
- A Woods
- Drug Delivery Research Group, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom
| | - A Patel
- Drug Delivery Research Group, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom; Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, United Kingdom
| | - D Spina
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, United Kingdom
| | - Y Riffo-Vasquez
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, United Kingdom
| | - A Babin-Morgan
- Drug Delivery Research Group, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom; Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London SE1 9NH, United Kingdom
| | - R T M de Rosales
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - K Sunassee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - S Clark
- Division of Imaging Sciences and Biomedical Engineering, King's College London, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - H Collins
- Division of Immunology, Infection & Inflammatory Diseases, Guy's Campus, King's College London, 15-16 Newcomen Street, London SE1 1UL, United Kingdom
| | - K Bruce
- Drug Delivery Research Group, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom
| | - L A Dailey
- Drug Delivery Research Group, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom.
| | - B Forbes
- Drug Delivery Research Group, Institute of Pharmaceutical Science, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom
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Sadoff JC, Wright DC, Futrovsky S, Sidberry H, Collins H, Kaufmann B. Characterization of mouse monoclonal antibodies directed against Pseudomonas aeruginosa lipopolysaccharides. Antibiot Chemother (1971) 2015; 36:134-46. [PMID: 3923911 DOI: 10.1159/000410478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mouse monoclonal antibodies that react with O-side chain specific, O-side chain cross-reactive, and core P. aeruginosa lipopolysaccharide determinants have been isolated. The monoclonals directed at O-side chain determinants are generally opsonophagocytic with human neutrophils and human complement. They also protect mice from intraperitoneal and intravenous challenge and protect in the burned rat model of infection.
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Kempen H, Schranz D, Asztalos B, Otvos J, Jeyarajah E, Drazul-Schrader D, Collins H, Adelman S. Incubation of MDCO216 with human serum potentiates ABCA1 mediated cholesterol efflux capacity and generates new prebeta-1 Hdl. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.103] [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: 10/25/2022]
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Alderson-Day B, McCarthy-Jones S, Bedford S, Collins H, Dunne H, Rooke C, Fernyhough C. Shot through with voices: dissociation mediates the relationship between varieties of inner speech and auditory hallucination proneness. Conscious Cogn 2014; 27:288-96. [PMID: 24980910 PMCID: PMC4111865 DOI: 10.1016/j.concog.2014.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 05/23/2014] [Accepted: 05/25/2014] [Indexed: 11/18/2022]
Abstract
Inner speech is a commonly experienced but poorly understood phenomenon. The Varieties of Inner Speech Questionnaire (VISQ; McCarthy-Jones & Fernyhough, 2011) assesses four characteristics of inner speech: dialogicality, evaluative/motivational content, condensation, and the presence of other people. Prior findings have linked anxiety and proneness to auditory hallucinations (AH) to these types of inner speech. This study extends that work by examining how inner speech relates to self-esteem and dissociation, and their combined impact upon AH-proneness. 156 students completed the VISQ and measures of self-esteem, dissociation and AH-proneness. Correlational analyses indicated that evaluative inner speech and other people in inner speech were associated with lower self-esteem and greater frequency of dissociative experiences. Dissociation and VISQ scores, but not self-esteem, predicted AH-proneness. Structural equation modelling supported a mediating role for dissociation between specific components of inner speech (evaluative and other people) and AH-proneness. Implications for the development of "hearing voices" are discussed.
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Affiliation(s)
- Ben Alderson-Day
- Psychology Department, Science Laboratories, Durham University, South Road, Durham DH1 3LE, United Kingdom.
| | - Simon McCarthy-Jones
- Department of Cognitive Science, Macquarie University, Australian Hearing Hub, 16 University Avenue, NSW 2109, Australia
| | - Sarah Bedford
- Psychology Department, Science Laboratories, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - Hannah Collins
- Psychology Department, Science Laboratories, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - Holly Dunne
- Psychology Department, Science Laboratories, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - Chloe Rooke
- Psychology Department, Science Laboratories, Durham University, South Road, Durham DH1 3LE, United Kingdom
| | - Charles Fernyhough
- Psychology Department, Science Laboratories, Durham University, South Road, Durham DH1 3LE, United Kingdom
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Nooka AK, Harvey RD, Langston A, Collins H, Lonial S, Kaufman JL. Optimal Dosing of Melphalan As High-Dose Therapy Before Autologous Hematopoietic Stem Cell Transplantation in Myeloma Patients With Solitary Kidney: A Case Series. Clinical Lymphoma Myeloma and Leukemia 2014; 14:e59-63. [DOI: 10.1016/j.clml.2013.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/05/2013] [Indexed: 12/21/2022]
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Ingram JSI, Wright HL, Foster L, Aldred T, Barling D, Benton TG, Berryman PM, Bestwick CS, Bows-Larkin A, Brocklehurst TF, Buttriss J, Casey J, Collins H, Crossley DS, Dolan CS, Dowler E, Edwards R, Finney KJ, Fitzpatrick JL, Fowler M, Garrett DA, Godfrey JE, Godley A, Griffiths W, Houlston EJ, Kaiser MJ, Kennard R, Knox JW, Kuyk A, Linter BR, Macdiarmid JI, Martindale W, Mathers JC, McGonigle DF, Mead A, Millar SJ, Miller A, Murray C, Norton IT, Parry S, Pollicino M, Quested TE, Tassou S, Terry LA, Tiffin R, van de Graaf P, Vorley W, Westby A, Sutherland WJ. Priority research questions for the UK food system. Food Secur 2013. [DOI: 10.1007/s12571-013-0294-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
The rise of food security up international political, societal and academic agendas has led to increasing interest in novel means of improving primary food production and reducing waste. There are however, also many ‘post-farm gate’ activities that are critical to food security, including processing, packaging, distributing, retailing, cooking and consuming. These activities all affect a range of important food security elements, notably availability, affordability and other aspects of access, nutrition and safety. Addressing the challenge of universal food security, in the context of a number of other policy goals (e.g. social, economic and environmental sustainability), is of keen interest to a range of UK stakeholders but requires an up-to-date evidence base and continuous innovation. An exercise was therefore conducted, under the auspices of the UK Global Food Security Programme, to identify priority research questions with a focus on the UK food system (though the outcomes may be broadly applicable to other developed nations). Emphasis was placed on incorporating a wide range of perspectives (‘world views’) from different stakeholder groups: policy, private sector, non-governmental organisations, advocacy groups and academia. A total of 456 individuals submitted 820 questions from which 100 were selected by a process of online voting and a three-stage workshop voting exercise. These 100 final questions were sorted into 10 themes and the ‘top’ question for each theme identified by a further voting exercise. This step also allowed four different stakeholder groups to select the top 7–8 questions from their perspectives. Results of these voting exercises are presented. It is clear from the wide range of questions prioritised in this exercise that the different stakeholder groups identified specific research needs on a range of post-farm gate activities and food security outcomes. Evidence needs related to food affordability, nutrition and food safety (all key elements of food security) featured highly in the exercise. While there were some questions relating to climate impacts on production, other important topics for food security (e.g. trade, transport, preference and cultural needs) were not viewed as strongly by the participants.
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Pirolli M, Collins H, Quigley J, Hulnick S. 4026 POSTER Rate of Hemoglobin (Hb) Decline by Age and Tumour Type in Patients (pts) Receiving Chemotherapy (CT) Without an Erythropoiesis-stimulating Agent (ESA) in the United States Community Setting. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pirker R, Collins H, Legg JC, Vansteenkiste JF. Rate of hemoglobin (Hb) decline from less than 10 g/dl to less than 9 g/dl in placebo-treated patients (pts) receiving chemotherapy: A pooled analysis of data from six randomized darbepoetin alfa trials. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Pirolli M, Collins H, Hulnick SA, Quigley J. Rate of hemoglobin (Hb) decline from less than 10 g/dl to less than 9 g/dl by electronic medical-record (EMR) evaluation in community oncology patients (pts) receiving chemotherapy in the absence of erythropoiesis-stimulating agents (ESAs). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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49
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Green BG, Roman C, Schoen K, Collins H. Nociceptive sensations evoked from 'spots' in the skin by mild cooling and heating. Pain 2008; 135:196-208. [PMID: 18194841 DOI: 10.1016/j.pain.2007.11.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 10/29/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
It was recently found that nociceptive sensations (stinging, pricking, or burning) can be evoked by cooling or heating the skin to innocuous temperatures (e.g., 29 and 37 degrees C). Here, we show that this low-threshold thermal nociception (LTN) can be traced to sensitive 'spots' in the skin equivalent to classically defined warm spots and cold spots. Because earlier work had shown that LTN is inhibited by simply touching a thermode to the skin, a spatial search procedure was devised that minimized tactile stimulation by sliding small thermodes (16 and 1mm(2)) set to 28 or 36 degrees C slowly across the lubricated skin of the forearm. The procedure uncovered three types of temperature-sensitive sites (thermal, bimodal, and nociceptive) that contained one or more thermal, nociceptive, or (rarely) bimodal spots. Repeated testing indicated that bimodal and nociceptive sites were less stable over time than thermal sites, and that mechanical contact differentially inhibited nociceptive sensations. Intensity ratings collected over a range of temperatures showed that LTN increased monotonically on heat-sensitive sites but not on cold-sensitive sites. These results provide psychophysical evidence that stimulation from primary afferent fibers with thresholds in the range of warm fibers and cold fibers is relayed to the pain pathway. However, the labile nature of LTN implies that these low-threshold nociceptive inputs are subject to inhibitory controls. The implications of these findings for the roles of putative temperature receptors and nociceptors in innocuous thermoreception and thermal pain are discussed.
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Affiliation(s)
- Barry G Green
- The John B. Pierce Laboratory, 290 Congress Avenue, New Haven, CT 06519, USA.
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Rader D, Wang X, Tohyama J, Tanigawa H, Collins H, Cuchel M, Fuki I, Billheimer J, Rothblat G. Tu-PL2:2 Molecular and pharmacologic regulation of reverse cholesterol transport. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80592-1] [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: 11/28/2022]
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