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Expert consensus-based guidance on approaches to opioid management in individuals with advanced cancer-related pain and nonmedical stimulant use. Cancer 2023; 129:3978-3986. [PMID: 37691479 PMCID: PMC10910244 DOI: 10.1002/cncr.34921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/19/2023] [Accepted: 04/17/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis. METHODS The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. RESULTS Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. CONCLUSION Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. PLAIN LANGUAGE SUMMARY Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.
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MDT practice determines treatment pathway for patients with advanced ovarian cancer: A multi-centre observational study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1504-1510. [PMID: 36958949 DOI: 10.1016/j.ejso.2023.03.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/27/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVE To investigate decision making for patients with advanced ovarian cancer as a possible explanation of geographical variation in treatment patterns. METHODS We carried out a multi-centre observational study in multidisciplinary teams meetings for five major UK cancer centres. All patients presenting to five cancer centres with advanced ovarian cancer over a six-week period. The GO-MDT-MODe tool was used to provide a measure of participation and quality of case discussion for all cases of advanced ovarian cancer. MDT scores were correlated with surgical data extracted from national audit data. Data were recorded for overall MDT performance. RESULTS A total of 870 case discussions, including 145 cases of advanced ovarian cancer, were observed. MDTs varied in structure, format and time allocation between centres. Cluster analysis showed significant variation in quality and participation of discussion between centres (p < 0.0025) and this correlated with the proportion of patients in the wider cancer alliance undergoing surgery. CONCLUSIONS We have shown that at least part of the variation in practice seen in the UK correlates with different behaviours within MDTs. Increasing time for discussion and encouraging participation from all staff groups may increase proportions of patients undergoing optimal treatment regimens.
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Opioid-prescribing considerations in patients with cancer and substance misuse or substance use disorder: a scoping review protocol. JBI Evid Synth 2023; 21:812-825. [PMID: 36404752 PMCID: PMC10260276 DOI: 10.11124/jbies-22-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This scoping review aims to describe factors in the existing literature that may inform opioid-prescribing decisions for patients with a past or present history of cancer and past or present substance misuse or substance use disorder. INTRODUCTION Opioids and opioid-related decisions are critical components of cancer care. Most individuals with cancer will experience pain during cancer care, and over half of patients will receive an opioid prescription. Opioid-prescribing decisions require weighing the benefits and harms. The presence of substance misuse or substance use disorder may elevate the risk of opioid-related harms, but there is a lack of consensus on managing patients at this intersection. INCLUSION CRITERIA This review will consider studies that include adult patients with a past or present history of cancer who also have pain and current or historical substance misuse or substance use disorder. The pain may be cancer-related or non-cancer-related. Studies of patients with all types of cancer will be eligible for inclusion, with the exception of non-melanoma skin cancers. Eligible studies will explore factors that inform opioid-prescribing decisions in this patient population. METHODS The review will be conducted according to JBI methodology for scoping reviews. Studies written in English since database inception will be included. The databases to be searched include MEDLINE (Ovid), CINAHL (EBSCO), Embase, APA PsycINFO, and Google Scholar. Eligible studies will undergo data extraction by 2 independent reviewers using a data extraction tool created by the authors. A narrative summary will describe study characteristics, population details, and strategies used to determine appropriate pain management in the patient population.
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Abstract No. 72 Factors Associated with Overall Survival after Thrombectomy for Massive and Submassive Pulmonary Embolism. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Compact high repetition rate Thomson parabola ion spectrometer. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:023505. [PMID: 36859067 DOI: 10.1063/5.0101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/04/2023] [Indexed: 06/18/2023]
Abstract
We present the development of a compact Thomson parabola ion spectrometer capable of characterizing the energy spectra of various ion species of multi-MeV ion beams from >1020W/cm2 laser produced plasmas at rates commensurate with the highest available from any of the current and near-future PW-class laser facilities. This diagnostic makes use of a polyvinyl toluene based fast plastic scintillator (EJ-260), and the emitted light is collected using an optical imaging system coupled to a thermoelectrically cooled scientific complementary metal-oxide-semiconductor camera. This offers a robust solution for data acquisition at a high repetition rate, while avoiding the added complications and nonlinearities of micro-channel plate based systems. Different ion energy ranges can be probed using a modular magnet setup, a variable electric field, and a varying drift-distance. We have demonstrated operation and data collection with this system at up to 0.2 Hz from plasmas created by irradiating a solid target, limited only by the targeting system. With the appropriate software, on-the-fly ion spectral analysis will be possible, enabling real-time experimental control at multi-Hz repetition rates.
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A flexible proton beam imaging energy spectrometer (PROBIES) for high repetition rate or single-shot high energy density (HED) experiments (invited). THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:023507. [PMID: 36859040 DOI: 10.1063/5.0101845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
The PROBIES diagnostic is a new, highly flexible, imaging and energy spectrometer designed for laser-accelerated protons. The diagnostic can detect low-mode spatial variations in the proton beam profile while resolving multiple energies on a single detector or more. When a radiochromic film stack is employed for "single-shot mode," the energy resolution of the stack can be greatly increased while reducing the need for large numbers of films; for example, a recently deployed version allowed for 180 unique energy measurements spanning ∼3 to 75 MeV with <0.4 MeV resolution using just 20 films vs 180 for a comparable traditional film and filter stack. When utilized with a scintillator, the diagnostic can be run in high-rep-rate (>Hz rate) mode to recover nine proton energy bins. We also demonstrate a deep learning-based method to analyze data from synthetic PROBIES images with greater than 95% accuracy on sub-millisecond timescales and retrained with experimental data to analyze real-world images on sub-millisecond time-scales with comparable accuracy.
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Ultra-compact x-ray spectrometer for high-repetition-rate laser-plasma experiments. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2022; 93:113508. [PMID: 36461516 DOI: 10.1063/5.0100970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/28/2022] [Indexed: 06/17/2023]
Abstract
We present in this work the development of an ultra-compact, multi-channel x-ray spectrometer (UCXS). This diagnostic has been specially built and adapted to perform at high-repetition-rate (>1 Hz) for high-intensity, short-pulse laser plasma experiments. X-ray filters of varying materials and thicknesses are chosen to provide spectral resolution up to ΔE ≈ 1 keV over the x-ray energy range of 1-30 keV. These filters are distributed over a total of 25 channels, where each x-ray filter is coupled to a single scintillator. The UCXS is designed to detect and resolve a large variety of laser-driven x-ray sources such as low energy bremsstrahlung emission, fluorescence, and betatron radiation (up to 30 keV). Preliminary results from commissioning experiments at the ABL laser facility at Colorado State University are provided.
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209EMF Combined Hepatitis B Virus and Hepatocellular Carcinoma Screening Using Point-of-Care Testing and Ultrasound in a Tanzanian Emergency Department: A Preliminary Report. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Placenta Accreta Spectrum: A 2-year Retrospective Observational Study. IRISH MEDICAL JOURNAL 2022; 115:629. [PMID: 36300594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aims To assess the management and outcomes of Placenta Accreta Spectrum disorders and highlight the important management recommendations from international guidelines. Methods A retrospective audit of women diagnosed with Placenta Accreta Spectrum disorder from January 2018 to December 2019. Results Nine cases (0.16%) of placenta accreta from 5695 births were identified. All women received caesarean section under general anaesthesia. Caesarean hysterectomy occurred in seven cases (78%). Mean (±SD) age of women was (34.4 ± 3.9 years) and mean parity score was (3.2 ± 1.2). Mean gestational age at birth was 35.1 ± 0.8 weeks. Bilateral iliac artery balloon occlusion occurred in eight (89%) cases. Median estimated blood loss [range] was 1700 mL [1000-7000] with only 11% of patients (1/9) experiencing more than 3L of blood loss. Intraoperative red blood cell transfusion occurred in six cases (67%). Median number of units of red cell transfusion [range] was four units [0-10]. Mean hospital length of stay was (6.7 ± 1.1 days) and there were no maternal deaths. Multidisciplinary team involvement of senior anaesthetists and obstetricians was noted in all cases. Discussion Placenta accreta spectrum is increasing in incidence in obstetric practice and is associated with significant maternal morbidity and mortality. Implementing national guidelines can improve patient outcomes.
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Gender bias in the primary prevention of cardiovascular disease. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/introduction
Women receive less aggressive treatment for cardiovascular disease (CVD), partly due to a delayed or incorrect diagnosis. However, there is little research into whether this gender bias extends to primary prevention of CVD (i.e. prevention of CVD in those individuals with no prior CVD events), and the reasons behind this bias.
Purpose
This study analysed gender differences in the primary prevention of CVD in the USA, using data from the National Health and Nutrition Examination Survey (NHANES) for the years 2015-2018. It also explored the drivers behind these differences. The hypothesis was that the known gender bias in CVD treatment also extends to primary prevention.
Methods
The risk of developing CVD over the next ten years was calculated using the Pooled Cohort Equations (PCEs) for 9,623 healthy men and women aged 40 to 79 years. 3,035 participants were found to be at higher CVD risk (ASCVD score above 7.5%) and potentially eligible for statins. Individuals with prior diagnosis of CVD were excluded from this study. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR) in the usage of preventive treatment between genders.
Results
The results showed that men were 21% more likely to be prescribed statins than women whilst women were 20-37% more likely to be told to make behaviour modifications than men (Table 1). An interdisciplinary literature review showed that lower CVD risk perception in women is a likely driver of this gender difference.
Conclusion
The well-known gender bias in the treatment of CVD also appears to take place in the primary prevention of CVD with statin therapy. These findings have highlighted the gender bias in primary prevention of CVD, supporting the scarce existing literature on this topic and providing more recent evidence in line with the updated CVD prevention guidance. This has implications in developing interventions based in the health system and community context to improve the treatment and survival outcomes for women with CVD.
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PO-1848 Exploring uterus motion with full and empty bladder in preparation for adaptive cervix radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03811-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Regional Left Ventricular Myocardial Injury and Function Characterisation by Cardiac Magnetic Resonance Imaging in a Sheep Model of Myocardial Infarction. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Quality of life from cytoreductive surgery in advanced Ovarian cancer: investigating association with disease burden and surgical complexity in the international, prospective, SOCQER2 cohort study. BJOG 2021; 129:1122-1132. [PMID: 34865316 PMCID: PMC9306902 DOI: 10.1111/1471-0528.17041] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/22/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach DESIGN: Prospective multicentre observational study SETTING: United Kingdom, Kolkata, India, and Melbourne, Australia gynaecological cancer surgery centres. PARTICIPANTS Patients undergoing surgical resection for late stage ovarian cancer. Exposure Low, intermediate or high Surgical Complexity Score (SCS) surgery MAIN OUTCOMES AND MEASURES: Primary: EORTC-QLQ-C30 Global score change. Secondary: EORTC OV28, progression free survival. RESULTS Patients' pre-operative disease burden and SCS varied between centres, confirming differences in surgical ethos. QoL response rates were 90% up to 18 months. Mean change from the pre-surgical baseline in the EORTC QLQ-C30 was 3.4 (SD 1.8, n=88) in the low, 4.0 (SD 2.1, n=55) in the intermediate and 4.3 (SD 2.1, n=52) in the high SCS group after 6 weeks (p=0.048) and 4.3 (SD 2.1, n=51), 5.1 (SD 2.2, n=41) and 5.1 (SD 2.2, n=35) respectively after 12 months (p=0.133). In a repeated measures model, there were no clinically or statistically meaningful differences in EORTC QLQ-C30 global scores between the three SCS groups, p= 0.840 but there was a small statistically significant improvement in all groups over time (p<0.001). The high SCS group experienced small to moderate decreases in physical (p=0.004), role (p=0.016) and emotional (p=0.001) function at 6 weeks post-surgery which resolved by 6-12 months. CONCLUSIONS AND RELEVANCE Global QoL of patients undergoing low, intermediate, and high SCS surgery improved at 12 months post operation and was no worse in patients undergoing extensive surgery.
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A funfair without the candy floss: engaging communities to prevent diabetes in Nepal. Public Health 2021; 193:23-25. [PMID: 33711779 PMCID: PMC8128096 DOI: 10.1016/j.puhe.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/08/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The World Health Organization estimates that 422 million people have diabetes, three-quarters of whom live in low- and middle-income countries. Global action plans to address non-communicable diseases (NCDs) recognise the centrality of community engagement to create an enabling environment within which to address risk factors. STUDY DESIGN In this article, we describe and critically reflect on a cocreated community engagement approach to address type 2 diabetes in the southern plains of Nepal. We coproduced the engagement approach with 40 artists from the Janakpur Women's Development Centre to create an environment for dialogue about diabetes and NCD risk between artists and the general public. METHODS We used participatory action research to produce contextually relevant interactive methods and materials. Methods included artists' peer research to inform creative workshops, a drama performed in 19 villages and a two-day funfair in a public park. We used qualitative and participatory methods to analyse the effect of this engagement and reflect on lessons learned. RESULTS Around 2000 people saw the drama, and around 4000 people attended the funfair. Community dialogue about prevention of diabetes was facilitated by drama and through games and songs at the funfair. Artists grew confident to interact with their peers and drama audiences about the causes of diabetes and prevention strategies. Despite crowds at the funfair, it was difficult to reach women because the venue was often used by men and boys, and patriarchal norms prevent women from free movement. Village interactions were able to engage a more mixed audience. CONCLUSION Innovative, asset-based community engagement about diabetes and other NCDs at scale is possible through locating, building on and strengthening community resources to address local health issues. Engagement could be enhanced by considering the gendered nature of community engagement spaces and by increasing opportunities for interaction between artists and the general public through more intimate and large-scale events.
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215 Understanding and Improving Population Health from the Emergency Department Through Medical-Legal Partnerships. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Necessary duration of follow-up to assess complications of mesh in hernia surgery: a time-lapse study based on 460 explants. Hernia 2020; 25:1239-1251. [PMID: 32960368 DOI: 10.1007/s10029-020-02297-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. METHODS Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. Patterns of percentage growth and time lapses at 50th and 95th percentiles were used to compare groups of different hernia type, age, gender and reason for excision. RESULTS The 50th and 95th case percentiles in the dataset were at 3.75 and 15.0 years between mesh implantation and excision. For hernia types, the longest time lapses were for groin hernias (4.0 and 16.11 years at 50th and 95th percentiles). The shortest were for umbilical hernias (2.16 and 9.68 years). Males had later excisions than females (4.11 and 16.1 vs. 2.47 and 9.79 years). Younger patients (< 45 y.o.) had later excisions than older patients (4.12 and 17.68 vs. 3.37 and 10.0 years). Out of all subgroups, the longest time lapses were for groin hernias in younger males (4.77 and 18.89 years) and for mesh erosion into organs (4.67 and 17.0 years). CONCLUSIONS Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks. We propose to use cumulative incidence for standardized risk reporting (y% risk at x years). This will show time-dependent patterns and allow comparisons between different techniques and studies of variable duration. Standardization will also help to predict long-term risks beyond shorter (practical) follow-ups and facilitate real-time monitoring during surveillance.
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0438 Automatic Nighttime Agitation and Sleep Disruption Detection Using a Wearable Ankle Device and Machine Learning. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Nighttime agitation behavior such as wandering and restlessness during awake and sleep in people with Alzheimer’s disease (AD) is expensive to manage and adversely affects sleep. Nighttime agitation is mostly noted by subjective caregiver reports. An automated process for this assessment would improve clinical management. Here we report on the RestEaZeTM system that uses an ankle band and machine learning to automatically classify sleep status and nighttime agitation behaviors in older adults with AD.
Methods
We collected data on 7 adults (mean: 81 years, SD: 10.6) with AD. They wore the RestEaZeTM ankle band with a 3-axis accelerometer, a 3-axis gyroscope, and three textile capacitive sensors. A trained Research Assistant (RA) continuously observed for wandering, restlessness, wake, and sleep between 5pm and 7am using the Cohen Mansfield Agitation Inventory (CMAI). We merged, and band-pass filtered the data and divided it into 10-second non-overlapping windows. CMAI labels and time-series features (scaled using StandardScaler) extracted from the RestEaZeTM data were used to train a Random Forest binary classifier. The significant features were extracted based on the impact on the p-value for the classifier. We used the Synthetic Minority Oversampling Technique (SMOTE) to balance the dataset and performed 5-fold cross-validation with a 67-33 train-test split.
Results
We report the sensitivity, specificity, accuracy, and Area-under-the Curve (AUC) for the ROC curve for the classifiers: (1) Sleep/Awake: sensitivity=0.95, specificity=0.87, accuracy=0.92, AUC=0.97; (2) Wandering/Non-Wandering: sensitivity=0.85, specificity=0.99, accuracy=0.98, AUC=0.99; and (3) Restless/Non-Restless: sensitivity=0.84, specificity=0.84, accuracy=0.84, AUC=0.92. The significant features were related to the intensity of movements.
Conclusion
Our preliminary results show the feasibility of using RestEaZeTM for quantitatively measuring nighttime agitation. These can provide clinically useful objective measures of agitation that can be automatically transmitted to clinical or research records with minimal staff time requirements.
Support
The authors acknowledge the funding support from the National Institute on Aging under award R01AG051588 and Arbor Pharmaceuticals for support for Horizant and the matching placebo.
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0861 Age, Race, And Continuous Positive Airway Pressure (CPAP) Confidence Score At 1-week Predict 3-month CPAP Adherence In Older Adults With Amnestic Mild Cognitive Impairment And Moderate To Severe Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Adherence to continuous positive airway pressure (CPAP) may delay cognitive decline in older adults with obstructive sleep apnea (OSA) and amnestic mild cognitive impairment (MCI), defined as deficits in memory that do not significantly impact daily functioning. The aim of this analysis was to identify predictors of CPAP adherence in this population.
Methods
Data are from Memories 2, an ongoing multisite clinical trial on the effect of treatment of moderate to severe OSA on cognitive decline in older adults 65-85 years of age who have amnestic MCI. Unadjusted and adjusted linear models were used to examine predictors of mean hours of CPAP use at 3 months. Predictors were age, sex (male/female), race (White/Non-White), education (more than high school, less than high school), Apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and CPAP Comfort and Confidence scores at 7 days. Collinearity in the adjusted model for CPAP use at 3 months was examined using the variance inflation factor.
Results
Of 57 participants, most were male (54%), White (72%), with a mean age of 66.3 years (SD: 6.1). Mean AHI in this sample was 35.1 (SD: 19.9), with mean daily hours of CPAP use at 3 months 5.3 hours (SD: 2.3). Adjusted linear model results demonstrated that younger age (β=-0.13, SE=0.04, p=0.0032), White race (β=2.56, SE=0.58, p<0.0001), and higher 7-day CPAP Confidence score (β=0.48, SE=0.17, p=0.0086) were significantly associated with CPAP use at 3 months. Sex, education, AHI, ESS, and CPAP comfort were not statistically significant predictors of adherence.
Conclusion
Tailored interventions to increase self-efficacy during the first 7 days of CPAP treatment, especially in Non-Whites and those older than 74 years, may improve long-term CPAP adherence in older adults with amnestic MCI.
Support
R01AG054435
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Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam. PHYSICAL REVIEW LETTERS 2020; 124:161802. [PMID: 32383902 DOI: 10.1103/physrevlett.124.161802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/26/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.
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Constraint on the matter–antimatter symmetry-violating phase in neutrino oscillations. Nature 2020; 580:339-344. [DOI: 10.1038/s41586-020-2177-0] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022]
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Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis. BMC Psychiatry 2020; 20:125. [PMID: 32183799 PMCID: PMC7076946 DOI: 10.1186/s12888-020-02532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/04/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which "symptom severity measures" and "complexity measures" assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment. METHODS Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of "case complexity" (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ. RESULTS 298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment. CONCLUSIONS These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.
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Prevalence of factors associated with edentulousness (no natural teeth) in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1475-1481. [PMID: 31062460 DOI: 10.1111/jir.12628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Poor oral health is largely preventable. Prevention includes toothbrushing and regular dental checks. Oral health has important consequences for general nutrition, chewing, communication, wider systemic disease, self-confidence and participation in society. This study investigated the prevalence of edentulousness (no natural teeth) in adults with intellectual disabilities (IDs) compared with the general population and associated factors. METHODS An adult cohort with IDs residing in Greater Glasgow and Clyde, Scotland, underwent detailed health assessments between 2002 and 2004. Between 2004 and 2006, a subsample had an oral check. Data on edentulousness in the cohort were compared with adult participants from Greater Glasgow and Clyde in the 2008 Scottish Health Survey. Within the IDs cohort, binary logistic regression analyses investigated potential relationships between edentulousness and demographic and clinical factors. RESULTS Five hundred sixty adults with IDs were examined [53.2% (298) male, mean age = 46.3 years, range 18-81 years] and compared with 2547 general population: edentulousness was 9% vs. 1% aged 25-34 years; 22% vs. 2% aged 35-44 years; 39% vs. 7% aged 45-54 years; 41% vs. 18% aged 55-64 years; and 76% vs. 34% aged 65-74 years. In both groups, edentulousness increased with age. After stratification for age, rates of edentulousness were consistently higher in the ID cohort. Odds ratios within age strata were not homogenous (Mantel-Haenszel test, P < 0.0001). Edentulousness was more likely in those with more severe IDs (adjusted odds ratio (AOR) = 2.36; 95% confidence interval (CI) [1.23 to 4.51]); those taking antipsychotics (AOR = 2.09; 95% CI [1.25 to 3.51]) and those living in the most deprived neighbourhoods (AOR = 2.69; 95% CI [1.11 to 6.50]). There was insufficient evidence for associations with sex, type of accommodation/support, antiepileptics, problem behaviours or autism. CONCLUSIONS Adults with IDs have a high prevalence of edentulousness and need supported daily oral care to reduce the need for extractions. Despite previous reports on poor oral care and the move towards person-centred care, carers and care-giving organisations need greater support to implement daily oral care. Prescribers need awareness of the potentially contributory role of antipsychotics, which may relate to xerostomia.
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Measuring for management in science, technology, engineering, and mathematics learning ecosystems. ACTA ACUST UNITED AC 2019. [DOI: 10.1088/1742-6596/1379/1/012042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Superinfection with Mycobacteria goodii in a young infant with exogenous lipoid pneumonia. Pediatr Pulmonol 2019; 54:1345-1347. [PMID: 31206238 DOI: 10.1002/ppul.24355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
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Implementation of Machine Learning-Based Treatment Planning Tool for Whole Breast Radiotherapy Using Irregular Surface Compensator Technique. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Making the Most of Mealtimes (M3): effect of eating occasions and other covariates on energy and protein intake among Canadian older adult residents in long‐term care. J Hum Nutr Diet 2019; 33:3-11. [DOI: 10.1111/jhn.12686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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State of the art: open mesh-based inguinal hernia repair. Hernia 2019; 23:485-492. [DOI: 10.1007/s10029-019-01983-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
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Acute haemolytic reaction secondary to an ABO minor mismatched platelet transfusion from a group A blood donor. Transfus Med 2019; 29:133-135. [DOI: 10.1111/tme.12591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/18/2019] [Accepted: 02/12/2019] [Indexed: 12/23/2022]
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03:45 PM Abstract No. 223 Conventional versus drug-eluting embolic transarterial chemoembolization with doxorubicin: comparative pharmacokinetics and drug delivery in a rabbit VX2 tumor model. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
BACKGROUND AND OBJECTIVES The Mealtime Scan (MTS) was developed to assess the dining environment in Long Term Care (LTC). MTS has been reviewed and updated to ensure its standardization and responsiveness to changes in the dining environment. The objectives of this paper are to provide an overview of the changes made in the new MTS+ tool and to describe its inter-rater reliability. RESEARCH DESIGN AND METHODS The observational and scoring methods used to evaluate the physical, social, and relational-centered dining environments in LTC homes were reviewed and updated into MTS+ and an overall quality of dining rating derived. Two trained assessors were evaluated for the inter-rater reliability. Nine dining rooms in three LTC homes at different meals were observed for a total of 45 observations. Interclass Correlation Coefficient (ICC) was used to assess reliability. RESULTS MTS+ demonstrated good reliability on the orientation cues, social environment, and relationship-centered activities (orientation cues ICC: 0.75, social ICC: 0.78, relational ICC: 0.78). However, the tool's reliability was poor for the physical environment, ICC: 0.48 and moderate for the overall rating of the quality of the dining environment, ICC: 0.67. Discussion and Implications: Although deemed more effective and practical for use in intervention studies, MTS+ has some limitations with respect to its reliability, particularly in assessing the physical environment. It is hypothesized that more extensive training of the assessors may lead to improvements in the reliability of MTS+. MTS+ can be used in intervention research when one assessor completes repeat observations of a dining area.
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Connecting Learning Opportunities in STEM Education: Ecosystem Collaborations across Schools, Museums, Libraries, Employers, and Communities. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1742-6596/1065/2/022009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Search for CP Violation in Neutrino and Antineutrino Oscillations by the T2K Experiment with 2.2×10^{21} Protons on Target. PHYSICAL REVIEW LETTERS 2018; 121:171802. [PMID: 30411920 DOI: 10.1103/physrevlett.121.171802] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Indexed: 06/08/2023]
Abstract
The T2K experiment measures muon neutrino disappearance and electron neutrino appearance in accelerator-produced neutrino and antineutrino beams. With an exposure of 14.7(7.6)×10^{20} protons on target in the neutrino (antineutrino) mode, 89 ν_{e} candidates and seven anti-ν_{e} candidates are observed, while 67.5 and 9.0 are expected for δ_{CP}=0 and normal mass ordering. The obtained 2σ confidence interval for the CP-violating phase, δ_{CP}, does not include the CP-conserving cases (δ_{CP}=0, π). The best-fit values of other parameters are sin^{2}θ_{23}=0.526_{-0.036}^{+0.032} and Δm_{32}^{2}=2.463_{-0.070}^{+0.071}×10^{-3} eV^{2}/c^{4}.
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1011 Restless Legs Syndrome is Highly Prevalent in Long Term Care Residents with Alzheimer’s Disease and Nighttime Agitation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Diagnosing diffuse lung disease in children in a middle-income country: the role of open lung biopsy. Int J Tuberc Lung Dis 2018; 21:869-874. [PMID: 28786794 DOI: 10.5588/ijtld.16.0853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A tertiary care hospital situated in a middle-income country with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE To determine the diagnostic yield of open lung biopsy (OLB) in children with diffuse lung disease (DLD), comparing findings in HIV-infected and non-HIV-infected children. DESIGN This 9-year retrospective study included 51 children with DLD (oxygen-dependent or on artificial ventilation), who required an OLB where the diagnosis remained uncertain after extensive investigations. RESULTS The median age was 7 months, median body weight was 6.6 kg (61% were severely malnourished) and 30% were HIV-infected (62% on antiretroviral treatment). The diagnostic yield of the OLB was 86% (n = 44) and was significantly higher in HIV-infected (77%) than in non-HIV-infected (48%) children (P = 0.01). Pneumonia was the most common diagnosis (n = 25, 57%), with common agents being cytomegalovirus (CMV), viruses other than CMV, Pneumocystis jiroveci pneumonia and previously undiagnosed TB (10%). Mycobacterium tuberculosis as a cause of DLD was not suspected before the OLB, as all investigations for TB were negative. Non-infectious causes of DLD were established in 10% of cases. CONCLUSION The OLB is a useful diagnostic tool to diagnose idiopathic DLD, including TB, in young children.
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Embedding routine health checks for adults with intellectual disabilities in primary care: practice nurse perceptions. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:349-357. [PMID: 29423981 DOI: 10.1111/jir.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/10/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (IDs) have consistently poorer health outcomes than the general population. There is evidence that routine health checks in primary care may improve outcomes. We conducted a randomised controlled trial of practice nurse led health checks. Here, we report findings from the nested qualitative study. AIM To explore practice nurse perceptions and experience of delivering an anticipatory health check for adults with IDs. DESIGN AND SETTING Qualitative study in General Practices located in NHS Greater Glasgow and Clyde, Scotland, UK. METHOD Eleven practice nurses from 11 intervention practices participated in a semi-structured interview. Analysis was guided by a framework approach. RESULTS Practice nurses reported initially feeling 'swamped' and 'baffled' by the prospect of the intervention, but early misgivings were not realised. Health checks were incorporated into daily routines with relative ease, but this was largely contingent on existing patient engagement. The intervention was thought most successful with patients already well known to the practice. Chronic disease management models are commonly used by practice nurses and participants tailored health checks to existing practice. It emerged that few of the nurses utilised the breadth of the check instead modifying the check to respond to individual patients' needs. As such, already recognised 'problems' or issues dominated the health check process. Engaging with the health checks in this way appeared to increase the acceptability and feasibility of the check for nurses. There was universal support for the health check ethos, although some questioned whether all adults with IDs would access the health checks, and as a consequence, the long-term benefits of checks. CONCLUSION While the trial found the intervention to be dominant over standard health care, the adjustments nurses made may not have maximised potential benefits to patients. Increasing training could further improve the benefits that health checks provide for people with IDs.
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Are Sex-Dependent Cardiometabolic Effects of a Postnatal Western Diet Exacerbated by Low Birth Weight? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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A population-based, cross-sectional study of the prevalence and correlates of sedentary behaviour of adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:60-71. [PMID: 29214701 DOI: 10.1111/jir.12454] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/29/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND High levels of sedentary behaviour have a negative impact on health and well-being. There is limited evidence on the prevalence and correlates of sedentary behaviour of adults with intellectual disabilities (ID). METHODS A population-based sample of adults with ID were invited to take part in a comprehensive health check programme. Demographic and health data were collected during a structured interview and physical examination. Screen time was used as a proxy measure of sedentary behaviour. Bivariate and multivariate statistical modelling examined correlates of screen time. RESULTS Fifty per cent of the 725 participants reported four or more hours of screen time per day. Male gender, higher levels of intellectual ability, mobility problems, obesity, not having hearing impairment and not having epilepsy were all significantly associated with higher screen time in the final multivariate model (R2 = 0.16; Hosmer-Lemeshow goodness of fit statistic P = 0.36). CONCLUSIONS This is the first study to publish population-based data on the prevalence and correlates of sedentary behaviour in adults with ID. Compared with adults who do not have ID, adults with ID have higher levels, and different correlates, of sedentary behaviour. A better understanding of the social context of sedentary behaviour will inform the design of effective behaviour change programmes for adults with ID.
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Compliance of CT chest surveillance following oral cancer treatment: An audit of Edinburgh OMFS practice. Br J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.bjoms.2017.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Improving the Rate of Paediatric Day Case Tonsillectomy. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Regional mortality in countries of Central and Eastern Europe: findings from Euro-Healthy project. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Collaboration as a core element for dissemination: examples from the EURO-HEALTHY project. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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SUN-P057: Improving Energy Intake and Malnutrition in Long Term Care: Using a Conceptual Model to Identify Determinants and Potential Solutions. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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PERSON-CENTERED CARE (PCC) PRACTICES AND EATING ASSISTANCE IN CANADIAN LONG-TERM CARE FACILITIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Prevalence, types and associations of medically unexplained symptoms and signs. A cross-sectional study of 1023 adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:637-642. [PMID: 28295826 DOI: 10.1111/jir.12372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Medically unexplained symptoms and signs are common in the general population and can respond to appropriate managements. We aimed to quantify the types and prevalence of unexplained symptoms and signs experienced by adults with ID and to determine the associated factors. METHOD In a population-based study, 1023 adults with ID aged 16 and over had a detailed health assessment, which systematically considered symptoms and signs. Descriptive data were generated on their symptoms and signs. Backwards stepwise logistic modelling was undertaken to determine the factors independently associated with the unexplained symptoms. RESULTS Medically unexplained symptoms and signs were present in 664 (64.9%), 3.8 times higher than in the general population, and 470 (45.9%) had multiple unexplained symptoms or signs. Some were similar to those reported in the general population, such as dyspnoea, dyspepsia, headache, nausea and dizziness. However, others are not commonly reported in the general population, including dysphagia, ataxia, polyuria, oedema and skin rash. Having unexplained symptoms and signs was independently associated with older age, female gender, not having Down syndrome, extent of ID and more GP visits in the last 12 months. It was not associated with living in deprived areas, type of living/support arrangements, number of hospital visit in the last 12 months, smoking, autism, problem behaviours or mental disorders. CONCLUSIONS People with ID have substantial additional unexplained symptoms and signs, some of which are painful or disabling. These findings should inform the content of health checks undertaken for adults with intellectual disabilities, which should not just focus on management of their long-term conditions and health promotion.
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COMPARISON OF PUREED AND REGULAR MENUS IN CANADIAN LONG-TERM CARE HOMES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
There is strong evidence that participatory approaches to health and participatory women's groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women's participation in women's groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world's population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women's groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women's groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people's participation in broader community groups, not focused on disability, has been little studied. We conclude that women's groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women.
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Release of endothelial cell associated VEGFR2 during TGF-β modulated angiogenesis in vitro. BMC Cell Biol 2017; 18:10. [PMID: 28114883 PMCID: PMC5260130 DOI: 10.1186/s12860-017-0127-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/18/2017] [Indexed: 01/11/2023] Open
Abstract
Background Sprouting angiogenesis requires vascular endothelial proliferation, migration and morphogenesis. The process is regulated by soluble factors, principally vascular endothelial growth factor (VEGF), and via bidirectional signaling through the Jagged/Notch system, leading to assignment of tip cell and stalk cell identity. The cytokine transforming growth factor beta (TGF-β) can either stimulate or inhibit angiogenesis via its differential surface receptor signaling. Here we evaluate changes in expression of angiogenic signaling receptors when bovine aortic endothelial cells were exposed to TGF-β1 under low serum conditions. Results TGF-β1 induced a dose dependent inhibition of tip cell assignment and subsequent angiogenesis on Matrigel, maximal at 5.0 ng/ml. This occurred via ALK5-dependent pathways and was accompanied by significant upregulation of the TGF-β co-receptor endoglin, and SMAD2 phosphorylation, but no alteration in Smad1/5 activation. TGF-β1 also induced ALK5-dependent downregulation of Notch1 but not of its ligand delta-like ligand 4. Cell associated VEGFR2 (but not VEGFR1) was significantly downregulated and accompanied by reciprocal upregulation of VEGFR2 in conditioned medium. Quantitative polymerase chain reaction analysis revealed that this soluble VEGFR2 was not generated by a selective shift in mRNA isoform transcription. This VEGFR2 in conditioned medium was full-length protein and was associated with increased soluble HSP-90, consistent with a possible shedding of microvesicles/exosomes. Conclusions Taken together, our results suggest that endothelial cells exposed to TGF-β1 lose both tip and stalk cell identity, possibly mediated by loss of VEGFR2 signaling. The role of these events in physiological and pathological angiogenesis requires further investigation. Electronic supplementary material The online version of this article (doi:10.1186/s12860-017-0127-y) contains supplementary material, which is available to authorized users.
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Immune Response in the Fetus and Six Month-Old Sheep Heart in Response to Myocardial Infarction. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Interventions to reduce inequalities in health and early child development in Europe from a qualitative perspective. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw173.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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