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Crebert M, Kasunic D, Karunaratne S, Alexander K, Scholtz A, Boyle R, Steffens D. Patient-Reported Outcomes and Range of Motion Following Knee Arthroplasty Using a Megaprosthesis in Non-Oncological Patients: A Systematic Review. J Arthroplasty 2024:S0883-5403(24)00461-3. [PMID: 38754706 DOI: 10.1016/j.arth.2024.05.028] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND This review aimed to determine outcomes following megaprostheses in non-oncological indications for knee arthroplasty, including range of motion (ROM) and patient-reported outcome measures (PROMs) of function, pain, and quality of life (QoL). METHODS A search of MEDLINE, Embase, and Cochrane via Ovid, and PubMed between January 2003 and June 2023 was conducted. Studies reporting function, pain, ROM, and/or QoL in non-oncological patients who have received knee megaprostheses were included. Studies with sample sizes (n ≤ 5) were excluded. The risk of bias was assessed using the Downs and Black Quality Checklist for Health Care Intervention Studies. Central tendency measures (mean or median) were reported at each time point, and dispersion measures were extracted and reported whenever data were available. RESULTS A total of 30 studies (involving 1,294 megaprostheses) were included. Of which, 14 of 30 studies reviewed patients who had mixed indications, 14 of 30 looked at fracture only; 1 of 30 focused on distal femur nonunion; and 1 of 30 focused on patients who had periprosthetic infections. The average patient follow-up time was 40.1 months (range, 1.0-93.5). Most studies presented a high risk of bias (27 of 30), while a few (3 of 30) presented a low risk of bias. Improvements from preoperative baseline were observed in 85.7% of studies that reported baseline and follow-up data for function (12 of 14), 100.0% pain (4 of 4), 90.9% ROM (10 of 11), and 66.6% QoL (2 of 3). CONCLUSION Favorable function, pain, ROM, and QoL outcomes following knee megaprostheses in non-oncological patients were observed. Heterogeneity in outcome measures and follow-up periods prevented the pooling of data. Future comparative studies are warranted to enhance the body of evidence relating to knee megaprostheses in non-oncological patients.
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Affiliation(s)
- Mitchell Crebert
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and Sydney Medical School, The University of Sydney, Level 9, Building 89 Missenden Road, Camperdown, NSW, 2050 Australia.
| | - Daniel Kasunic
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and Sydney Medical School, The University of Sydney, Level 9, Building 89 Missenden Road, Camperdown, NSW, 2050 Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and Sydney Medical School, The University of Sydney, Level 9, Building 89 Missenden Road, Camperdown, NSW, 2050 Australia
| | - Kate Alexander
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and Sydney Medical School, The University of Sydney, Level 9, Building 89 Missenden Road, Camperdown, NSW, 2050 Australia
| | - Amelia Scholtz
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and Sydney Medical School, The University of Sydney, Level 9, Building 89 Missenden Road, Camperdown, NSW, 2050 Australia
| | - Richard Boyle
- Orthopaedic Surgery Department, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital and Sydney Medical School, The University of Sydney, Level 9, Building 89 Missenden Road, Camperdown, NSW, 2050 Australia
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Hirst N, McBride KE, Thanigasalam R, Leslie S, Karunaratne S, Alexander K, Treacy PJ, Steffens D. Impact of Preoperative Mental Health on Surgical Outcomes Following Robotic-assisted Radical Prostatectomy. Urology 2023; 182:136-142. [PMID: 37778478 DOI: 10.1016/j.urology.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES To explore the association between preoperative mental health status and surgical outcomes following robotic-assisted radical prostatectomy (RARP). METHODS This cohort study included consecutive patients undergoing RARP surgery for prostate cancer between October 2016 and May 2022 at a major public hospital in Sydney, Australia. The primary outcome was preoperative self-reported mental health status measured using the mental component score from the Short Form 36 survey. Other variables included patients' characteristics, surgical outcomes, postoperative quality of life, pain and decision regret. Data were analysed using linear regression analysis. RESULTS A total of 266 men underwent RARP during the studied period. Of these, 242 patients (91%) completed the preoperative survey and were analyzed. Poorer preoperative mental health had significant univariate associations with younger age (P = .025), reduced access to economic resources (P = .043), diagnosis of a mental illness (P = .033), poorer mental health at 6 weeks and 6 months postoperatively (both P <.001), greater pain (P = .001), and higher decision regret (P = .001) 6 weeks following surgery. In the multivariate analysis, poorer preoperative mental health status was associated with younger age (P = .028) and poorer mental health at 6 weeks (P <.001) and 6 months (P = .025) postoperatively. CONCLUSION For patients undergoing RARP, poor preoperative mental health status was associated with younger age and poorer postoperative mental health. Future studies should investigate if targeted preoperative psychological interventions would improve postoperative mental health outcomes, specifically in younger men undergoing RARP.
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Affiliation(s)
- Nicholas Hirst
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Kate E McBride
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruban Thanigasalam
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Urology, Concord Repatriation General Hospital (CRGH), Sydney, New South Wales, Australia
| | - Scott Leslie
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Department of Urology, Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Alexander
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Patrick-Julien Treacy
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Alexander K, Zhou A, Wise S, Humphreys C. Why do mothers stay? Challenging attitudes in decision making about children at risk because of domestic violence. Child Abuse Negl 2023; 146:106511. [PMID: 37879256 DOI: 10.1016/j.chiabu.2023.106511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND This article reports findings from research commenced in 2019. Stage one assessed the attitudes and beliefs of child protection practitioners towards domestic violence. Stage two considered the impact of combining Structured Decision Making (SDM - the standard assessment approach) with Response Based Practice (RBP - a contemporary approach to understanding violence), on child protection decisions. OBJECTIVE To improve the child protection response to children who experience domestic violence. This article reports on stage three; considering the impact of practitioner attitudes and beliefs on child protection decisions and whether the combined assessment approach (SDM + RBP) moderated the impact of practitioner attitudes and beliefs. PARTICIPANTS AND SETTING 1041 child protection practitioners participated in the research while attending one of 17 practice conferences across New South Wales, Australia. METHODS An innovative video vignette experiment with a between-subjects design was used, relying on professional actors to play the roles of practitioner and mother of the children reported. Participants watched a video interview of a safety assessment and completed a survey. RESULTS Practitioner attitudes and beliefs were not significantly correlated with assessments about the children's safety; but attitudes did impact decisions about the likelihood of the children being brought into care. Attitudes and beliefs moderated the impact of misinformed attitudes, to some extent. CONCLUSIONS The research confirms the value of the combined SDM + RBP approach to guide practitioners to a more holistic understanding of domestic violence. It also confirms that assessment approaches are only ever as good as the beliefs and attitudes of the people who apply them.
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Affiliation(s)
- Kate Alexander
- NSW Department of Communities and Justice, Locked Bag 4028, Ashfield, NSW 2131, Australia.
| | - Albert Zhou
- NSW Department of Communities and Justice, Locked Bag 4028, Ashfield, NSW 2131, Australia.
| | - Sarah Wise
- Department of Social Work, University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Cathy Humphreys
- Department of Social Work, University of Melbourne, Parkville, Victoria 3010, Australia.
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Ravindran B, Gatens E, Pal N, Sheppeard V, Calik A, Alexander K, Ashraf K, Arnott A, Sintchenko V, Dalton CB. First documented gymnasium cluster of COVID-19 with whole genome sequencing in Australia. Commun Dis Intell (2018) 2023; 47. [PMID: 37817336 DOI: 10.33321/cdi.2023.47.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
Background Transmission of coronavirus disease 2019 (COVID-19) has been demonstrated in fitness settings internationally. We report the first documented case of transmission of COVID-19 in a gymnasium in Australia in 2020. Methods Case finding and case interviews were conducted among attendees in a Western Sydney gymnasium, Australia. Whole genome sequencing using an amplicon-based approach was performed on all SARS CoV-2 polymerase chain reaction positive samples detected through surveillance. Results We show that five cases of COVID-19 were linked to the gymnasium, with transmission occurring on 7 July 2020, when the index case transmitted the infection to four other gymnasium attendees through the sharing of an enclosed space. Conclusions There is an ongoing risk of transmission of COVID-19 within gymnasium environments and they are justifiably classified as a 'high-risk' venue. There may be a need to expand ventilation and space requirements to prevent transmission of COVID-19 in such settings in the context of severe COVID-19 variants or to prevent respiratory disease transmission in general.
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Affiliation(s)
- Bhavi Ravindran
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth Gatens
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Naru Pal
- Public Health Unit, Population Health, South Western Sydney Local Health District, New South Wales, Australia
| | - Vicky Sheppeard
- South Eastern Sydney Public Health Unit, New South Wales, Australia
| | - Anna Calik
- Public Health Unit, Population Health, South Western Sydney Local Health District, New South Wales, Australia
| | - Kate Alexander
- Public Health Unit, Population Health, South Western Sydney Local Health District, New South Wales, Australia
| | - Khizar Ashraf
- Public Health Unit, Population Health, South Western Sydney Local Health District, New South Wales, Australia
| | - Alicia Arnott
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Vitali Sintchenko
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Craig B Dalton
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
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Brown VR, Miller RS, Bowden CF, Smyser TJ, Ledesma NA, Hartwig A, Gordy P, Anderson AM, Porter SM, Alexander K, Gouker Z, Gidlewski T, Bowen RA, Bosco-Lauth AM. Disease Progression and Serological Assay Performance in Heritage Breed Pigs following Brucella suis Experimental Challenge as a Model for Naturally Infected Feral Swine. Pathogens 2023; 12:pathogens12050638. [PMID: 37242308 DOI: 10.3390/pathogens12050638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Invasive feral swine (Sus scrofa) are one of the most important wildlife species for disease surveillance in the United States, serving as a reservoir for various diseases of concern for the health of humans and domestic animals. Brucella suis, the causative agent of swine brucellosis, is one such pathogen carried and transmitted by feral swine. Serology assays are the preferred field diagnostic for B. suis infection, as whole blood can be readily collected and antibodies are highly stable. However, serological assays frequently have lower sensitivity and specificity, and few studies have validated serological assays for B. suis in feral swine. We conducted an experimental infection of Ossabaw Island Hogs (a breed re-domesticated from feral animals) as a disease-free proxy for feral swine to (1) improve understanding of bacterial dissemination and antibody response following B. suis infection and (2) evaluate potential changes in the performance of serological diagnostic assays over the course of infection. Animals were inoculated with B. suis and serially euthanized across a 16-week period, with samples collected at the time of euthanasia. The 8% card agglutination test performed best, whereas the fluorescence polarization assay demonstrated no capacity to differentiate true positive from true negative animals. From a disease surveillance perspective, using the 8% card agglutination test in parallel with either the buffered acidified plate antigen test or the Brucella abortus/suis complement fixation test provided the best performance with the highest probability of a positive assay result. Application of these combinations of diagnostic assays for B. suis surveillance among feral swine would improve understanding of spillover risks at the national level.
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Affiliation(s)
- Vienna R Brown
- National Feral Swine Damage Management Program, USDA APHIS Wildlife Services, Fort Collins, CO 80521, USA
| | - Ryan S Miller
- Centers for Epidemiology and Animal Health, USDA APHIS Veterinary Services, Fort Collins, CO 80521, USA
| | - Courtney F Bowden
- National Wildlife Research Center, USDA APHIS Wildlife Services, Fort Collins, CO 80521, USA
| | - Timothy J Smyser
- National Wildlife Research Center, USDA APHIS Wildlife Services, Fort Collins, CO 80521, USA
| | - Nicholas A Ledesma
- National Veterinary Services Laboratories, USDA APHIS Veterinary Services, Ames, IA 50010, USA
| | - Airn Hartwig
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Paul Gordy
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Aaron M Anderson
- National Wildlife Research Center, USDA APHIS Wildlife Services, Fort Collins, CO 80521, USA
| | - Stephanie M Porter
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Kate Alexander
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Zane Gouker
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Thomas Gidlewski
- National Wildlife Disease Program, USDA APHIS Wildlife Services, Fort Collins, CO 80521, USA
| | - Richard A Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
| | - Angela M Bosco-Lauth
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO 80521, USA
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Silkens MEWM, Alexander K, Viney R, O'Keeffe C, Taylor S, Noble LM, Griffin A. A national qualitative investigation of the impact of service change on doctors' training during Covid-19. BMC Med Educ 2023; 23:174. [PMID: 36941665 PMCID: PMC10027255 DOI: 10.1186/s12909-023-04143-1] [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] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Covid-19 crisis sparked service reconfigurations in healthcare systems worldwide. With postgraduate medical education sitting within these systems, service reconfigurations substantially impact trainees and their training environment. This study aims to provide an in-depth qualitative understanding of the impact of service reconfiguration on doctors' training during the pandemic, identifying opportunities for the future as well as factors that pose risks to education and training and how these might be mitigated. METHODS Qualitative parallel multi-centre case studies examined three Trusts/Health Boards in two countries in the United Kingdom. Data were collected from online focus groups and interviews with trainees and supervisors using semi-structured interview guides (September to December 2020). A socio-cultural model of workplace learning, the expansive-restrictive continuum, informed data gathering, analysis of focus groups and coding. RESULTS Sixty-six doctors participated, representing 25 specialties/subspecialties. Thirty-four participants were male, 26 were supervisors, 17 were specialty trainees and 23 were foundation doctors. Four themes described the impact of pandemic-related service reconfigurations on training: (1) Development of skills and job design, (2) Supervision and assessments, (3) Teamwork and communication, and (4) Workload and wellbeing. Service changes were found to both facilitate and hinder education and training, varying across sites, specialties, and trainees' grades. Trainees' jobs were redesigned extensively, and many trainees were redeployed to specialties requiring extra workforce during the pandemic. CONCLUSIONS The rapid and unplanned service reconfigurations during the pandemic caused unique challenges and opportunities to doctors' training. This impaired trainees' development in their specialty of interest, but also presented new opportunities such as cross-boundary working and networking.
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Affiliation(s)
- M E W M Silkens
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK
- Centre for Healthcare Innovation Research, Department of Health Services Research and Management, City University of London, London, UK
| | - K Alexander
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - R Viney
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK
| | - C O'Keeffe
- UCL Medical School, University College London, London, UK
| | - S Taylor
- Institute of Education, University College London, London, UK
| | - L M Noble
- UCL Medical School, University College London, London, UK
| | - A Griffin
- Research Department of Medical Education (RDME), UCL Medical School, University College London, The Directorate, 74 Huntley Street, London, WC1E 6AU, UK.
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Carter A, McManus H, Ward JS, Vickers T, Asselin J, Baillie G, Chow EPF, Chen MY, Fairley CK, Bourne C, McNulty A, Read P, Heath K, Ryder N, McCloskey J, Carmody C, McCormack H, Alexander K, Casey D, Stoove M, Hellard ME, Donovan B, Guy RJ. Infectious syphilis in women and heterosexual men in major Australian cities: sentinel surveillance data, 2011-2019. Med J Aust 2023; 218:223-228. [PMID: 36854387 PMCID: PMC10952992 DOI: 10.5694/mja2.51864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health. DESIGN, SETTING Analysis of data extracted from de-identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS). PARTICIPANTS First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011-2019. MAIN OUTCOME MEASURES Positive infectious syphilis test rate; change in annual positive test rate. RESULTS 180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9-3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0-4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12; 95% CI, 1.01-1.25); for heterosexual men it was 6.1 (95% CI, 3.8-9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6-10) per 1000 tests in 2019 (RR, 1.10; 95% CI, 1.03-1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85; 95% CI, 1.34-2.55) and heterosexual men (aRR, 2.39; 95% CI, 1.53-3.74) in areas of greatest socio-economic disadvantage than for those in areas of least socio-economic disadvantage. It was also higher for Indigenous women (aRR, 2.39; 95% CI, 1.22-4.70) and for women who reported recent injection drug use (aRR, 4.87; 95% CI, 2.18-10.9) than for other women; it was lower for bisexual than heterosexual women (aRR, 0.48; 95% CI, 0.29-0.81) and for women who reported recent sex work (aRR, 0.35; 95% CI, 0.29-0.44). The positive test rate was higher for heterosexual men aged 40-49 years (aRR, 2.11; 95% CI, 1.42-3.12) or more than 50 years (aRR, 2.36; 95% CI, 1.53-3.65) than for those aged 15-29 years. CONCLUSION The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis.
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Affiliation(s)
- Allison Carter
- The Kirby InstituteSydneyNSW
- Australian Human Rights InstituteSydneyNSW
| | | | | | | | - Jason Asselin
- Centre for Population HealthBurnet InstituteMelbourneVIC
| | | | - Eric PF Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
- Central Clinical SchoolMonash UniversityMelbourneVIC
| | - Marcus Y Chen
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
| | - Christopher K Fairley
- The Kirby InstituteSydneyNSW
- Melbourne Sexual Health CentreAlfred HealthMelbourneVIC
- Central Clinical SchoolMonash UniversityMelbourneVIC
| | - Christopher Bourne
- New South Wales Ministry of HealthSydneyNSW
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
| | - Anna McNulty
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
- University of New South WalesSydneyNSW
| | - Phillip Read
- The Kirby InstituteSydneyNSW
- South Eastern Sydney Local Health DistrictSydneyNSW
| | - Kevin Heath
- South Eastern Sydney Local Health DistrictSydneyNSW
| | - Nathan Ryder
- Hunter New England Sexual Health Pacific ClinicNewcastleNSW
| | | | | | | | - Kate Alexander
- National Aboriginal Community Controlled Health OrganisationCanberraACT
| | - Dawn Casey
- National Aboriginal Community Controlled Health OrganisationCanberraACT
| | | | | | - Basil Donovan
- The Kirby InstituteSydneyNSW
- Sydney Sexual Health CentreSydney HospitalSydneyNSW
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Alexander K, Simon E, Mama K, Rao S, Bass L. Intrathecal mepivacaine after general anesthesia is an effective method of equine euthanasia when compared to intravenous pentobarbital. Am J Vet Res 2023; 84:ajvr.22.11.0201. [PMID: 36921025 DOI: 10.2460/ajvr.22.11.0201] [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: 11/19/2022] [Accepted: 02/25/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES This study aims to assess intrathecal mepivacaine for euthanasia in anesthetized horses and compare it to a traditional euthanasia method using a single intravenous injection of pentobarbital in sedated horses. ANIMALS Client-owned horses and horses requiring euthanasia due to involvement in concurrent research projects were used. Horses were randomly assigned to 1 of 2 groups: intrathecal mepivacaine after anesthesia or intravenous pentobarbital after sedation. All horses had normal vital parameters and no signs of infectious disease at the time of euthanasia. PROCEDURES The intrathecal mepivacaine group was anesthetized before the intrathecal injection of mepivacaine. The pentobarbital group was sedated, concurrently anesthetized and euthanized using intravenous pentobarbital, then received an intrathecal saline (0.9% NaCl) solution injection to a blind observer. Both groups were sedated with detomidine and the time from sedation to the cessation of vital parameters (respirations, pulse, corneal reflex, and ECG) was recorded. Euthanasias were recorded for review by a blinded anesthesiologist, using an independent scale to assess the quality of sedation, anesthesia induction, and lateral recumbency. RESULTS Time from detomidine administration to cessation of each vital parameter was significantly longer in the intrathecal mepivacaine group. There was no statistically significant difference in qualitative scores between groups for sedation or induction, but lateral recumbency was subjectively superior in the anesthetized intrathecal mepivacaine group. CLINICAL RELEVANCE Intrathecal mepivacaine provided a safe, effective, alternative method of euthanasia to intravenous pentobarbital and addresses concerns about barbiturate availability. This study also informs practitioners of what to expect (ie, longer cessation of vital parameters) when using the intrathecal mepivacaine method.
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Affiliation(s)
- Kate Alexander
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
| | - Embry Simon
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
| | - Khursheed Mama
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
| | - Sangeeta Rao
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
| | - Luke Bass
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO
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Joslyn S, Alexander K. Evaluating artificial intelligence algorithms for use in veterinary radiology. Vet Radiol Ultrasound 2022; 63 Suppl 1:871-879. [PMID: 36514228 DOI: 10.1111/vru.13159] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/16/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence is increasingly being used for applications in veterinary radiology, including detection of abnormalities and automated measurements. Unlike human radiology, there is no formal regulation or validation of AI algorithms for veterinary medicine and both general practitioner and specialist veterinarians must rely on their own judgment when deciding whether or not to incorporate AI algorithms to aid their clinical decision-making. The benefits and challenges to developing clinically useful and diagnostically accurate AI algorithms are discussed. Considerations for the development of AI research projects are also addressed. A framework is suggested to help veterinarians, in both research and clinical practice contexts, assess AI algorithms for veterinary radiology.
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Affiliation(s)
- Steve Joslyn
- ACVR/ECVDI AI Education and Development Committee, Vedi, Perth, Western Australia, Australia
| | - Kate Alexander
- ACVR/ECVDI AI Education and Development Committee, DMV Veterinary Center, Lachine, Quebec, Canada
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Mee H, Anwar F, Timofeev I, Owens N, Grieve K, Whiting G, Alexander K, Kendrick K, Helmy A, Hutchinson P, Kolias A. Cranioplasty: A Multidisciplinary Approach. Front Surg 2022; 9:864385. [PMID: 35656088 PMCID: PMC9152220 DOI: 10.3389/fsurg.2022.864385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Decompressive craniectomy (DC) is an operation where a large section of the skull is removed to accommodate brain swelling. Patients who survive will usually require subsequent reconstruction of the skull using either their own bone or an artificial prosthesis, known as cranioplasty. Cranioplasty restores skull integrity but can also improve neurological function. Standard care following DC consists of the performance of cranioplasty several months later as historically, there was a concern that earlier cranioplasty may increase the risk of infection. However, recent systematic reviews have challenged this and have demonstrated that an early cranioplasty (within three months after DC) may enhance neurological recovery. However, patients are often transferred to a rehabilitation unit following their acute index admission and before their cranioplasty. A better understanding of the pathophysiological effects of cranioplasty and the relationship of timing and complications would enable more focused patient tailored rehabilitation programs, thus maximizing the benefit following cranioplasty. This may maximise recovery potential, possibly resulting in improved functional and cognitive gains, enhancement of quality of life and potentially reducing longer-term care needs. This narrative review aims to update multi-disciplinary team regarding cranioplasty, including its history, pathophysiological consequences on recovery, complications, and important clinical considerations both in the acute and rehabilitation settings.
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Affiliation(s)
- H. Mee
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
- Correspondence: Harry Mee
| | - F. Anwar
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - I. Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - N. Owens
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Grieve
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - G. Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Alexander
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - K. Kendrick
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - A. Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - P. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
| | - A. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke’s Hospital, Cambridge, UK
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11
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Zajaczkowski P, Lee R, Fletcher-Lartey SM, Alexander K, Mahimbo A, Stark D, Ellis JT. The controversies surrounding Giardia intestinalis assemblages A and B. Curr Res Parasitol Vector Borne Dis 2022; 1:100055. [PMID: 35284870 PMCID: PMC8906113 DOI: 10.1016/j.crpvbd.2021.100055] [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] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022]
Abstract
Giardia intestinalis continues to be one of the most encountered parasitic diseases around the world. Although more frequently detected in developing countries, Giardia infections nonetheless pose significant public health problems in developed countries as well. Molecular characterisation of Giardia isolates from humans and animals reveals that there are two genetically different assemblages (known as assemblage A and B) that cause human infections. However, the current molecular assays used to genotype G. intestinalis isolates are quite controversial. This is in part due to a complex phenomenon where assemblages are incorrectly typed and underreported depending on which targeted locus is sequenced. In this review, we outline current knowledge based on molecular epidemiological studies and raise questions as to the reliability of current genotyping assays and a lack of a globally accepted method. Additionally, we discuss the clinical symptoms caused by G. intestinalis infection and how these symptoms vary depending on the assemblage infecting an individual. We also introduce the host-parasite factors that play a role in the subsequent clinical presentation of an infected person, and explore which assemblages are most seen globally.
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Affiliation(s)
- Patricia Zajaczkowski
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | | | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - Abela Mahimbo
- Faculty of Health, School of Public Health, University of Technology Sydney, Australia
| | - Damien Stark
- Department of Microbiology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - John T Ellis
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
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12
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Farmery AK, Alexander K, Anderson K, Blanchard JL, Carter CG, Evans K, Fischer M, Fleming A, Frusher S, Fulton EA, Haas B, MacLeod CK, Murray L, Nash KL, Pecl GT, Rousseau Y, Trebilco R, van Putten IE, Mauli S, Dutra L, Greeno D, Kaltavara J, Watson R, Nowak B. Food for all: designing sustainable and secure future seafood systems. Rev Fish Biol Fish 2022; 32:101-121. [PMID: 34092936 PMCID: PMC8164055 DOI: 10.1007/s11160-021-09663-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2021] [Indexed: 05/19/2023]
Abstract
UNLABELLED Food from the sea can make a larger contribution to healthy and sustainable diets, and to addressing hunger and malnutrition, through improvements in production, distribution and equitable access to wild harvest and mariculture resources and products. The supply and consumption of seafood is influenced by a range of 'drivers' including ecosystem change and ocean regulation, the influence of corporations and evolving consumer demand, as well as the growing focus on the importance of seafood for meeting nutritional needs. These drivers need to be examined in a holistic way to develop an informed understanding of the needs, potential impacts and solutions that align seafood production and consumption with relevant 2030 Sustainable Development Goals (SDGs). This paper uses an evidence-based narrative approach to examine how the anticipated global trends for seafood might be experienced by people in different social, geographical and economic situations over the next ten years. Key drivers influencing seafood within the global food system are identified and used to construct a future scenario based on our current trajectory (Business-as-usual 2030). Descriptive pathways and actions are then presented for a more sustainable future scenario that strives towards achieving the SDGs as far as technically possible (More sustainable 2030). Prioritising actions that not only sustainably produce more seafood, but consider aspects of access and utilisation, particularly for people affected by food insecurity and malnutrition, is an essential part of designing sustainable and secure future seafood systems. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11160-021-09663-x.
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Affiliation(s)
- A. K. Farmery
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
| | - K. Alexander
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K. Anderson
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
| | - J. L. Blanchard
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C. G. Carter
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K. Evans
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - M. Fischer
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - A. Fleming
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Land and Water, Hobart, TAS Australia
| | - S. Frusher
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - E. A. Fulton
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - B. Haas
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C. K. MacLeod
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - L. Murray
- College of Health, Massey University, Massey, New Zealand
| | - K. L. Nash
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - G. T. Pecl
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - Y. Rousseau
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - R. Trebilco
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - I. E. van Putten
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - S. Mauli
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - L. Dutra
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - D. Greeno
- College of Arts, Law and Education, University of Tasmania, Hobart, TAS Australia
| | - J. Kaltavara
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - R. Watson
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - B. Nowak
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
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13
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Farmery AK, Alexander K, Anderson K, Blanchard JL, Carter CG, Evans K, Fischer M, Fleming A, Frusher S, Fulton EA, Haas B, MacLeod CK, Murray L, Nash KL, Pecl GT, Rousseau Y, Trebilco R, van Putten IE, Mauli S, Dutra L, Greeno D, Kaltavara J, Watson R, Nowak B. Food for all: designing sustainable and secure future seafood systems. Rev Fish Biol Fish 2022; 32:101-121. [PMID: 34092936 DOI: 10.22541/au.160322471.16891119/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2021] [Indexed: 05/23/2023]
Abstract
UNLABELLED Food from the sea can make a larger contribution to healthy and sustainable diets, and to addressing hunger and malnutrition, through improvements in production, distribution and equitable access to wild harvest and mariculture resources and products. The supply and consumption of seafood is influenced by a range of 'drivers' including ecosystem change and ocean regulation, the influence of corporations and evolving consumer demand, as well as the growing focus on the importance of seafood for meeting nutritional needs. These drivers need to be examined in a holistic way to develop an informed understanding of the needs, potential impacts and solutions that align seafood production and consumption with relevant 2030 Sustainable Development Goals (SDGs). This paper uses an evidence-based narrative approach to examine how the anticipated global trends for seafood might be experienced by people in different social, geographical and economic situations over the next ten years. Key drivers influencing seafood within the global food system are identified and used to construct a future scenario based on our current trajectory (Business-as-usual 2030). Descriptive pathways and actions are then presented for a more sustainable future scenario that strives towards achieving the SDGs as far as technically possible (More sustainable 2030). Prioritising actions that not only sustainably produce more seafood, but consider aspects of access and utilisation, particularly for people affected by food insecurity and malnutrition, is an essential part of designing sustainable and secure future seafood systems. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11160-021-09663-x.
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Affiliation(s)
- A K Farmery
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
| | - K Alexander
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K Anderson
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
| | - J L Blanchard
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C G Carter
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - K Evans
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - M Fischer
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - A Fleming
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Land and Water, Hobart, TAS Australia
| | - S Frusher
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - E A Fulton
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - B Haas
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - C K MacLeod
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - L Murray
- College of Health, Massey University, Massey, New Zealand
| | - K L Nash
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - G T Pecl
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - Y Rousseau
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - R Trebilco
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - I E van Putten
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, Hobart, TAS Australia
| | - S Mauli
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - L Dutra
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- CSIRO Oceans and Atmosphere, St Lucia, QLD Australia
| | - D Greeno
- College of Arts, Law and Education, University of Tasmania, Hobart, TAS Australia
| | - J Kaltavara
- Australian National Centre for Ocean Resource and Security, University of Wollongong, Wollongong, NSW Australia
| | - R Watson
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Hobart, TAS Australia
| | - B Nowak
- Centre for Marine Socioecology, University of Tasmania, Hobart, TAS Australia
- Institute for Marine and Antarctic Studies, University of Tasmania, Newnham, TAS Australia
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14
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Koszewski W, Alexander K, Licata A. Impact of COVID-19 on Food Insecurity and Resiliency in College Students. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Dronavalli M, Lord H, Alexander K, Boonwaat L, Pal N, Fletcher-Lartey SM. Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care. J Epidemiol Glob Health 2021; 10:184-189. [PMID: 32538036 PMCID: PMC7310780 DOI: 10.2991/jegh.k.200402.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 03/20/2020] [Indexed: 11/25/2022] Open
Abstract
Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08–0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34–0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05–0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.
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Affiliation(s)
- Mithilesh Dronavalli
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Heidi Lord
- Centre for Research in Nursing and Health, St George Hospital, South Eastern Sydney Local Health District, Australia.,Centre for Evidence Based Initiatives in Health Care: A JBI Centre for Excellence, Wollongong, NSW, Australia
| | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Leng Boonwaat
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Narugopal Pal
- Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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16
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Dronavalli M, Fletcher-Lartey S, Lord H, Boonwaat L, Pal N, Alexander K. Antiviral prophylaxis is effective in reducing influenza outbreak severity in residential care. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.884] [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: 10/22/2022] Open
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17
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Lord H, Fletcher-Lartey S, Alexander K. Is it or is it not? Lessons learned from a case of suspected vaccine-associated measles. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.445] [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: 10/22/2022] Open
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18
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Drehner DM, Nazario A, Franco G, Riggins S, Cadilla A, Alexander K. Use of the BioFire Film Array Blood Culture Identification(BCID) Panel(BioFire Diagnostics, Salt Lake City, Utah) on Pleural Fluid Samples in Pediatric Patients Hospitalized for Community Acquired Pneumonia(CAP). Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.309] [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: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
CAP accounts for approximately 124,000 pediatric hospitalizations annually. Those patients often have received antibiotics prior to admission. Many have concurrent viral infections. Bacterial infections accompanying viral respiratory infections are known to increase morbidity and mortality. Traditional bacterial culture methods are often negative because of previous antibiotic therapy. The BCID, a multiplex polymerase chain reaction(PCR) assay, can identify 19 bacterial pathogens in approximately 90 minutes. It is FDA approved for blood culture isolates. We hypothesized it would detect bacterial pathogens in pleural effusions.
Methods
BCID panels were done on residual pleural fluid samples from 10 patients with severe community acquired pneumonia during the period 5/2018 – 12/2019. The patients had positive radiographic findings of pneumonia, were inpatients, had intact immune systems by clinical history and had received antibiotic therapy for more than 8 hours before specimen collection. Treatment required 133 inpatient days. 6 of 10 were diagnosed with viral respiratory pathogens. 1 of 9 had a positive blood culture. 1 of 10 had a positive pleural fluid culture.
Results
10 of 10 pleural fluid specimens were positive for a pathogen on the BCID panel – 8, Streptococcus pneumoniae, 1, Staphylococcus aureus and I, Streptococcus pyogens. Two of ten had confirmatory positive cultures. Also, one pleural fluid gram stain showed gram positive cocci in chains and clusters. The BCID detected Streptococcus pyogens. Anti Streptolysin O was strongly positive, 964(0 – 70) IU/mL.
Conclusion
The yield of bacterial culture plummets with previous antibiotic treatment. FDA approved multiplex PCR panels have narrowly defined specimen requirements. That increases the cost and decreases test applicability.
Despite a history of appropriate immunizations in the sample population Streptococcus pneumoniae may be prevalent in the complex pediatric pneumonia population. The BCID may be effective at pathogen detection in cases of complex pneumonia where patients have received prior antibiotic treatment.
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Affiliation(s)
- D M Drehner
- Pathology and Laboratory Medicine, Nemours Children’s Hospital, Orlando, Florida, UNITED STATES
| | - A Nazario
- Pathology and Laboratory Medicine, Nemours Children’s Hospital, Orlando, Florida, UNITED STATES
| | - G Franco
- Pathology and Laboratory Medicine, Nemours Children’s Hospital, Orlando, Florida, UNITED STATES
| | - S Riggins
- Pathology and Laboratory Medicine, Nemours Children’s Hospital, Orlando, Florida, UNITED STATES
| | - A Cadilla
- Infectious Disease Service, Nemours Children’s Hospital, Orlando, Florida, UNITED STATES
| | - K Alexander
- Infectious Disease Service, Nemours Children’s Hospital, Orlando, Florida, UNITED STATES
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19
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Lord H, Kok J, Fletcher-Lartey S, Alexander K. Is it or is it not? Lessons learned from a case of suspected vaccine strain measles. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.829] [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: 11/12/2022] Open
Abstract
Abstract
Background
Measles continues to be a threat to Australia. While post eradication risks are low, imported measles cases from overseas travellers who are non-immune can cause small outbreaks. This case report discusses the challenge of identifying wild-type measles in an individual who was recently vaccinated with measles - containing vaccine (MCV).
Methods
A positive polymerase chain reaction (PCR) result for measles for an adult who had recently received a measles -containing vaccine was notified. Investigation revealed no known epidemiological link, recent overseas travel or contact with recent measles cases during the incubation period.
Results
The results of the initial sequencing to distinguish between wild-type and vaccine-strain measles were inconclusive. A decision was made to re-run the genotyping, collect additional specimens, and quarantine the case until a definitive result was obtained. Sequencing and genotyping revealed that this indeed was a wild-type measles strain.
Conclusions
Changing epidemiology of measles means distinguishing between wild-type and vaccine-strain measles has become a new challenge. The reflection of the public health management of this case has provided is a valuable teaching tool for public health professionals globally, particularly in low incidence measles countries.
Key messages
The lack of an epidemiological link can create confusion for public health staff when investigating possible measles cases. Changes in the epidemiology of measles means distinguishing between wild type and vaccine strain measles is a challenge.
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Affiliation(s)
- H Lord
- Centre for Research in Nursing and Health, South Eastern Sydney Local Health District, Kogarah, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
- Centre for Evidence based Initiatives in health Care, A Joanna Briggs Institute Centre for Excellence, Wollongong, Australia
| | - J Kok
- Centre for Infectious Diseases and Microbiology Laboratory S, NSW Health Pathology, Westmead, Australia
| | - S Fletcher-Lartey
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - K Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
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20
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Lord H, Kok J, Fletcher S, Alexander K. Is it or is it not? Lessons learned from a case of suspected vaccine strain measles. Aust N Z J Public Health 2020; 44:160-162. [PMID: 32190947 DOI: 10.1111/1753-6405.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Measles continues to be a threat to Australia. While post-eradication risks are low, imported measles cases from overseas travellers who are non-immune can cause small outbreaks. This case report discusses the challenge of identifying wild-type measles in an individual who was recently vaccinated with measles-containing vaccine (MCV). METHODS A positive polymerase chain reaction (PCR) result for measles for an adult who had recently received a measles-containing vaccine was notified. Investigation revealed no known epidemiological link, recent overseas travel or contact with recent measles cases during the incubation period. RESULTS The results of the initial sequencing to distinguish between wild-type and vaccine-strain measles were inconclusive. A decision was made to re-run the genotyping, collect additional specimens and quarantine the case until a definitive result was obtained. Sequencing and genotyping revealed that this indeed was a wild-type measles strain. CONCLUSIONS Changing epidemiology of measles means distinguishing between wild-type and vaccine-strain measles has become a new challenge. Implications for public health: The reflection of the public health management of this case has provided a valuable teaching tool for public health professionals globally, particularly in low incidence measles countries.
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Affiliation(s)
- Heidi Lord
- Centre for Research in Nursing and Health, South Eastern Sydney Local Health District, New South Wales
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology and Medical Research, New South Wales
| | - Stephanie Fletcher
- Public Health Unit, South Western Sydney Local Health District, New South Wales
| | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, New South Wales
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Alexander K. President's message 2020. Vet Radiol Ultrasound 2020; 61:8-9. [DOI: 10.1111/vru.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 11/29/2022] Open
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Ali I, Sarraf S, Downey R, Kim S, Alexander K, Grodzicki B, Shahrokni A. NEUTROPHIL TO LYMPHOCYTE RATIO ≥4 CORRELATES WITH 6-MONTH POSTOPERATIVE MORTALITY IN CANCER PATIENTS AGED >75. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fletcher-Lartey S, Dronavalli M, Alexander K, Ghosh S, Boonwaat L, Thomas J, Robinson A, Patel Z, Forssman B, Pal N. Trends in Antimicrobial Resistance Patterns in Neisseria Gonorrhoeae in Australia and New Zealand: A Meta-analysis and Systematic Review. Antibiotics (Basel) 2019; 8:E191. [PMID: 31652729 PMCID: PMC6963718 DOI: 10.3390/antibiotics8040191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/19/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
(1) Background: The widespread development of resistance among Neisseria gonorrhoeae (NG) clinical isolates has been reported by surveillance systems around the world. This meta-analysis estimated the changes in susceptibility patterns among antibiotics under surveillance in Australia and New Zealand. (2) Methods: Articles published in English from 1980-2018, from Australia or New Zealand, that met the selection criteria were included. The meta-analysis was carried out using the R statistical software. (3) Results: In Australia, there has been decreasing susceptibility of gonococcal isolates to selected antimicrobials over time. Azithromycin (Odds Ratio (OR): 0.73; 95% Confidence Interval (CI) 0.64-0.82) and ceftriaxone (OR: 0.69; 95% CI 0.59-0.80) showed decreasing levels of susceptibility each year. Western Australia (OR: 0.76; 95% CI 0.60-0.96) and Victoria (OR: 0.74; 95% CI 0.60-0.90) also had decreasing levels of susceptibility to ceftriaxone over time compared with other states and territories. (4) Conclusions: The results highlight the need for the development of new approaches for managing cases of gonorrhoea. Improved antimicrobial stewardship, enhanced surveillance and contact tracing are needed to identify and respond to changes in antibiotic resistance in a timely manner. Increasing awareness and public health follow-up of cases can help to interrupt the cycle of infection and limit transmission.
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Affiliation(s)
| | - Mithilesh Dronavalli
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Sayontonee Ghosh
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Leng Boonwaat
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Jane Thomas
- Public Health Unit, Nepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
| | - Amanda Robinson
- Public Health Unit, Nepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
| | - Zeel Patel
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
| | - Bradley Forssman
- Public Health Unit, Nepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
| | - Naru Pal
- Public Health Unit, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia.
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Riely G, Lovly C, Messina C, Bienert S, Alexander K, Pao W, Magee K, Baxi S, Doebele R. P1.01-25 Real-World Outcomes of Advanced NSCLC Patients with Common and Uncommon/Complex EGFR Mutation Profiles. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dyleva Y, Gruzdeva O, Uchasova E, Borodkina D, Brel N, Alexander K, Karetnikova V, Barbarash O. Epicardial and perivascular fatty tissue and adipokine-cytokine level in ischemic heart disease patients. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.04.033] [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: 11/16/2022]
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Alexander K, Barrett C, Dobos K, Cheng P, Liao R, Wheeler M, Liedtke M, Weisshaar D, Witteles R. Contemporary Outcomes in Patients with Cardiac Amyloidosis Undergoing Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.524] [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] Open
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Artz CE, Ward Jr MA, Miles MP, Alexander K, Blanche AL, Lintner A, Leonard C, Bright A, Kahn SA. 239 Intraoperative Liposomal Bupivacaine for Skin Graft Donor Site Analgesia. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C E Artz
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - M A Ward Jr
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - M P Miles
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - K Alexander
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - A L Blanche
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - A Lintner
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - C Leonard
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - A Bright
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
| | - S A Kahn
- University of South Alabama, Mobile, AL; University of South Alabama Medical Center, Mobile, AL; University of South Alabama College of Medicine, Mobile, AL
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Alexander K. MODEL EDUCATIONAL INITIATIVES FOR CAREGIVERS: 4 GWEPS REPORT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Alexander
- Memorial Sloan Kettering Cancer Center, New York, New York
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Hilgeman M, Block P, Alexander K, Collins A, Kunik M, Allen R, Snow A. RELATIONSHIP QUALITY AMONG SPOUSES AND EX-SPOUSES OF VETERANS WITH DEMENTIA AS CAREGIVING CONTEXT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Hilgeman
- Tuscaloosa VA Medical Center & University of Alabama
| | - P Block
- University of Alabama & Tuscaloosa VA Medical Center
| | | | | | - M Kunik
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Science
| | | | - A Snow
- Tuscaloosa VA Medical Center & University of Alabama
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Alexander K, Banerjee S, Walters C, Staley J, Parker P. EXPLORATION OF ONCOLOGY HEALTHCARE PROVIDERS’ KNOWLEDGE OF LESBIAN, GAY, BISEXUAL AND TRANSGENDER HEALTHCARE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - J Staley
- Memorial Sloan Kettering Cancer Center
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Alexander K, Gangai NC, Manna R, Korc-Grodzicki B. EDUCATIONAL INITIATIVE FOR MINORITY COMMUNITY CAREGIVERS ON GERIATRIC SYNDROMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Alexander
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - N C Gangai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Manna
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
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Kotzé HF, Lamprecht S, Badenhorst PN, van Wyk V, Roodt JP, Alexander K. In Vivo Inhibition of Acute Platelet-Dependent Thrombosis in a Baboon Model by BAY U3405, a Thromboxane A2-Receptor Antagonist. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryBay U3405 is a thromboxane A2 (TxA2)-receptor antagonist that inhibits the binding of TxA2 to its target cells. The aim of this study was to determine if Bay U3405 could be used to inhibit arterial thrombosis. A thrombogenic de vice, consisting of uncrimped Dacron vascular graft material (0.5 cm2) built into the wall of silicone rubber tubing with 4 mm inside diameter, was exposed to native flowing blood under arterial blood flow conditions (100-140 ml/min) by interposing the devices as extension segments into permanent femoral arteriovenous shunts implanted in baboons. Thrombus formation was quantified in vivo by measuring the deposition of 111In-labelled platelets onto the graft material with a scintillation camera. In six baboons, a bolus injection of Bay U3405, calculated to attain an initial plasma concentration of 300 ng/ml, reduced the maximum thrombus formation measured over a 2 h study period. Platelet deposition was reduced by 33 ± 14% (SD) at 2 h as compared to control studies done in the same baboons. The accumulation of additional platelets onto a thrombus that was allowed to form for 1 h, was reduced by 58 ± 28% at 2 h. Ex vivo platelet aggregation in response to ADP, activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) were not affected by the treatment. Ex vivo platelet aggregation in response to collagen was markedly inhibited for 2 h after treatment. The results demonstrated that selective blocking of the TxA2-receptor on platelets reduced platelet-dependent thrombus formation and the accumulation of additional platelets in a freshly formed thrombus. This may provide a viable approach for preventing excessive thrombus formation in patients undergoing arterial reconstructive surgery.
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Affiliation(s)
- H F Kotzé
- The Department of Haematology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa
| | - S Lamprecht
- The Department of Haematology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa
| | - P N Badenhorst
- The Department of Haematology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa
| | - V van Wyk
- The Department of Haematology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa
| | - J P Roodt
- The Department of Haematology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa
| | - K Alexander
- The Department of Haematology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa
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Saul N, Wang K, Bag S, Baldwin H, Alexander K, Chandra M, Thomas J, Quinn H, Sheppeard V, Conaty S. Effectiveness of maternal pertussis vaccination in preventing infection and disease in infants: The NSW Public Health Network case-control study. Vaccine 2018; 36:1887-1892. [PMID: 29501321 DOI: 10.1016/j.vaccine.2018.02.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [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: 10/27/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Infants are at the highest risk of severe complications - including death - as a result of pertussis infection. Controlling pertussis in this group has been challenging, particularly in those too young to be vaccinated. Following revised national recommendations in March 2015, the state of New South Wales, Australia, introduced a funded maternal vaccination campaign at 28 - 32 weeks of gestation using a 3-component tetanus-diphtheria-acellular pertussis vaccine (dTpa; Boostrix, GSK). This study aimed to assess the effectiveness of maternal vaccination and add to the growing body of evidence for this strategy. METHODS A 1:1 matched case-control study was conducted between 16 August 2015 and 17 August 2016. Cases were laboratory or doctor notified, laboratory confirmed (nucleic acid testing or culture) and aged <6 months at onset. Each control infant was randomly selected from public hospital births in the same geographical area in the period up to 3 days before and after the case's birthdate. Odds ratios (OR) were calculated using conditional logistic regression. Vaccine effectiveness (VE) was calculated as 1 - OR. FINDINGS In total, 117 cases and 117 controls were recruited. The overall VE estimate was non-significantly protective for infants <6 months old (VE 39%, 95% CI -12 to 66%). Higher VE was observed for infants <3 months old (VE 69%, 95% CI 13-89%) and against hospitalisation (VE 94%, 95% CI 59-99%). INTERPRETATION Maternal pertussis vaccination with a 3-component acellular vaccine was found to be highly effective at preventing severe disease in infants, but was less effective at preventing disease which did not require hospitalisation. The overall VE reported in this study was lower than in prior studies and suggests that maternal vaccination, while an effective strategy at preventing severe pertussis, is less effective at protecting against infection or mild disease.
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Affiliation(s)
- Nathan Saul
- Communicable Disease Branch, 73 Miller Street, North Sydney, New South Wales 2060, Australia.
| | - Kevin Wang
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 73 Miller Street, North Sydney, New South Wales 2060, Australia.
| | - Shopna Bag
- Centre for Population Health, Western Sydney Local Health District, North Parramatta, New South Wales 2151, Australia
| | - Heather Baldwin
- Biostatistics Training Program, New South Wales Ministry of Health, 73 Miller Street, North Sydney, New South Wales 2060, Australia
| | - Kate Alexander
- South Western Sydney Local Health District Public Health Unit, Level 2, 157-161 George St, Liverpool, New South Wales 2170, Australia
| | - Meena Chandra
- Public Health Registrar, Public Health Unit and Department of Community Paediatrics, South Western Sydney Local Health District, 157-161 George Street, Liverpool, New South Wales 2170, Australia.
| | - Jane Thomas
- Nepean Blue Mountains Local Health District Public Health Unit, PO Box 63, Penrith, New South Wales 2751, Australia.
| | - Helen Quinn
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Cnr Hawkesbury Road and Hainsworth Street, Westmead, New South Wales 2145, Australia.
| | - Vicky Sheppeard
- Communicable Disease Branch, 73 Miller Street, North Sydney, New South Wales 2060, Australia.
| | - Stephen Conaty
- South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC, New South Wales 1871, Australia.
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Alexander K, Northrup N, Clarke D, Lindell H, Laver T. Engineering controls in veterinary oncology: A survey of 148 ACVIM board-certified oncologists and environmental surveillance in 20 specialty hospitals. Vet Comp Oncol 2018; 16:385-391. [PMID: 29446222 DOI: 10.1111/vco.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Abstract
Engineering controls (EC, facility and equipment barriers between hazards and people) are used to avoid exposure to chemotherapy drugs. In this study, American College of Veterinary Internal Medicine board-certified veterinary oncologists were surveyed about their use of containment primary EC (C-PEC) and supplemental EC (closed system transfer devices, CSTD). The survey was completed by 148 (38%) of practicing diplomates. All used EC. Both C-PEC and CSTD were used at 92% of hospitals; however, US Pharmacopoeial Convention Chapter <800> (USP <800>) standards were met at only 19% of hospitals and oncologists did not know the type of C-PEC at 18% of hospitals. Next, surface contamination and EC use were assessed with environmental surveillance for carboplatin, cyclophosphamide, doxorubicin, and vincristine in 20 veterinary specialty hospitals using a commercially available kit. No contamination with carboplatin, doxorubicin, or vincristine was detected, however, there was contamination with cyclophosphamide at 4 hospitals. Based on this study, most veterinary oncologists use C-PEC and CSTD, but few meet USP <800> standards. Current measures appear effective for preventing contamination with IV drugs, but additional measures are needed for oral drugs.
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Affiliation(s)
- K Alexander
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - N Northrup
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - D Clarke
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - H Lindell
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - T Laver
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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Alexander K, Nonaillada J, Gangai N, Costas Muniz R, Korc-Grodzicki B. INITIATIVE TO PROMOTE KNOWLEDGE OF GERIATRIC SYNDROMES IN MINORITY OLDER COMMUNITIES AND CAREGIVERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K. Alexander
- Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York,
- Weill Cornell Medical College, New York, New York
| | - J. Nonaillada
- Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York,
| | - N. Gangai
- Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York,
| | - R. Costas Muniz
- Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York,
| | - B. Korc-Grodzicki
- Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York,
- Weill Cornell Medical College, New York, New York
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Cléroux A, Alexander K, Beauchamp G, Dunn M. Evaluation for association between urolithiasis and chronic kidney disease in cats. J Am Vet Med Assoc 2017; 250:770-774. [DOI: 10.2460/javma.250.7.770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zoller G, Langlois I, Alexander K. Glomerular filtration rate determination by computed tomography in two pet rabbits with renal disease. J Am Vet Med Assoc 2017; 250:681-687. [DOI: 10.2460/javma.250.6.681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Choquette A, Del Castillo JRE, Moreau M, Guillot M, Alexander K, Kona-Boun JJ, Gauvin D, Troncy E. Comparison of lidocaine and lidocaine-epinephrine for the paravertebral brachial plexus block in dogs. Vet Anaesth Analg 2017; 44:317-328. [PMID: 28461127 DOI: 10.1016/j.vaa.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/02/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the motor and sensory block efficacy and duration of a modified paravertebral brachial plexus block (PBPB) after administration of lidocaine alone (LI) or combined with epinephrine (LE). STUDY DESIGN Prospective, randomized, blinded, crossover study. ANIMALS A total of eight healthy female Beagle dogs. METHODS Under general anesthesia, modified PBPB was performed on the left thoracic limb using neurostimulation and/or ultrasound guidance to administer lidocaine (2 mg kg-1; 0.2 mL kg-1) either alone (treatment LI, n = 10) or with epinephrine (1:100,000; treatment LE, n = 9). Sensory block was evaluated through reaction to a painful mechanical stimulus applied at five sites on the limb. Motor block effect was evaluated according to visual gait assessments and thoracic limb vertical force measurements under dynamic and static conditions. Data were analyzed using repeated-measures generalized estimating equations. All statistical tests were performed two-sided at the α = 0.05 significance threshold. RESULTS The duration of sensory block did not differ significantly between treatments. Visible gait impairment was more persistent in LE than in LI (118 ± 63 minutes for LI and 163 ± 23 minutes for LE; mean ± standard deviation) (p = 0.027). At nadir value, dynamic peak vertical force was lower in LE than in LI (p = 0.007). For both dynamic and static evaluations, the nadir and the return to baseline force were delayed in LE (return to normal at 180-200 minutes) when compared with LI (130-140 minutes) (p < 0.005). CONCLUSIONS AND CLINICAL RELEVANCE The addition of epinephrine to lidocaine prolonged the duration and increased the intensity of the regional block, as verified by visual gait assessment and kinetic analysis. No significant difference was noted between treatments regarding sensory blockade. Kinetic analysis could be useful to evaluate regional anesthetic effect in dogs.
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Affiliation(s)
- Amélie Choquette
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Jérôme R E Del Castillo
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Maxim Moreau
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Martin Guillot
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Kate Alexander
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Jean-Jacques Kona-Boun
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Dominique Gauvin
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Eric Troncy
- Animal Pharmacology Research Group of Quebec (GREPAQ), Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC, Canada.
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Gibbins N, Luckett J, Alexander K, Conroy E, Dixon R, Lang J, Luddington T, Saunders A, Hartley P. The effect of cognitive impairment on functional recovery of elderly patients admitted to medical wards: a systematic review and meta-analysis. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.217] [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: 11/25/2022]
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Auger M, Alexander K, Beauchamp G, Dunn M. Use of CT to evaluate and compare intranasal features in brachycephalic and normocephalic dogs. J Small Anim Pract 2016; 57:529-536. [PMID: 27508338 DOI: 10.1111/jsap.12541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/05/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate and compare nasal mucosal contact, septal deviation and caudal aberrant nasal turbinates in brachycephalic and normocephalic dogs using computed tomography. METHODS Dogs without nasal disease and having undergone computed tomography scan of the head (plica alaris to the cribiform plate) were retrospectively selected and divided into brachycephalic and normocephalic groups. Eighteen brachycephalic and 32 normocephalic dogs were included. Anatomic criteria were used to locate predetermined pairs of intranasal structures and nasal mucosal contact was described as present or absent for each site. Septal deviations were identified and measured using angle of septal deviation. Caudal aberrant nasal turbinates were identified and categorised when present. RESULTS Prevalence of nasal mucosal contact was significantly higher in brachycephalic dogs. No significant difference was seen in prevalence or in angle of septal deviation between groups. Prevalence of caudal aberrant nasal turbinates was significantly higher in brachycephalic dogs. CLINICAL SIGNIFICANCE Nasal mucosal contact and caudal aberrant nasal turbinates were significantly more prevalent in brachycephalic dogs than in normocephalic dogs in our study. Computed tomography can be a valuable aid in obtaining data on nasal mucosal contact, caudal aberrant nasal turbinates and septal deviations. Combination of computed tomography with endoscopy and functional airway testing would be useful to further evaluate the correlation between intranasal features and symptoms of brachycephalic airway syndrome.
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Affiliation(s)
- M Auger
- Centre Vétérinaire Laval, Laval, Quebec, Canada, H7T 2P7
| | - K Alexander
- DMV Veterinary Center, Lachine, Quebec, Canada, H8T 3R2.
| | - G Beauchamp
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada, J2S 8H5
| | - M Dunn
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada, J2S 8H5
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Creutzig A, Caspary L, Alexander K. Changes of Skin Microcirculation in Patients with Chronic Venous Insufficiency Assessed by Laser Doppler Fluxmetry and Transcutaneous Oxymetry. Phlebology 2016. [DOI: 10.1177/026835559400900406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate whether microcirculatory disturbances of the skin in patients with chronic venous insufficiency are a generalized phenomenon or restricted to visible skin changes. Design: Open, prospective study in patients and healthy, age-matched subjects. Setting: Department of Angiology, Hannover Medical School. Patients: Seventy-one patients with chronic venous insufficiency. Measurements: Transcutaneous oxygen pressure (tc Po2) at electrode core temperatures of 37°C and 44°C and laser Doppler flux (LDF) were measured simultaneously in different regions of the legs. Results: On the forefoot, tc Po2 (37°C) at rest and tc Po2 (44°C) during arterial ischaemia were significantly higher in patients ( P<0.05), increasing with the severity of chronic venous insufficiency. Conclusions: Cutaneous capillary flow on the forefoot is increased in patients with chronic venous insufficiency, demonstrating the general effect of venous hypertension.
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Affiliation(s)
- A. Creutzig
- Department of Angiology, Hannover Medical School, Hannover, Germany
| | - L. Caspary
- Department of Angiology, Hannover Medical School, Hannover, Germany
| | - K. Alexander
- Department of Angiology, Hannover Medical School, Hannover, Germany
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De Lasalle J, Alexander K, Olive J, Laverty S. COMPARISONS AMONG RADIOGRAPHY, ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY FOR EX VIVO CHARACTERIZATION OF STIFLE OSTEOARTHRITIS IN THE HORSE. Vet Radiol Ultrasound 2016; 57:489-501. [DOI: 10.1111/vru.12370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/28/2016] [Indexed: 01/12/2023] Open
Affiliation(s)
- Julie De Lasalle
- Department of Clinical Sciences, Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, PO Box 5000 Saint-Hyacinthe QC Canada
- Comparative Orthopedic Research Laboratory, Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, PO Box 5000 Saint-Hyacinthe J2S 7C6, QC Canada
| | - Kate Alexander
- Department of Clinical Sciences, Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, PO Box 5000 Saint-Hyacinthe QC Canada
| | - Julien Olive
- Department of Clinical Sciences, Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, PO Box 5000 Saint-Hyacinthe QC Canada
| | - Sheila Laverty
- Department of Clinical Sciences, Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, PO Box 5000 Saint-Hyacinthe QC Canada
- Comparative Orthopedic Research Laboratory, Faculty of Veterinary Medicine; University of Montreal; 3200 Sicotte, PO Box 5000 Saint-Hyacinthe J2S 7C6, QC Canada
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Trencart P, Alexander K, De Lasalle J, Laverty S. Radiographic evaluation of the width of the femorotibial joint space in horses. Am J Vet Res 2016; 77:127-36. [DOI: 10.2460/ajvr.77.2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Xu S, Alexander K, Bryant W, Cohen N, Craig ME, Forbes M, Fulcher G, Greenaway T, Harrison N, Holmes-Walker DJ, Howard G, Jackson J, Jenkins A, Kamp M, Kaye J, Sinha A, Stranks S, O'Neal D, Colman P. Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia. Intern Med J 2015; 45:86-93. [PMID: 25370368 DOI: 10.1111/imj.12619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/22/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Healthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care. AIM This study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery. METHODS Twenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT. RESULTS Data on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 ± 6.4 weeks for 895 patients; age 35.4 ± 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 ± 2.8, dietitians 0.4 ± 0.2 and doctors 1.0 ± 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 ± 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively. CONCLUSIONS IPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.
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Affiliation(s)
- S Xu
- St Vincent's Hospital, Melbourne, Victoria, Australia
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McDonald-Mosley R, Choi S, Alexander K, Decker M. Perception and prevalence of LARC methods among family planning patients in Baltimore. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.209] [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: 11/26/2022]
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Alexander K, Shahrokni A, Korc-Grodzicki B. P-167: Delirium in elderly patients undergoing intraabdominal cancer surgery – associated factors and consequences. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30267-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Case summary An indoor 9-year-old castrated male domestic cat was referred with a 4 month history of increased upper airway noise. Computed tomography revealed a nasopharyngeal polypoid mass, which was removed endoscopically with basket forceps. Histopathology was compatible with a polypoid granulomatous pharyngitis with Cryptococcus-like organisms. This was supported by a positive serum latex cryptococcal antigen agglutination test (LCAT). Minimal inflammation of the nasal tissue was noted on histopathology, with no evidence of fungus. Following endoscopic removal of the mass, the patient was treated with systemic antifungal medication (itraconazole). One year after diagnosis, the LCAT titer was negative and the cat remained free of clinical signs. Relevance and novel information This case report emphasizes the importance of considering Cryptococcus species as a potential etiology in cats presented with signs of nasopharyngeal obstruction with an isolated nasopharyngeal polypoid mass, even if kept indoors.
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Affiliation(s)
- Véronique Livet
- Companion Animal Research Group, Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Romain Javard
- Companion Animal Research Group, Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Kate Alexander
- Companion Animal Research Group, Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Christiane Girard
- Companion Animal Research Group, Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
| | - Marilyn Dunn
- Companion Animal Research Group, Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada
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Kaplan SA, Jack ML, Cotler S, Alexander K. Utilization of area under the curve to elucidate the disposition of an extensively biotransformed drug. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/bf01062347] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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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Nasr AT, Alexander K, Schreiner LJ, McAuley KB. Leuco-crystal-violet micelle gel dosimeters: I. Influence of recipe components and potential sensitizers. Phys Med Biol 2015; 60:4665-83. [PMID: 26020840 DOI: 10.1088/0031-9155/60/12/4665] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiochromic leuco crystal violet (LCV) micelle gel dosimeters are promising three-dimensional radiation dosimeters because of their spatial stability and suitability for optical readout. The effects of surfactant type and surfactant concentration on dose sensitivity of LCV micelle gels are tested, demonstrating that dose sensitivity and initial colour of the gel increases with increasing Triton x-100 (Tx100) concentration. Using Cetyl Trimethyl Ammonium Bromide (CTAB) in place of Tx100 produces gels that are nearly colourless prior to irradiation, but reduces the dose sensitivity. The separate effects of Tri-chloro acetic acid concentration and pH are investigated, revealing that controlling the pH near 3.6 is crucial for achieving high dose sensitivity. The sensitizing effect of chlorinated species on dose sensitivity is tested using 2,2,2-trichloroethanol (TCE), chloroform, and 1,1,1-trichloro-2-methyl-2-propanol hemihydrate. TCE gives the largest improvement in dose sensitivity and is recommended for use in micelle gel dosimeters because it is less volatile and safer to use than chloroform. Preliminary experiments on a new gel containing CTAB as the surfactant and TCE show that this new gel gives a dose sensitivity that is 24% higher than that of previous LCV micelle gels and is nearly colourless prior to irradiation.
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Affiliation(s)
- A T Nasr
- Department Chemical Engineering, Queen's University, Kingston, Ontario K7L 3N6, Canada
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Olive J, Javard R, Specchi S, Bélanger MC, Bélanger C, Beauchamp G, Alexander K. Effect of cardiac and respiratory cycles on vertebral heart score measured on fluoroscopic images of healthy dogs. J Am Vet Med Assoc 2015; 246:1091-7. [DOI: 10.2460/javma.246.10.1091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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