1
|
Lown M, Smith KA, Muller I, Woods C, Maund E, Rogers K, Becque T, Hayward G, Moore M, Little P, Glogowska M, Hay A, Stuart B, Mantzourani E, Wilcox CR, Thompson N, Francis NA. Internet Tool to Support Self-Assessment and Self-Swabbing of Sore Throat: Development and Feasibility Study. J Med Internet Res 2023; 25:e39791. [PMID: 38064265 PMCID: PMC10746968 DOI: 10.2196/39791] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics. OBJECTIVE We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats. METHODS We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients' throat photographs. RESULTS A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples. CONCLUSIONS Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples.
Collapse
Affiliation(s)
- Mark Lown
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Kirsten A Smith
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Ingrid Muller
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Catherine Woods
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Emma Maund
- School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, United Kingdom
| | - Kirsty Rogers
- Local Clinical Research Network Wessex, Southampton, United Kingdom
| | - Taeko Becque
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Michael Moore
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Paul Little
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Alastair Hay
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Beth Stuart
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, United Kingdom
| | - Efi Mantzourani
- Cardiff School of Pharmacy, Cardiff University, Cardiff, United Kingdom
| | | | - Natalie Thompson
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Nick A Francis
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| |
Collapse
|
2
|
Vennik J, Hughes S, Lyness E, McDermott C, Smith KA, Steele M, Bostock J, Howick J, Little P, Leydon G, Mallen C, Morrison L, Stuart B, Everitt H, Bishop FL. Patient perceptions of empathy in primary care telephone consultations: A mixed methods study. Patient Educ Couns 2023; 113:107748. [PMID: 37141693 DOI: 10.1016/j.pec.2023.107748] [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] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Clinical empathy can enhance patient outcomes. This study examined patients' perceptions of empathy in primary care consultations delivered by telephone. METHODS A mixed methods study was nested in a larger feasibility study conducted May-October 2020. Adults reporting a UK primary care consultation in the previous 2 weeks completed an online survey. A sample of survey respondents participated in a semi-structured qualitative interview. Interviews were analysed thematically. RESULTS Survey respondents (n = 359) rated practitioners as between 'good' and 'very good' at established patient-reported indicators of clinical empathy. Telephone consultations were rated slightly lower than face-to-face or other consultations. 30 survey respondents were interviewed. Three qualitative themes identified how telephone consultations can shape clinical empathy: setting for an empathic encounter; feeling connected; being acknowledged. CONCLUSION Primary care patients typically perceive good levels of clinical empathy in telephone consultations; specific features of telephone consultations may facilitate and/or hinder clinical empathy. PRACTICE IMPLICATIONS To ensure patients feel listened to, acknowledged and understood, practitioners may need to increase their empathic verbalisations in telephone consultations. By using verbal responses to demonstrate active listening and by clearly describing and/or implementing next steps in management, practitioners may be able to enhance clinical empathy in telephone consultations.
Collapse
Affiliation(s)
- Jane Vennik
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Stephanie Hughes
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Clare McDermott
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care Research Centre, University of Southampton, Southampton, UK; School of Computing, University of Portsmouth, Portsmouth, UK
| | - Mary Steele
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | | | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, UK; Centre for Evaluation and Methods Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hazel Everitt
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| |
Collapse
|
3
|
Lown M, Miles EA, Fisk HL, Smith KA, Muller I, Maund E, Rogers K, Becque T, Hayward G, Moore M, Little P, Glogowska M, Hay AD, Stuart B, Mantzourani E, Butler C, Bostock J, Davies F, Dickerson I, Thompson N, Francis N. Self-sampling to identify pathogens and inflammatory markers in patients with acute sore throat: Feasibility study. Front Immunol 2022; 13:1016181. [PMID: 36275691 PMCID: PMC9582425 DOI: 10.3389/fimmu.2022.1016181] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Sore throat is a common reason for overuse of antibiotics. The value of inflammatory or biomarkers in throat swab or saliva samples in predicting benefit from antibiotics is unknown. Methods We used the ‘person-based approach’ to develop an online tool to support self-swabbing and recruited adults and children with sore throats through participating general practices and social media. Participants took bacterial and viral swabs and a saliva sponge swab and passive drool sample. Bacterial swabs were cultured for streptococcus (Group A, B, C, F and G). The viral swab and saliva samples were tested using a routine respiratory panel PCR and Covid-19 PCR testing. We used remaining viral swab and saliva sample volume for biomarker analysis using a panel of 13 biomarkers. Results We recruited 11 asymptomatic participants and 45 symptomatic participants. From 45 symptomatic participants, bacterial throat swab, viral throat swab, saliva sponge and saliva drool samples were returned by 41/45 (91.1%), 43/45 (95.6%), 43/45 (95.6%) and 43/45 (95.6%) participants respectively. Three saliva sponge and 6 saliva drool samples were of insufficient quantity. Two adult participants had positive bacterial swabs. Six participants had a virus detected from at least one sample (swab or saliva). All of the biomarkers assessed were detectable from all samples where there was sufficient volume for testing. For most biomarkers we found higher concentrations in the saliva samples. Due to low numbers, we were not able to compare biomarker concentrations in those who did and did not have a bacterial pathogen detected. We found no evidence of a difference between biomarker concentrations between the symptomatic and asymptomatic participants but the distributions were wide. Conclusions We have demonstrated that it is feasible for patients with sore throat to self-swab and provide saliva samples for pathogen and biomarker analysis. Typical bacterial and viral pathogens were detected but at low prevalence rates. Further work is needed to determine if measuring biomarkers using oropharyngeal samples can help to differentiate between viral and bacterial pathogens in patients classified as medium or high risk using clinical scores, in order to better guide antibiotic prescribing and reduce inappropriate prescriptions.
Collapse
Affiliation(s)
- Mark Lown
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
- *Correspondence: Mark Lown,
| | - Elizabeth A. Miles
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Helena L. Fisk
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Kirsten A. Smith
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Ingrid Muller
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Emma Maund
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Kirsty Rogers
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Taeko Becque
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - Michael Moore
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Margaret Glogowska
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - Alastair D. Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Chris Butler
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - Jennifer Bostock
- Southampton Primary Care Research Centre, Patient and Public Involvement Representative, Southampton, United Kingdom
| | - Firoza Davies
- Southampton Primary Care Research Centre, Patient and Public Involvement Representative, Southampton, United Kingdom
| | - Ian Dickerson
- Southampton Primary Care Research Centre, Patient and Public Involvement Representative, Southampton, United Kingdom
| | - Natalie Thompson
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | - Nick Francis
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
4
|
Essery R, Pollet S, Bradbury K, Western MJ, Grey E, Denison-Day J, Smith KA, Hayter V, Kelly J, Somerville J, Stuart B, Becque T, Zhang J, Slodkowska-Barabasz J, Mowbray F, Ferrey A, Yao G, Zhu S, Kendrick T, Griffin S, Mutrie N, Robinson S, Brooker H, Griffiths G, Robinson L, Rossor M, Ballard C, Gallacher J, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Parallel randomized controlled feasibility trials of the "Active Brains" digital intervention to protect cognitive health in adults aged 60-85. Front Public Health 2022; 10:962873. [PMID: 36203694 PMCID: PMC9530972 DOI: 10.3389/fpubh.2022.962873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Multidomain interventions to address modifiable risk factors for dementia are promising, but require more cost-effective, scalable delivery. This study investigated the feasibility of the "Active Brains" digital behavior change intervention and its trial procedures. Materials and methods Active Brains aims to reduce cognitive decline by promoting physical activity, healthy eating, and online cognitive training. We conducted 12-month parallel-design randomized controlled feasibility trials of "Active Brains" amongst "lower cognitive scoring" (n = 180) and "higher cognitive scoring" (n = 180) adults aged 60-85. Results We collected 67.2 and 76.1% of our 12-month primary outcome (Baddeley verbal reasoning task) data for the "lower cognitive score" and "higher cognitive score" groups, respectively. Usage of "Active Brains" indicated overall feasibility and satisfactory engagement with the physical activity intervention content (which did not require sustained online engagement), but engagement with online cognitive training was limited. Uptake of the additional brief telephone support appeared to be higher in the "lower cognitive score" trial. Preliminary descriptive trends in the primary outcome data might indicate a protective effect of Active Brains against cognitive decline, but further investigation in fully-powered trials is required to answer this definitively. Discussion Whilst initial uptake and engagement with the online intervention was modest, it was in line with typical usage of other digital behavior change interventions, and early indications from the descriptive analysis of the primary outcome and behavioral data suggest that further exploration of the potential protective benefits of Active Brains are warranted. The study also identified minor modifications to procedures, particularly to improve online primary-outcome completion. Further investigation of Active Brains will now seek to determine its efficacy in protecting cognitive performance amongst adults aged 60-85 with varied levels of existing cognitive performance.
Collapse
Affiliation(s)
- Rosie Essery
- University of Southampton, Southampton, United Kingdom,*Correspondence: Rosie Essery
| | | | - Katherine Bradbury
- University of Southampton, Southampton, United Kingdom,NIHR ARC Wessex, Southampton, United Kingdom
| | | | | | | | | | | | - Joanne Kelly
- University of Southampton, Southampton, United Kingdom
| | | | - Beth Stuart
- University of Southampton, Southampton, United Kingdom,Queen Mary University of London, London, United Kingdom
| | - Taeko Becque
- University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- University of Southampton, Southampton, United Kingdom
| | | | | | - Anne Ferrey
- University of Oxford, Oxford, United Kingdom
| | - Guiqing Yao
- University of Leicester, Leicester, United Kingdom
| | - Shihua Zhu
- University of Southampton, Southampton, United Kingdom
| | - Tony Kendrick
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Gareth Griffiths
- NIHR Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- University of Southampton, Southampton, United Kingdom,University of Bristol, Bristol, United Kingdom
| |
Collapse
|
5
|
McHugh T, Sommer DD, Thamboo A, Tewfik MA, Smith KA. Correction: Image guidance system use amongst Canadian otolaryngologists: a nationwide survey. J Otolaryngol Head Neck Surg 2022; 51:31. [PMID: 35902983 PMCID: PMC9336095 DOI: 10.1186/s40463-022-00589-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- T McHugh
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
| | - D D Sommer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - A Thamboo
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.,Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - M A Tewfik
- Department of Otolaryngology, Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - K A Smith
- ENT Clinic, The Montreal Children's Hospital, 1001 Boulevard Décarie, A.RC.4221, Montréal, QC, H4A 3J1, Canada
| |
Collapse
|
6
|
Vennik J, Hughes S, Smith KA, Misurya P, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Dambha-Miller H, Morrison L, Leydon G, Everitt H, Bishop FL. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography. Patient Educ Couns 2022; 105:1865-1877. [PMID: 35125208 DOI: 10.1016/j.pec.2022.01.009] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/10/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore primary care practitioners' (PCPs) and patients' priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. METHODS We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a 'line of argument' synthesis. RESULTS Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations. CONCLUSION Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management. PRACTICE IMPLICATIONS Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations.
Collapse
Affiliation(s)
- Jane Vennik
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Pranati Misurya
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Christian Mallen
- School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mohana Ratnapalan
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Emily Lyness
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hajira Dambha-Miller
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Hazel Everitt
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Felicity L Bishop
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
7
|
McHugh T, Sommer DD, ThambooTewfik AM, Smith KA, McHugh T. Image guidance system use amongst Canadian otolaryngologists: a nationwide survey. J Otolaryngol Head Neck Surg 2022; 51:27. [PMID: 35698181 PMCID: PMC9190092 DOI: 10.1186/s40463-022-00581-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background The use of image guidance systems has gained widespread acceptance as an adjunctive tool for endoscopic sinus surgery. However, the accessibility and usage of this technology is variable across hospitals in Canada.
Study objective The aim of this study is to investigate the availability, usage, and related issues surrounding the use of image guidance systems in endoscopic sinus surgery across Canadian otolaryngology practice settings. Methods An online survey was electronically distributed to practicing otolaryngologists across Canada. The survey contained 27 questions pertaining to the availability, usage, barriers and overall experience of image guidance systems. Results The survey was electronically sent to a total of 654 Canadian otolaryngologists of which 158 responded (response rate 24.2%). Image guidance was available to 56.3% of respondents. Of the respondents without access to IGS, 85.5% indicated they would use it if it was available. Financial (capital cost) was identified as the most important barrier in obtaining IGS by 76.3% of respondents. Conclusion Over half of Canadian otolaryngologists have access to IGS with over 85% of those without access interested in using it if it was made available. A multitude of different factors contribute to this disparity. We hope that the results of this study will help support Canadian otolaryngologists to access IGS. Graphical Abstract ![]()
Collapse
Affiliation(s)
- T McHugh
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - D D Sommer
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - A Ma ThambooTewfik
- Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.,Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - K A Smith
- Department of Otolaryngology, Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Tobial McHugh
- A.RC.4221 ENT Clinic, The Montreal Children's Hospital, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada.
| |
Collapse
|
8
|
Smith KA, Vennik J, Morrison L, Hughes S, Steele M, Tiwari R, Bostock J, Howick J, Mallen C, Little P, Ratnapalan M, Lyness E, Misurya P, Leydon GM, Dambha-Miller H, Everitt HA, Bishop FL. Harnessing Placebo Effects in Primary Care: Using the Person-Based Approach to Develop an Online Intervention to Enhance Practitioners' Communication of Clinical Empathy and Realistic Optimism During Consultations. Front Pain Res (Lausanne) 2021; 2:721222. [PMID: 35295512 PMCID: PMC8915751 DOI: 10.3389/fpain.2021.721222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Empathic communication and positive messages are important components of "placebo" effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is common, costly and difficult to manage. Digital interventions can be effective tools for changing practitioner behavior. This paper describes the systematic planning, development and optimization of an online intervention-"Empathico"-to help primary healthcare practitioners enhance their communication of clinical empathy and realistic optimism during consultations. Methods: The Person-Based Approach to intervention development was used. This entailed integrating insights from placebo and behavior change theory and evidence, and conducting primary and secondary qualitative research. Systematic literature reviews identified barriers, facilitators, and promising methods for enhancing clinical empathy and realistic optimism. Qualitative studies explored practitioners' and patients' perspectives, initially on the communication of clinical empathy and realistic optimism and subsequently on different iterations of the Empathico intervention. Insights from the literature reviews, qualitative studies and public contributor input were integrated into a logic model, behavioral analysis and principles that guided intervention development and optimization. Results: The Empathico intervention comprises 7 sections: Introduction, Empathy, Optimism, Application of Empathico for Osteoarthritis, Reflection on my Consultations, Setting Goals and Further Resources. Iterative refinement of Empathico, using feedback from patients and practitioners, resulted in highly positive feedback and helped to (1) contextualize evidence-based recommendations from placebo studies within the complexities of primary healthcare consultations and (2) ensure the intervention addressed practitioners' and patients' concerns and priorities. Conclusions: We have developed an evidence-based, theoretically-grounded intervention that should enable practitioners to better harness placebo effects of communication in consultations. The extensive use of qualitative research throughout the development and optimization process ensured that Empathico is highly acceptable and meaningful to practitioners. This means that practitioners are more likely to engage with Empathico and make changes to enhance their communication of clinical empathy and realistic optimism in clinical practice. Empathico is now ready to be evaluated in a large-scale randomized trial to explore its impact on patient outcomes.
Collapse
Affiliation(s)
- Kirsten A. Smith
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Jane Vennik
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Leanne Morrison
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Stephanie Hughes
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mary Steele
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Riya Tiwari
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Jennifer Bostock
- Policy Innovation & Evaluation Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Christian Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Mohana Ratnapalan
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Emily Lyness
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Pranati Misurya
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Geraldine M. Leydon
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hajira Dambha-Miller
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Hazel A. Everitt
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Felicity L. Bishop
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
9
|
Essery R, Pollet S, Smith KA, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Bradbury K, Grey E, Western MJ, Milton A, Hunter C, Ferrey AE, Müller AM, Stuart B, Mutrie N, Griffin S, Kendrick T, Brooker H, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Planning and optimising a digital intervention to protect older adults' cognitive health. Pilot Feasibility Stud 2021; 7:158. [PMID: 34407886 PMCID: PMC8371874 DOI: 10.1186/s40814-021-00884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
Collapse
Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| | - Sebastien Pollet
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Victoria Hayter
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | | | | | - Alexander Milton
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Centre for Sport & Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - John Niven
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
| |
Collapse
|
10
|
Chan Y, Angel D, Aron M, Hartl T, Moubayed SP, Smith KA, Sommer DD, Sowerby L, Spafford P, Mertz D, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on return to Otolaryngology - Head & Neck Surgery Clinic Practice during the COVID-19 pandemic in Canada. J Otolaryngol Head Neck Surg 2020; 49:76. [PMID: 33106189 PMCID: PMC7586368 DOI: 10.1186/s40463-020-00466-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
The novel Coronavirus (COVID-19) has created a worldwide deadly pandemic that has become a major public health challenge. All semi-urgent and elective medical care has come to a halt to conserve capacity to care for patients during this pandemic. As the numbers of COVID-19 cases decrease across Canada, our healthcare system also began to reopen various facilities and medical offices. The aim for this document is to compile the current evidence and provide expert consensus on the safe return to clinic practice in Otolaryngology - Head & Neck Surgery. These recommendations will also summarize general precaution principles and practical tips for office across Canada to optimize patient and provider safety. Risk assessment and patient selection are crucial to minimizing exposure to COVID-19. Controversial topics such as COVID-19 mode of transmission, duration of exposure, personal protective equipment, and aerosol-generating procedures will be analyzed and discussed. Practical solutions of pre-visit office preparation, front office and examination room set-up, and check out procedures are explored. Specific considerations for audiology, pediatric population, and high risk AGMPs are also addressed. Given that the literature surrounding COVID-19 is rapidly evolving, these guidelines will serve to start our specialty back into practice over the next weeks to months and they may change as we learn more about this disease.
Collapse
Affiliation(s)
- Y Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - D Angel
- Division of Otolaryngology - Head & Neck Surgery, Memorial University of Newfoundland, St. John's, NL, Canada
| | - M Aron
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - T Hartl
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - S P Moubayed
- Division of Otolaryngology - Head & Neck Surgery, University of Montreal, Montreal, QC, Canada
| | - K A Smith
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - D D Sommer
- Otolaryngology - Head & Neck Surgery Division, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - L Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, ON, Canada
| | - P Spafford
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - I J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Smith KA, Bishop FL, Dambha-Miller H, Ratnapalan M, Lyness E, Vennik J, Hughes S, Bostock J, Morrison L, Mallen C, Yardley L, Everitt H, Little P, Howick J. Improving Empathy in Healthcare Consultations-a Secondary Analysis of Interventions. J Gen Intern Med 2020; 35:3007-3014. [PMID: 32666488 PMCID: PMC7572919 DOI: 10.1007/s11606-020-05994-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
A recent systematic review of randomised trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routine clinical practice. In this secondary analysis of seven trials in the review, we aimed to identify (1) the methods used to train HCPs, (2) the empathy behaviours they were trained to perform and (3) behaviour change techniques (BCTs) used to encourage the adoption of those behaviours. This detailed understanding of interventions is necessary to inform implementation in clinical practice. We conducted a content analysis of intervention descriptions, using an inductive approach to identify training methods and empathy behaviours and a deductive approach to describe the BCTs used. The most commonly used methods to train HCPs to enhance empathy were face-to-face training (n = 5), role-playing (n = 3) and videos (self or model; n = 3). Duration of training was varied, with both long and short training having high effect sizes. The most frequently targeted empathy behaviours were providing explanations of treatment (n = 5), providing non-specific empathic responses (e.g. expressing understanding) and displaying a friendly manner and using non-verbal behaviours (e.g. nodding, leaning forward, n = 4). The BCT most used to encourage HCPs to adopt empathy behaviours was "Instruction on how to perform behaviour" (e.g. a video demonstration, n = 5), followed by "Credible source" (e.g. delivered by a psychologist, n = 4) and "Behavioural practice" (n = 3 e.g. role-playing). We compared the effect sizes of studies but could not extrapolate meaningful conclusions due to high levels of variation in training methods, empathy skills and BCTs. Moreover, the methods used to train HCPs were often poorly described which limits study replication and clinical implementation. This analysis of empathy training can inform future research, intervention reporting standards and clinical practice.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Lucy Yardley
- University of Southampton , Southampton, UK
- University of Bristol , Bristol, UK
| | | | | | | |
Collapse
|
12
|
Hoxworth JM, Eschbacher JM, Gonzales AC, Singleton KW, Leon GD, Smith KA, Stokes AM, Zhou Y, Mazza GL, Porter AB, Mrugala MM, Zimmerman RS, Bendok BR, Patra DP, Krishna C, Boxerman JL, Baxter LC, Swanson KR, Quarles CC, Schmainda KM, Hu LS. Performance of Standardized Relative CBV for Quantifying Regional Histologic Tumor Burden in Recurrent High-Grade Glioma: Comparison against Normalized Relative CBV Using Image-Localized Stereotactic Biopsies. AJNR Am J Neuroradiol 2020; 41:408-415. [PMID: 32165359 DOI: 10.3174/ajnr.a6486] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Perfusion MR imaging measures of relative CBV can distinguish recurrent tumor from posttreatment radiation effects in high-grade gliomas. Currently, relative CBV measurement requires normalization based on user-defined reference tissues. A recently proposed method of relative CBV standardization eliminates the need for user input. This study compares the predictive performance of relative CBV standardization against relative CBV normalization for quantifying recurrent tumor burden in high-grade gliomas relative to posttreatment radiation effects. MATERIALS AND METHODS We recruited 38 previously treated patients with high-grade gliomas (World Health Organization grades III or IV) undergoing surgical re-resection for new contrast-enhancing lesions concerning for recurrent tumor versus posttreatment radiation effects. We recovered 112 image-localized biopsies and quantified the percentage of histologic tumor content versus posttreatment radiation effects for each sample. We measured spatially matched normalized and standardized relative CBV metrics (mean, median) and fractional tumor burden for each biopsy. We compared relative CBV performance to predict tumor content, including the Pearson correlation (r), against histologic tumor content (0%-100%) and the receiver operating characteristic area under the curve for predicting high-versus-low tumor content using binary histologic cutoffs (≥50%; ≥80% tumor). RESULTS Across relative CBV metrics, fractional tumor burden showed the highest correlations with tumor content (0%-100%) for normalized (r = 0.63, P < .001) and standardized (r = 0.66, P < .001) values. With binary cutoffs (ie, ≥50%; ≥80% tumor), predictive accuracies were similar for both standardized and normalized metrics and across relative CBV metrics. Median relative CBV achieved the highest area under the curve (normalized = 0.87, standardized = 0.86) for predicting ≥50% tumor, while fractional tumor burden achieved the highest area under the curve (normalized = 0.77, standardized = 0.80) for predicting ≥80% tumor. CONCLUSIONS Standardization of relative CBV achieves similar performance compared with normalized relative CBV and offers an important step toward workflow optimization and consensus methodology.
Collapse
Affiliation(s)
- J M Hoxworth
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| | | | | | - K W Singleton
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - G D Leon
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - K A Smith
- Keller Center for Imaging Innovation (A.M.S.), Barrow Neurological Institute, Phoenix, Arizona
| | - A M Stokes
- Keller Center for Imaging Innovation (A.M.S.), Barrow Neurological Institute, Phoenix, Arizona
| | - Y Zhou
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| | - G L Mazza
- Department of Health Sciences Research (G.L.M.), Division of Biomedical Statistics and Informatics, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | | | | | | | - B R Bendok
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - D P Patra
- Departments of Neurosurgery (D.P.P.)
| | | | - J L Boxerman
- Department of Diagnostic Imaging (J.L.B.), Rhode Island Hospital, Providence, Rhode Island
| | - L C Baxter
- Neuropsychology (L.C.B.), Mayo Clinic Hospital, Phoenix, Arizona
| | - K R Swanson
- Precision Neurotherapeutics Lab (K.W.S., G.D.L., B.R.B., K.R.S.), Mayo Clinic in Arizona, Phoenix, Arizona
| | | | - K M Schmainda
- Department of Radiology (K.M.S.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L S Hu
- From the Departments of Radiology (J.M.H., Y.Z., L.S.H.)
| |
Collapse
|
13
|
Smith KA, Frazzini Padilla P, Sprague ML. 2131 Trends in Patient Follow-Up after Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.132] [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: 12/01/2022]
|
14
|
Cardenas LM, Bhogal A, Chadwick DR, McGeough K, Misselbrook T, Rees RM, Thorman RE, Watson CJ, Williams JR, Smith KA, Calvet S. Nitrogen use efficiency and nitrous oxide emissions from five UK fertilised grasslands. Sci Total Environ 2019; 661:696-710. [PMID: 30684838 PMCID: PMC6383039 DOI: 10.1016/j.scitotenv.2019.01.082] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/31/2018] [Accepted: 01/08/2019] [Indexed: 05/15/2023]
Abstract
Intensification of grasslands is necessary to meet the increasing demand of livestock products. The application of nitrogen (N) on grasslands affects the N balance therefore the nitrogen use efficiency (NUE). Emissions of nitrous oxide (N2O) are produced due to N fertilisation and low NUE. These emissions depend on the type and rates of N applied. In this study we have compiled data from 5 UK N fertilised grassland sites (Crichton, Drayton, North Wyke, Hillsborough and Pwllpeiran) covering a range of soil types and climates. The experiments evaluated the effect of increasing rates of inorganic N fertiliser provided as ammonium nitrate (AN) or calcium ammonium nitrate (CAN). The following fertiliser strategies were also explored for a rate of 320 kg N ha-1: using the nitrification inhibitor dicyandiamide (DCD), changing to urea as an N source and splitting fertiliser applications. We measured N2O emissions for a full year in each experiment, as well as soil mineral N, climate data, pasture yield and N offtake. N2O emissions were greater at Crichton and North Wyke whereas Drayton, Hillsborough and Pwllpeiran had the smallest emissions. The resulting average emission factor (EF) of 1.12% total N applied showed a range of values for all the sites between 0.6 and 2.08%. NUE depended on the site and for an application rate of 320 kg N ha-1, N surplus was on average higher than 80 kg N ha-1, which is proposed as a maximum by the EU Nitrogen Expert Panel. N2O emissions tended to be lower when urea was applied instead of AN or CAN, and were particularly reduced when using urea with DCD. Finally, correlations between the factors studied showed that total N input was related to Nofftake and Nexcess; while cumulative emissions and EF were related to yield scaled emissions.
Collapse
Affiliation(s)
- L M Cardenas
- Rothamsted Research, Okehampton, Devon, EX20 2SB, UK.
| | - A Bhogal
- ADAS Boxworth, Battlegate Road, Boxworth, Cambridge CB23 4NN, UK
| | - D R Chadwick
- School of Natural Sciences, Bangor University, Bangor LL57 2UW, UK
| | - K McGeough
- Agri-Food and Biosciences Institute, 18a, Newforge Lane, BT9 5PX Belfast, UK
| | - T Misselbrook
- Rothamsted Research, Okehampton, Devon, EX20 2SB, UK
| | - R M Rees
- Scotland's Rural College (SRUC), King's Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - R E Thorman
- ADAS Boxworth, Battlegate Road, Boxworth, Cambridge CB23 4NN, UK
| | - C J Watson
- Agri-Food and Biosciences Institute, 18a, Newforge Lane, BT9 5PX Belfast, UK
| | - J R Williams
- ADAS Boxworth, Battlegate Road, Boxworth, Cambridge CB23 4NN, UK
| | - K A Smith
- School of Geosciences, University of Edinburgh, Crew Building, Alexander Crum Brown Road, Edinburgh EH9 3FF, and Weston Road, Totnes TQ9 5AH, Devon, UK
| | - S Calvet
- Universitat Politècnica de València, Institute of Animal Science and Technology, Camino de Vera s.n., 46022, Valencia, Spain
| |
Collapse
|
15
|
Smith KA, Dennis M, Masthoff J, Tintarev N. A methodology for creating and validating psychological stories for conveying and measuring psychological traits. User Model User-adapt Interact 2019; 29:573-618. [PMID: 31402809 PMCID: PMC6647554 DOI: 10.1007/s11257-019-09219-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 01/17/2019] [Indexed: 05/31/2023]
Abstract
Personality impacts all areas of our lives; it governs who we are and how we react to life's challenges. Personalized systems that adapt to end users should take into account the user's personality to perform well. Several methodologies (e.g. User-as-Wizard, indirect studies) that use personality adaptation require first for personality to be conveyed to the participant; this has few validated approaches. Furthermore, measuring personality is often time consuming, prone to response bias (e.g. using questionnaires) or data intensive (e.g. using behaviour or text mining). This paper presents a methodology for creating and validating stories to convey psychological traits and for using such stories with a personality slider scale to measure these traits. We present the validation of the scale and evaluate its reliability. To evidence the validity of the methodology, we outline studies where the stories and scale have been effectively applied (in recommender systems, intelligent tutoring systems, and persuasive systems).
Collapse
Affiliation(s)
| | | | - Judith Masthoff
- University of Aberdeen, Aberdeen, UK
- Utrecht University, Utrecht, Netherlands
| | | |
Collapse
|
16
|
Hu LS, Yoon H, Eschbacher JM, Baxter LC, Dueck AC, Nespodzany A, Smith KA, Nakaji P, Xu Y, Wang L, Karis JP, Hawkins-Daarud AJ, Singleton KW, Jackson PR, Anderies BJ, Bendok BR, Zimmerman RS, Quarles C, Porter-Umphrey AB, Mrugala MM, Sharma A, Hoxworth JM, Sattur MG, Sanai N, Koulemberis PE, Krishna C, Mitchell JR, Wu T, Tran NL, Swanson KR, Li J. Accurate Patient-Specific Machine Learning Models of Glioblastoma Invasion Using Transfer Learning. AJNR Am J Neuroradiol 2019; 40:418-425. [PMID: 30819771 DOI: 10.3174/ajnr.a5981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/13/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-based modeling of tumor cell density can substantially improve targeted treatment of glioblastoma. Unfortunately, interpatient variability limits the predictive ability of many modeling approaches. We present a transfer learning method that generates individualized patient models, grounded in the wealth of population data, while also detecting and adjusting for interpatient variabilities based on each patient's own histologic data. MATERIALS AND METHODS We recruited patients with primary glioblastoma undergoing image-guided biopsies and preoperative imaging, including contrast-enhanced MR imaging, dynamic susceptibility contrast MR imaging, and diffusion tensor imaging. We calculated relative cerebral blood volume from DSC-MR imaging and mean diffusivity and fractional anisotropy from DTI. Following image coregistration, we assessed tumor cell density for each biopsy and identified corresponding localized MR imaging measurements. We then explored a range of univariate and multivariate predictive models of tumor cell density based on MR imaging measurements in a generalized one-model-fits-all approach. We then implemented both univariate and multivariate individualized transfer learning predictive models, which harness the available population-level data but allow individual variability in their predictions. Finally, we compared Pearson correlation coefficients and mean absolute error between the individualized transfer learning and generalized one-model-fits-all models. RESULTS Tumor cell density significantly correlated with relative CBV (r = 0.33, P < .001), and T1-weighted postcontrast (r = 0.36, P < .001) on univariate analysis after correcting for multiple comparisons. With single-variable modeling (using relative CBV), transfer learning increased predictive performance (r = 0.53, mean absolute error = 15.19%) compared with one-model-fits-all (r = 0.27, mean absolute error = 17.79%). With multivariate modeling, transfer learning further improved performance (r = 0.88, mean absolute error = 5.66%) compared with one-model-fits-all (r = 0.39, mean absolute error = 16.55%). CONCLUSIONS Transfer learning significantly improves predictive modeling performance for quantifying tumor cell density in glioblastoma.
Collapse
Affiliation(s)
- L S Hu
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.)
| | - H Yoon
- Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | | | | | - A C Dueck
- Department of Biostatistics (A.C.D.), Mayo Clinic in Arizona, Scottsdale, Arizona
| | | | | | - P Nakaji
- Neurosurgery (K.A.S., P.N., N.S.)
| | - Y Xu
- Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | - L Wang
- Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | | | - A J Hawkins-Daarud
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.)
| | - K W Singleton
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.)
| | - P R Jackson
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.)
| | - B J Anderies
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - B R Bendok
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.).,Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - R S Zimmerman
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - C Quarles
- Neuroimaging Research (C.Q.), Barrow Neurological Institute, Phoenix, Arizona
| | | | - M M Mrugala
- Department of Neuro-Oncology (A.B.P.-U., M.M.M., A.S.)
| | - A Sharma
- Department of Neuro-Oncology (A.B.P.-U., M.M.M., A.S.)
| | - J M Hoxworth
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.)
| | - M G Sattur
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - N Sanai
- Neurosurgery (K.A.S., P.N., N.S.)
| | - P E Koulemberis
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - C Krishna
- Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - J R Mitchell
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.).,H. Lee Moffitt Cancer Center and Research Institute (J.R.M.), Tampa, Florida
| | - T Wu
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.).,Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| | - N L Tran
- Department of Cancer Biology (N.L.T.), Mayo Clinic in Arizona, Phoenix, Arizona
| | - K R Swanson
- Precision Neurotherapeutics Lab (A.J.H.-D., K.W.S., P.R.J, B.R.B., K.R.S.).,Department of Neurosurgery (B.J.A., B.R.B., R.S.Z., M.G.S., P.E.K., C.K., K.R.S.)
| | - J Li
- From the Department of Radiology (L.S.H., J.M.H., J.R.M., T.W., J.L.).,Arizona State University (H.Y., Y.X., L.W., T.W., J.L.), Tempe, Arizona
| |
Collapse
|
17
|
Harvey LFB, Smith KA, Curlin H. Improving Operative Room Costs and Efficiency Through Review of Surgeon Preference Cards. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.097] [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: 10/20/2022]
|
18
|
Pieniazek J, Smith KA, Williams MP, Manangi MK, Vazquez-Anon M, Solbak A, Miller M, Lee JT. Evaluation of increasing levels of a microbial phytase in phosphorus deficient broiler diets via live broiler performance, tibia bone ash, apparent metabolizable energy, and amino acid digestibility. Poult Sci 2016; 96:370-382. [PMID: 27444440 DOI: 10.3382/ps/pew225] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/08/2016] [Accepted: 05/09/2016] [Indexed: 11/20/2022] Open
Abstract
The objective was to investigate increasing concentrations of an evolved microbial phytase on male broiler performance, tibia bone ash, AME, and amino acid digestibility when fed diets deficient in available phosphorus (aP). Experiment 1 evaluated the effects of phytase during a 21 d battery cage study and Experiment 2 was a 42 d grow-out. Experiment 1 included six treatments; negative control (NC) with an aP level of 0.23% (starter) and 0.19% (grower), two positive controls (PC) consisting of an additional 0.12% and 0.22% aP (PC 1 and PC 2), and the NC supplemented with three levels of phytase (250, 500, and 2,000 U/kg). The NC diet reduced (P < 0.05) FC, BW, and bone ash. Phytase increased (P < 0.05) BW with 2,000 U/kg phytase yielding similar results to the PC2, and improved FCR and increased bone ash was observed at all phytase levels. Amino acid digestibility coefficients were increased (P < 0.05) with phytase at 250 U/kg. Phytase at all rates increased (P < 0.05) AME to levels similar level as PC diets. Linear regression analysis indicated average P equivalency values for BW and bone ash of 0.137, 0.147, and 0.226 for phytase inclusion of 250, 500, and 2000 U/kg, respectively. Experiment 2 included a PC consisting of 0.45%, 0.41%, and 0.38% aP for the starter, grower, and finisher, respectively; NC with reduced aP of 0.17%; and phytase at 500 and 2,000 U/kg. Phytase increased BW (P < 0.05) compared to the NC as 2,000 U/kg phytase resulted in further BW increases compared to the PC (starter and grower). Phytase improved FCR to levels comparable to the PC, with supplementation at 2,000 U/kg resulting in improvements beyond the PC in the starter phase. Amino acid digestibility coefficients were increased with phytase at 2,000 U/kg to levels comparable to that of the PC. These data confirm that the inclusion of phytase improves broiler performance and bone mineralization in aP reduced diets and levels beyond the traditional 500 U/kg can result in further improvements.
Collapse
Affiliation(s)
- J Pieniazek
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| | - K A Smith
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| | - M P Williams
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| | | | | | - A Solbak
- Verenium Corporation, San Diego, CA
| | - M Miller
- Verenium Corporation, San Diego, CA
| | - J T Lee
- Poultry Science Department, Texas A&M AgriLife Research and Extension, Texas A&M System, College Station, TX, USA
| |
Collapse
|
19
|
Abstract
OBJECTIVE The purpose of this pilot economic evaluation was to assess the cost-effectiveness of the endoscopic polypectomy in the clinic (EPIC) procedure compared to formal endoscopic sinus surgery (ESS) for the treatment of select chronic rhinosinusitis (CRS) patients with nasal polyposis. DESIGN Cost-effectiveness analysis using a Markov decision tree model with a 30-year time horizon. The two comparative treatment groups were as follows: (i) EPIC and (ii) ESS. Costs and effects were discounted at a rate of 3.5%. A probabilistic sensitivity analysis was performed. SETTING Economic perspective of the Canadian government third-party payer. PARTICIPANTS CRS patients with nasal polyposis who have predominantly isolated symptoms of nasal obstruction with or without olfactory loss. MAIN OUTCOME MEASURES Incremental cost per quality adjusted life year (QALY). RESULTS Over a time period of 30 years, the reference case demonstrated that the ESS strategy cost a total of $21,345 and produced 13.17 QALYs while the EPIC strategy cost a total of $5591 and produced 12.93 QALYs. The ESS versus EPIC incremental cost-effectiveness ratio was $65,641/QALY. The probability that EPIC is cost-effective compared to ESS at a maximum willingness-to-pay threshold of $30,000 and $50,000/QALY is 66% and 60%, respectively. CONCLUSIONS Outcomes from this study have demonstrated that the EPIC procedure may be a cost-effective treatment strategy for 'select' patients with nasal polyposis. Data from this study were obtained from a small pilot trial, and we feel the results warrant a future randomised controlled trial to strengthen the outcomes.
Collapse
Affiliation(s)
- L Rudmik
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Institute of Public Health (IPH), University of Calgary, Calgary, AB, Canada
| | - K A Smith
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - S Kilty
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| |
Collapse
|
20
|
Affiliation(s)
| | | | - Nava Tintarev
- Computing Science, University of Aberdeen, Aberdeen, UK
| | | |
Collapse
|
21
|
Mellor DD, Madden LA, Smith KA, Kilpatrick ES, Atkin SL. High-polyphenol chocolate reduces endothelial dysfunction and oxidative stress during acute transient hyperglycaemia in Type 2 diabetes: a pilot randomized controlled trial. Diabet Med 2013; 30:478-83. [PMID: 23039340 DOI: 10.1111/dme.12030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/24/2012] [Accepted: 10/01/2012] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the effects of high-polyphenol chocolate upon endothelial function and oxidative stress in Type 2 diabetes mellitus during acute transient hyperglycaemia induced following a 75-g oral glucose challenge. METHODS Ten subjects with Type 2 diabetes underwent a double-blinded randomized controlled crossover study. A 75-g oral glucose load was used to induce hyperglycaemia, which was administered to participants 60 min after they had ingested either low (control) or high-polyphenol chocolate. Participants undertook testing at weekly intervals, following an initial cocoa-free period. Endothelial function was assessed by both functional [reactive hyperaemia peripheral artery tonometry (EndoPAT-2000) and serum markers (including intercellular adhesion molecule 1, P-selectin and P-selectin glycoprotein ligand 1]. Urinary 15-F2t-isoprostane adjusted for creatinine was used as an oxidative stress marker. Measurements were made at baseline and 2 h post-ingestion of the glucose load. RESULTS Prior consumption of high-polyphenol chocolate before a glucose load improved endothelial function (1.7 ± 0.1 vs. 2.3 ± 0.1%, P = 0.01), whereas prior consumption of control chocolate resulted in a significant increase in intercellular adhesion molecule 1 (321.1 ± 7.6 vs. 373.6 ± 10.5 ng/ml, P = 0.04) and 15-F2t-isoprostane (116.8 ± 5.7 vs. 207.1 ± 5.7 mg/mol, P = 0.02). Analysis of percentage changes from baseline comparing control and high-polyphenol chocolate showed a significant improvement for high-polyphenol chocolate in both measures of endothelial function (P < 0.05) and for urinary 15-F2t-isoprostane (P = 0.04). CONCLUSION High-polyphenol chocolate protected against acute hyperglycaemia-induced endothelial dysfunction and oxidative stress in individuals with Type 2 diabetes mellitus.
Collapse
Affiliation(s)
- D D Mellor
- Department of Clinical Science, University of Chester, Chester, UK.
| | | | | | | | | |
Collapse
|
22
|
Wakil A, Smith KA, Atkin SL, Kilpatrick ES. Short-term glucose variability in healthy volunteers is not associated with raised oxidative stress markers. Diabetes Obes Metab 2012; 14:1047-9. [PMID: 22587382 DOI: 10.1111/j.1463-1326.2012.01625.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 01/18/2012] [Accepted: 05/09/2012] [Indexed: 12/01/2022]
Abstract
It is unknown whether glycaemic variability adds to the risk of microvascular complications of diabetes over and above the mean glucose value for a patient. We examined the effect of purposefully induced short-term glycaemic variability on oxidative stress markers. Eleven healthy subjects underwent three sequential glycaemic states; sustained hyperglycaemia, sustained euglycaemia and variable glycaemia, using glycaemic clamps for 3 h. Twenty-four hours urinary 8-isoprostane-PGF2α was measured before and after each glycaemic state to assess oxidative stress. The median and interquartile range of the urinary 8-iso-PGF2α in ng/24 h were (1373, 513), (996, 298) and (1227, 472) for the euglycaemic, hyperglycaemic and variable states, respectively. There was no significant difference in urinary isoprostanes between the three different states; mean ranks 20.9, 11.9 and 18.2 for the euglycaemic state, hyperglycaemic state and glycaemic variability state, respectively, p = 0.083. In conclusion, we did not see a significant increase in the urinary isoprostanes when glycaemic variability was induced under controlled conditions in healthy individuals.
Collapse
|
23
|
Hooper JMW, Stuijver DJF, Orme SM, van Zaane B, Hess K, Gerdes VE, Phoenix F, Rice P, Smith KA, Alzahrani SH, Standeven KF, Ajjan RA. Thyroid dysfunction and fibrin network structure: a mechanism for increased thrombotic risk in hyperthyroid individuals. J Clin Endocrinol Metab 2012; 97:1463-73. [PMID: 22378816 DOI: 10.1210/jc.2011-2894] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Hyperthyroidism is associated with increased thrombosis risk, and fibrin clot structure determines susceptibility to vascular thrombotic events. OBJECTIVE Our objective was to investigate clot formation and lysis in hyperthyroidism using observational and interventional studies. DESIGN Ex vivo fibrin clot structure/fibrinolysis and plasma levels of thrombotic/inflammatory markers were investigated in hyperthyroid individuals (n = 24) and matched controls (n = 19), using turbidimetric assays, ELISA, and confocal and electron microscopy. The effects of normalizing thyroid function were analyzed (n = 19) and the role of short-term exogenous hyperthyroidism in healthy volunteers studied (n = 16). RESULTS Hyperthyroid subjects displayed higher clot maximum absorbance compared with controls (0.41 ± 0.03 and 0.27 ± 0.01 arbitrary units, respectively; P < 0.01), and longer clot lysis time (518 ± 23 and 461 ± 18 sec, respectively; P < 0.05), which correlated with free T(4) levels. Plasma levels of fibrinogen and plasminogen activator inhibitor-1 were significantly higher in patients compared with controls. Normalizing thyroid function in 19 subjects was associated with lower maximum absorbance and shorter lysis time, accompanied by reduction in fibrinogen, plasminogen activator inhibitor-1, and D-dimer levels. Complement C3, but not C-reactive protein, levels were higher in hyperthyroid subjects compared with controls (0.92 ± 0.05 and 0.64 ± 0.03 g/liter, respectively; P < 0.01), correlated with clot structure parameters, and decreased after intervention. Confocal and electron microscopy confirmed more compact clots and impaired fibrinolysis during hyperthyroidism. Exogenous hyperthyroidism in healthy volunteers had no effect on any of the clot structure parameters. CONCLUSIONS Endogenous hyperthyroidism is associated with more compact clots and resistance to fibrinolysis ex vivo, related to the degree of hyperthyroidism and C3 plasma levels, and these changes are modulated by achieving euthyroidism. Altered clot structure/lysis may be one mechanism for increased thrombotic risk in hyperthyroidism.
Collapse
Affiliation(s)
- J M W Hooper
- Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds LS2 9JT, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Hess K, Alzahrani SH, Mathai M, Schroeder V, Carter AM, Howell G, Koko T, Strachan MWJ, Price JF, Smith KA, Grant PJ, Ajjan RA. A novel mechanism for hypofibrinolysis in diabetes: the role of complement C3. Diabetologia 2012; 55:1103-13. [PMID: 21918806 DOI: 10.1007/s00125-011-2301-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/12/2011] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Impaired fibrin clot lysis is a key abnormality in diabetes and complement C3 is one protein identified in blood clots. This work investigates the mechanistic pathways linking C3 and hypofibrinolysis in diabetes using ex vivo/in vitro studies. METHODS Fibrinolysis and C3 plasma levels were determined in type 1 diabetic patients and healthy controls, and the effects of glycaemia investigated. C3 incorporation into fibrin clots and modulation of fibrinolysis were analysed by ELISA, immunoblotting, turbidimetric assays and electron and confocal microscopy. RESULTS Clot lysis time was longer in diabetic children than in controls (599 ± 18 and 516 ± 12 s respectively; p < 0.01), C3 levels were higher in diabetic children (0.55 ± 0.02 and 0.43 ± 0.02 g/l respectively; p < 0.01) and both were affected by improving glycaemia. An interaction between C3 and fibrin was confirmed by the presence of lower protein levels in sera compared with corresponding plasma and C3 detection in plasma clots by immunoblot. In a purified system, C3 was associated with thinner fibrin fibres and more prolongation of lysis time of clots made from fibrinogen from diabetic participants compared with controls (244 ± 64 and 92 ± 23 s respectively; p < 0.05). Confocal microscopy showed higher C3 incorporation into diabetic clots compared with controls, and fully formed clot lysis was prolonged by 764 ± 76 and 428 ± 105 s respectively (p < 0.05). Differences in lysis, comparing diabetes and controls, were not related to altered plasmin generation or C3-fibrinogen binding assessed by plasmon resonance. CONCLUSIONS/INTERPRETATION C3 incorporation into clots from diabetic fibrinogen is enhanced and adversely affects fibrinolysis. This may be one novel mechanism for compromised clot lysis in diabetes, potentially offering a new therapeutic target.
Collapse
Affiliation(s)
- K Hess
- University of Leeds, Leeds, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hu LS, Eschbacher JM, Dueck AC, Heiserman JE, Liu S, Karis JP, Smith KA, Shapiro WR, Pinnaduwage DS, Coons SW, Nakaji P, Debbins J, Feuerstein BG, Baxter LC. Correlations between perfusion MR imaging cerebral blood volume, microvessel quantification, and clinical outcome using stereotactic analysis in recurrent high-grade glioma. AJNR Am J Neuroradiol 2012; 33:69-76. [PMID: 22095961 PMCID: PMC7966183 DOI: 10.3174/ajnr.a2743] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [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: 12/30/2010] [Accepted: 05/09/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Quantifying MVA rather than MVD provides better correlation with survival in HGG. This is attributed to a specific "glomeruloid" vascular pattern, which is better characterized by vessel area than number. Despite its prognostic value, MVA quantification is laborious and clinically impractical. The DSC-MR imaging measure of rCBV offers the advantages of speed and convenience to overcome these limitations; however, clinical use of this technique depends on establishing accurate correlations between rCBV, MVA, and MVD, particularly in the setting of heterogeneous vascular size inherent to human HGG. MATERIALS AND METHODS We obtained preoperative 3T DSC-MR imaging in patients with HGG before stereotactic surgery. We histologically quantified MVA, MVD, and vascular size heterogeneity from CD34-stained 10-μm sections of stereotactic biopsies, and we coregistered biopsy locations with localized rCBV measurements. We statistically correlated rCBV, MVA, and MVD under conditions of high and low vascular-size heterogeneity and among tumor grades. We correlated all parameters with OS by using Cox regression. RESULTS We analyzed 38 biopsies from 24 subjects. rCBV correlated strongly with MVA (r = 0.83, P < .0001) but weakly with MVD (r = 0.32, P = .05), due to microvessel size heterogeneity. Among samples with more homogeneous vessel size, rCBV correlation with MVD improved (r = 0.56, P = .01). OS correlated with both rCBV (P = .02) and MVA (P = .01) but not with MVD (P = .17). CONCLUSIONS rCBV provides a reliable estimation of tumor MVA as a biomarker of glioma outcome. rCBV poorly estimates MVD in the presence of vessel size heterogeneity inherent to human HGG.
Collapse
Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, Arizona, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
DeSilva JHSR, Udinwe V, Sideris PJ, Smart MC, Krause FC, Hwang C, Smith KA, Greenbaum SG. Solid State Multinuclear Magnetic Resonance Investigation of Electrolyte Decomposition Products on Lithium Ion Electrodes. ACTA ACUST UNITED AC 2012; 41:207-214. [PMID: 31007829 DOI: 10.1149/1.4717978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Solid electrolyte interphase (SEI) formation in lithium ion cells prepared with advanced electrolytes is investigated by solid state multinuclear (7Li, 19F, 31P) magnetic resonance (NMR) measurements of electrode materials harvested from cycled cells subjected to an accelerated aging protocol. The electrolyte composition is varied to include the addition of fluorinated carbonates and triphenyl phosphate (TPP, a flame retardant). In addition to species associated with LiPF6 decomposition, cathode NMR spectra are characterized by the presence of compounds originating from the TPP additive. Substantial amounts of LiF are observed in the anodes as well as compounds originating from the fluorinated carbonates.
Collapse
Affiliation(s)
- J H S R DeSilva
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
- Graduate Center of CUNY, New York, New York, 10016, USA
| | - V Udinwe
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
| | - P J Sideris
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
| | - M C Smart
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - F C Krause
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - C Hwang
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - K A Smith
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California 91109, USA
| | - S G Greenbaum
- Department of Physics and Astronomy, Hunter College of CUNY, New York, New York 10065, USA
- Graduate Center of CUNY, New York, New York, 10016, USA
| |
Collapse
|
27
|
Rashid RS, Smith KA, Nambiar KZ, Frew AJ, Tarzi MD. Pollen-food syndrome is related to Bet v 1/PR-10 protein sensitisation, but not all patients have spring rhinitis. Allergy 2011; 66:1391-2. [PMID: 21569050 DOI: 10.1111/j.1398-9995.2011.02618.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- R S Rashid
- Department of Immunology, Brighton and Sussex Medical School, University of Sussex, UK
| | | | | | | | | |
Collapse
|
28
|
Smith KA, Shepherd J, Wakil A, Kilpatrick ES. A comparison of methods for the measurement of 8-isoPGF(2α): a marker of oxidative stress. Ann Clin Biochem 2011; 48:147-54. [PMID: 21292864 DOI: 10.1258/acb.2010.010151] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oxidative stress describes the cellular damage caused by excess reactive oxygen species not adequately inactivated by antioxidants. Oxidative stress has been implicated in playing a role in many disorders. Lipid peroxidation end-products are employed as markers of oxidative stress, of which the isoprostane, 8-iso-PGF(2α), is widely used. 8-iso-PGF(2α) is measured in plasma or urine by gas chromatography-mass spectrometry (GC/MS), liquid chromatography-mass spectrometry (LC/MS), tandem-mass spectrometry or enzyme-linked immunosorbent assay (ELISA). However, discrepancies between the specificity of these methods means correlation is poor. METHODS A tandem-mass spectrometric (LC/MS/MS) method, using immunoaffinity purification, for urinary 8-iso-PGF(2α) was developed and compared with two commercial ELISAs (A--Cayman Chemicals, B--Oxford Biomedical Research) in urine samples (n = 156). RESULTS An LC/MS/MS method coupled to immunoaffinity purification was developed with satisfactory performance and comparison to ELISAs A and B. Spearman rank correlation demonstrated significant correlation between all methods (P = <0.0001); however, r² values ranged from 0.68 to 0.72. Bland-Altman plots revealed a proportional positive bias of ELISA B when compared with ELISA A and LC/MS/MS. Furthermore, the agreement between ELISA A and LC/MS/MS was poor. CONCLUSIONS The poor agreement between methods for measurement of 8-iso-PGF(2α) highlights differences in selectivity. 8-iso-PGF(2α) is an isoprostane, a family of isomeric end-products of arachidonic acid peroxidation, which are produced by peroxidation or enzymatically. This makes avoiding cross-reactivity between 8-iso-PGF(2α) and related isomers challenging. When assessing oxidative stress studies, the selectivity of the methods used should be taken into account, particularly when comparing studies.
Collapse
Affiliation(s)
- K A Smith
- Department of Clinical Biochemistry, Hull Royal Infirmary, Anlaby Road, Hull HU32JZ, UK
| | | | | | | |
Collapse
|
29
|
Smith KA, Qiu Z, Wong R, Tam VL, Tam BL, Joea DK, Quach A, Liu X, Pold M, Malyankar UM, Bot A. Multivalent immunity targeting tumor-associated antigens by intra-lymph node DNA-prime, peptide-boost vaccination. Cancer Gene Ther 2010; 18:63-76. [PMID: 20725097 DOI: 10.1038/cgt.2010.45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Active immunotherapy of cancer has yet to yield effective therapies in the clinic. To evaluate the translatability of DNA-based vaccines we analyzed the profile of T-cell immunity by plasmid vaccination in a murine model, using transcriptome microarray analysis and flow cytometry. DNA vaccination resulted in specific T cells expressing low levels of co-inhibitory molecules (most notably PD-1), strikingly different from the expression profile elicited by peptide immunization. In addition, the T-cell response primed through this dual-antigen-expressing plasmid (MART-1/Melan-A and tyrosinase) translated into a substantial proliferation capacity and functional conversion to antitumor effector cells after tyrosinase and MART-1/Melan-A peptide analog boost. Furthermore, peptide boost rescued the immune response against the subdominant tyrosinase epitope. This immunization approach could be adapted to elicit potent immunity against multiple tumor antigens, resulting in a broader immune response that was more effective in targeting human tumor cells. Finally, this study sheds light on a novel mechanism of immune homeostasis through synchronous regulation of co-inhibitory molecules on T cells, highly relevant to heterologous prime boost approaches involving DNA vaccines as priming agents.
Collapse
Affiliation(s)
- K A Smith
- Department of Research and Development, Mannkind Corporation, Valencia, CA 91355, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Meadows MD, Smith KA, Kinsey RA, Rothgeb TM, Skarjune RP, Oldfield E. High-resolution solid-state NMR of quadrupolar nuclei. Proc Natl Acad Sci U S A 2010; 79:1351-5. [PMID: 16593165 PMCID: PMC345967 DOI: 10.1073/pnas.79.4.1351] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report the observation of high-resolution solid-state NMR spectra of (23)Na (I = [unk]), (27)Al (I = [unk]) and (51)V (I = [unk]) in various inorganic systems. We show that, contrary to popular belief, relatively high-resolution ( approximately 10 ppm linewidth) spectra may be obtained from quadrupolar systems, in which electric quadrupole coupling constants (e(2)qQ/h) are in the range approximately 1-5 MHz, by means of observation of the ((1/2), -(1/2)) spin transition. The ((1/2), -(1/2)) transition for all nonintegral spin quadrupolar nuclei (I = [unk], [unk], [unk], or [unk]) is only normally broadened by dipolar, chemical shift (or Knight shift) anisotropy or second-order quadrupolar effects, all of which are to a greater or lesser extent averaged under fast magic-angle sample rotation. In the case of (23)Na and (27)Al, high-resolution spectra of (23)NaNO(3) (e(2)qQ/h approximately 300 kHz) and alpha-(27)Al(2)O(3) (e(2)qQ/h approximately 2-3 MHz) are presented; in the case of (51)V(2)O(5) (e(2)qQ/h approximately 800 kHz), rotational echo decays are observed due to the presence of a approximately 10(3)-ppm chemical shift anisotropy. The observation of high-resolution solid-state spectra of systems having spins I = [unk], [unk], and [unk] in asymmetric environments opens up the possibility of examining about two out of three nuclei by solid-state NMR that were previously thought of as "inaccessible" due to the presence of large (a few megahertz) quadrupole coupling constants. Preliminary results for an I = [unk] system, (93)Nb, having e(2)qQ/h approximately 19.5 MHz, are also reported.
Collapse
Affiliation(s)
- M D Meadows
- School of Chemical Sciences, University of Illinois at Urbana-Champaign, 505 South Mathews Avenue, Urbana, Illinois 61801
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
As an attempt to provide an organized way to study the chaotic structures and their effects in solving combinatorial optimization with chaotic neural networks (CNN's), a unifying framework is proposed to serve as a basis where the existing CNN models can be placed and compared. The key of this proposed framework is the introduction of an extra energy term into the computational energy of the Hopfield model, which takes on different forms for different CNN models, and modifies the original Hopfield energy landscape in various manners. Three CNN models, namely the Chen and Aihara model with self-feedback chaotic simulated annealing (CSA), the Wang and Smith model with timestep CSA, and the chaotic noise model, are chosen as examples to show how they can be classified and compared within the proposed framework.
Collapse
|
32
|
Hu LS, Baxter LC, Pinnaduwage DS, Paine TL, Karis JP, Feuerstein BG, Schmainda KM, Dueck AC, Debbins J, Smith KA, Nakaji P, Eschbacher JM, Coons SW, Heiserman JE. Optimized preload leakage-correction methods to improve the diagnostic accuracy of dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging in posttreatment gliomas. AJNR Am J Neuroradiol 2010; 31:40-8. [PMID: 19749223 DOI: 10.3174/ajnr.a1787] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Relative cerebral blood volume (rCBV) accuracy can vary substantially depending on the dynamic susceptibility-weighted contrast-enhanced (DSC) acquisition and postprocessing methods, due to blood-brain barrier disruption and resulting T1-weighted leakage and T2- and/or T2*-weighted imaging (T2/T2*WI) residual effects. We set out to determine optimal DSC conditions that address these errors and maximize rCBV accuracy in differentiating posttreatment radiation effect (PTRE) and tumor. MATERIALS AND METHODS We recruited patients with previously treated high-grade gliomas undergoing image-guided re-resection of recurrent contrast-enhancing MR imaging lesions. Thirty-six surgical tissue samples were collected from 11 subjects. Preoperative 3T DSC used 6 sequential evenly timed acquisitions, each by using a 0.05-mmol/kg gadodiamide bolus. Preload dosing (PLD) and baseline subtraction (BLS) techniques corrected T1-weighted leakage and T2/T2*WI residual effects, respectively. PLD amount and incubation time increased with each sequential acquisition. Corresponding tissue specimen stereotactic locations were coregistered to DSC to measure localized rCBV under varying PLD amounts, incubation times, and the presence of BLS. rCBV thresholds were determined to maximize test accuracy (average of sensitivity and specificity) in distinguishing tumor (n = 21) and PTRE (n = 15) samples under the varying conditions. Receiver operator characteristic (ROC) areas under the curve (AUCs) were statistically compared. RESULTS The protocol that combined PLD (0.1-mmol/kg amount, 6-minute incubation time) and BLS correction methods maximized test AUC (0.99) and accuracy (95.2%) compared with uncorrected rCBV AUC (0.85) and accuracy (81.0%) measured without PLD and BLS (P = .01). CONCLUSIONS Combining PLD and BLS correction methods for T1-weighted and T2/T2*WI errors, respectively, enables highly accurate differentiation of PTRE and tumor growth.
Collapse
Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, Arizona 85259, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
This paper outlines the risk assessment and communication strategy carried out by the Lothian Health Protection Team after notification of a probable case of meningococcal disease (later confirmed as Neisseria meningitidis) in a resident of a city centre backpackers hostel. Six close contacts were identified from the hostel and given rifampicin prophylaxis. Two days after commencing rifampicin one of these contacts was admitted to hospital with a purpuric/petechial rash and thrombocytopenia. The final diagnosis for this contact was thrombocytopenia, either idiopathic or secondary to rifampicin. This example and the potential side effects of administering rifampicin prophylaxis highlight the importance of a thorough risk assessment of contacts of a case to avoid prescribing prophylaxis to anyone other than those at highest risk of becoming a subsequent case.
Collapse
Affiliation(s)
- L C Davis
- Department of Public Health and Health Policy, NHS Lothian, Edinburgh, United Kingdom.
| | | | | |
Collapse
|
34
|
Dobbie KE, Heal KV, Aumônier J, Smith KA, Johnston A, Younger PL. Evaluation of iron ochre from mine drainage treatment for removal of phosphorus from wastewater. Chemosphere 2009; 75:795-800. [PMID: 19195678 DOI: 10.1016/j.chemosphere.2008.12.049] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 05/27/2023]
Abstract
Treatment of polluting discharges from abandoned coal mines in the UK currently produces ca 30,000 t y(-1) of hydrous iron oxides ("ochre"), for which there is no major end-use, but which has previously been shown to have potential for removing P from wastewater and agricultural runoff. The efficiency of ochre for P removal from wastewater was investigated in experiments at two sites in the UK: Leitholm in Scotland and Windlestone in England. The three-year experiment at Leitholm involved diverting secondary-treated wastewater effluent through a trough which contained granular and pelletized ochre at different times. In the nine-month experiment at Windlestone, beds of ochre pellets in horizontal and vertical flow configurations were tested. The ochre treatment systems at Leitholm reduced influent concentrations of total P (TP) and TP mass by ca 80% and 50%, respectively, during optimal flow conditions, and achieved a removal rate of up to 65+/-48 mg TP kg(-1) ochre d(-1). There was no detectable release of potentially toxic metals from the ochre during the experiments. P removal rates by concentration were inversely related to flow and declined during the different phases of the experiments, probably due to clogging. At Windlestone, higher removal rates up to 195 mg TP kg(-1) ochre d(-1) were achieved for short periods of time following cleaning of the experimental system. Ochre has considerable potential to remove P from wastewater in a multi-stage treatment system and has a lifetime estimated to be 10 times longer than other substrates tested for P removal.
Collapse
Affiliation(s)
- K E Dobbie
- School of GeoSciences, The University of Edinburgh, Crew Building, West Mains Road, Edinburgh EH9 3JN, UK
| | | | | | | | | | | |
Collapse
|
35
|
Hu LS, Baxter LC, Smith KA, Feuerstein BG, Karis JP, Eschbacher JM, Coons SW, Nakaji P, Yeh RF, Debbins J, Heiserman JE. Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements. AJNR Am J Neuroradiol 2009; 30:552-8. [PMID: 19056837 DOI: 10.3174/ajnr.a1377] [Citation(s) in RCA: 289] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating tumor growth from posttreatment radiation effect (PTRE) remains a common problem in neuro-oncology practice. To our knowledge, useful threshold relative cerebral blood volume (rCBV) values that accurately distinguish the 2 entities do not exist. Our prospective study uses image-guided neuronavigation during surgical resection of MR imaging lesions to correlate directly specimen histopathology with localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) measurements and to establish accurate rCBV threshold values, which differentiate PTRE from tumor recurrence. MATERIALS AND METHODS Preoperative 3T gradient-echo DSC and contrast-enhanced stereotactic T1-weighted images were obtained in patients with high-grade glioma (HGG) previously treated with multimodality therapy. Intraoperative neuronavigation documented the stereotactic location of multiple tissue specimens taken randomly from the periphery of enhancing MR imaging lesions. Coregistration of DSC and stereotactic images enabled calculation of localized rCBV within the previously recorded specimen locations. All tissue specimens were histopathologically categorized as tumor or PTRE and were correlated with corresponding rCBV values. All rCBV values were T1-weighted leakage-corrected with preload contrast-bolus administration and T2/T2*-weighted leakage-corrected with baseline subtraction integration. RESULTS Forty tissue specimens were collected from 13 subjects. The PTRE group (n = 16) rCBV values ranged from 0.21 to 0.71, tumor (n = 24) values ranged from 0.55 to 4.64, and 8.3% of tumor rCBV values fell within the PTRE group range. A threshold value of 0.71 optimized differentiation of the histopathologic groups with a sensitivity of 91.7% and a specificity of 100%. CONCLUSIONS rCBV measurements obtained by using DSC and the protocol we have described can differentiate HGG recurrence from PTRE with a high degree of accuracy.
Collapse
Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, AZ 85259, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Stem cell factor (SCF) is an early-acting, hematopoietic growth factor that binds to the receptor encoded by the proto-oncogene c-kit. It is a potent growth factor for primitive bone marrow cells as well as thymocytes. This unit describes three protocols for detecting human and murine SCF. In the first, human or rodent SCF is measured by its ability to stimulate proliferation of the human megakaryoblastic leukemia cell line, UT-7. Because rat and mouse SCF bind well to human c-kit, human and rodent SCF can both be measured using the first basic protocol. In an Alternate Protocol, rodent SCF is assayed by its ability to stimulate proliferation of the clonal murine mast cell line, MC/9. Human SCF is not very active on rodent cells and thus cannot be measured using this protocol. Both of the cell proliferation assays lack specificity because they are capable of detecting other cytokines in addition to SCF. The third protocol is a radioreceptor assay using the human erythroleukemia cell line, OCIM1; it specifically measures murine or human SCF and not other cytokines. Support protocols describe maintenance of UT-7 and MC/9 cells and preparation of plasma membranes from OCIM1 cells.
Collapse
Affiliation(s)
- K A Smith
- Amgen, Thousand Oaks, California, USA
| | | |
Collapse
|
37
|
Smith KA. Saints in shining armor: martial asceticism and masculine models of sanctity, ca. 1050-1250. Speculum 2008; 83:572-302. [PMID: 19618560 DOI: 10.1017/s0038713400014597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
38
|
Okabe T, Mintz GS, Weigold WG, Roswell R, Joshi S, Lee SY, Lee B, Roy P, Steinberg DH, Pinto Slottow TL, Torguson R, Smith KA, Xue Z, Satler LF, Kent KM, Pichard AD, Weissman NJ, Lindsay J, Waksman R. The predictive value of computed tomography calcium scores: a comparison with quantitative volumetric intravascular ultrasound. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.072] [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]
|
39
|
Okabe T, Torguson R, Roy P, Steinberg DH, Pinto Slottow TL, Smith KA, Xue Z, Satler LF, Kent KM, Pichard AD, Lindsay J, Waksman R. Safety and efficacy of direct stenting compared with distal protection device in saphenous vein graft lesions. Cardiovascular Revascularization Medicine 2008. [DOI: 10.1016/j.carrev.2008.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
Heal KV, Dobbie KE, Bozika E, McHaffie H, Simpson AE, Smith KA. Enhancing phosphorus removal in constructed wetlands with ochre from mine drainage treatment. Water Sci Technol 2005; 51:275-82. [PMID: 16042268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
No single end-use has yet been identified that is capable of consuming the projected production of ochre (mainly iron (III) oxides) from mine drainage treatment. However, the high sorption capacity of ochre for phosphorus (up to 26 mg kg(-1)) means that it could be used in constructed wetlands to enhance phosphorus removal. Laboratory batch experiments showed that coarse-grained ochre removes 90% of all phosphorus forms from sewage effluent after 15 minutes of shaking. From a larger-scale experiment, it is estimated that constructed wetlands with an ochre substrate should remove phosphorus from sewage effluent for up to 200-300 years. The suitability of ochre for phosphorus removal is being investigated at the field scale in a wastewater constructed wetland (175 m2 area) in Berwickshire, UK. The hydraulic and treatment performance of the wetland were monitored for 15 months prior to installation at the inlet in November 2003 of a tank containing approximately 1200 kg ochre. Results so far show that improved hydraulic design is required for ochre to increase the mean phosphorus removal efficiency of the system (27 +/- 28%), but potentially toxic metals (Al, Cd, Cr, Cu, Fe, Ni, Pb, Zn) have not been released from the ochre into the wetland outflow.
Collapse
Affiliation(s)
- K V Heal
- School of Geosciences, University of Edinburgh, Darwin Building, Mayfield Road, Edinburgh EH9 3JU, UK.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
We investigate the deformation and breakup in shear flow of an encapsulated drop in which both the core and shell are Newtonian fluids. The equations of motion are solved numerically using a level set method to track interface motion. We consider the case of a drop stretched to a given length in constant shear and then allowed to relax. A range of morphologies is produced, and novel kinematics occur, due to the interaction of the core and outer interfaces. A phase diagram is presented to describe the morphologies produced over a range of capillary numbers and core interfacial tensions.
Collapse
Affiliation(s)
- K A Smith
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, Illinois 60208, USA
| | | | | |
Collapse
|
42
|
Abstract
Recombinant antibodies are important tools for biomedical research and are increasingly being used as clinical diagnostic/therapeutic reagents. In this article, a background to humanized antibodies is given, together with details of the generation of antibody fragments--for example, single chain Fv fragments. Phage antibody fragments are fast becoming popular and can be generated by simple established methods of affinity enrichment from libraries derived from immune cells. Phage display methodology can also be used for the affinity enrichment of existing antibody fragments to provide a reagent with a higher affinity. Here, phage antibodies are demystified to provide a greater understanding of the potential of these reagents and to engage clinicians and biomedical scientists alike to think about potential applications in pathology and clinical settings.
Collapse
Affiliation(s)
- K A Smith
- Division of Cell and Molecular Medicine, Postgraduate Medical Institute, University of Hull, Cottingham Rd, Hull HU6 7RX, UK.
| | | | | | | | | | | |
Collapse
|
43
|
Smith KA, Ottino JM, de la Cruz MO. Dynamics of a drop at a fluid interface under shear. Phys Rev E Stat Nonlin Soft Matter Phys 2004; 69:046302. [PMID: 15169094 DOI: 10.1103/physreve.69.046302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Indexed: 05/24/2023]
Abstract
We analyze the dynamics of a two-dimensional drop lying on a fluid interface, sometimes called a liquid lens, subjected to simple shear flow. The three fluids, the drop and the two external fluids, meet at a triple point (or a triple line in three dimensions). A requirement for steady drop shapes is that the triple points are stationary. This leads to a flow topology different than that of a freely suspended drop. Results are substantiated with numerical results using a level set method for interface evolution and treatment of triple points. Possible implications for new drop instabilities are also discussed.
Collapse
Affiliation(s)
- K A Smith
- Department of Chemical Engineering, Northwestern University, Evanston, IL 60208, USA
| | | | | |
Collapse
|
44
|
Wennemann L, Shanks CH, Smith KA. Movement of entomopathogenic nematodes in soils of Fragaria spp. Commun Agric Appl Biol Sci 2004; 69:347-57. [PMID: 15759434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The mobility of three entomopathogenic nematodes (Steinernema carpocapsae UK and All Strain, and S. glaseri (Nematoda: Steinernematidae) was observed in strawberry fields in Vancouver, WA. Nematodes were sprinkled over the soil surface using a mason jar. Soil and soil-moisture content, soil composition, soil pH and conductivity was reported over the evaluation period. 12 cm deep soil samples were taken after surface application at 9 and 25 days, 7, 26 and 45 and 6, 22, 37 and 50 days at the three different test sites within the surface application site and at 5 cm distance. Soil samples taken were divided into three layers (0-4, 5-8 and 9-12 cm) and exposed once to five Galleria larvae in the laboratory to evaluate nematode presence and movement. Results after surface application demonstrated more vertical movement of S. glaseri into deeper soil layers in comparison to both S. carpocapsae strains.
Collapse
Affiliation(s)
- L Wennemann
- Washington State University, Vancouver Research and Extension Unit, 1919 N.E. 78th Street, Vancouver, WA 98665-9752, USA
| | | | | |
Collapse
|
45
|
Javedan SP, Manwaring K, Smith KA. Treatment of posterior third ventricular central neurocytoma with endoscopic biopsy, endoscopic third ventriculostomy and stereotactic radiosurgery. Minim Invasive Neurosurg 2003; 46:165-8. [PMID: 12872194 DOI: 10.1055/s-2003-40744] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Central neurocytomas of the posterior third ventricle are rare. These typically benign lesions have recently been shown to respond well to Gamma knife stereotactic radiosurgery (SRS). We present the case of a posterior third ventricle central neurocytoma presenting with aqueduct obstruction. The patient was treated with endoscopic biopsy and endoscopic third ventriculostomy, followed by Gamma knife radiosurgery. At 2 years the tumor has diminished in size and the patient is neurologically intact. This treatment strategy may avoid the risk of open ventricular surgery and the need for shunts in patients with central neurocytomas of appropriate size and location.
Collapse
Affiliation(s)
- S P Javedan
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | | |
Collapse
|
46
|
Smith KA, Kirkpatrick N, Madden LA, Topping KP, Monson JRT, Greenman J. Isolation and characterisation of vascular endothelial growth factor-165 specific scFv fragments by phage display. Int J Oncol 2003; 22:333-8. [PMID: 12527931 DOI: 10.3892/ijo.22.2.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vascular endothelial growth factor (VEGF) is a multifunctional cytokine which plays a major role in angiogenesis. Alternative splicing causes the production of several different isoforms (VEGF-A 121, 145, 165, 189, 206). VEGF is essential for tumor angiogenesis and several studies have correlated elevated VEGF levels with tumor stage, metastases and progression. Antibody phage display was employed to isolate two scFv antibody fragments, D8 and F10, with specificity for the VEGF165 isoform. It was shown by ELISA and competitive immunohistochemistry that each clone bound to VEGF165 but not VEGF121. Immunohistochemistry with D8 and F10 on colorectal carcinoma and adenoma sections revealed positive staining similar to that shown by a polyclonal VEGF antibody. The scFv antibody fragments, D8 and F10, will be useful in specifically detecting circulating VEGF165 in cancer patients as most studies to date have quantified the total level of circulating VEGF (121 and 165). These reagents will allow further elucidation of the role of VEGF in tumor angiogenesis.
Collapse
Affiliation(s)
- K A Smith
- Department of Surgery, Medical Research Laboratory, Wolfson Building, University of Hull, Hull, HU6 7RX, UK
| | | | | | | | | | | |
Collapse
|
47
|
Kung L, Smith KA, Smagala AM, Endres KM, Bessett CA, Ranjit NK, Yaissle J. Effects of 9,10 anthraquinone on ruminal fermentation, total-tract digestion, and blood metabolite concentrations in sheep. J Anim Sci 2003; 81:323-8. [PMID: 12597404 DOI: 10.2527/2003.811323x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate the effects of adding 9,10 anthraquinone, a known inhibitor of methanogenesis and sulfate reduction, on blood metabolites, digestibility, and distribution of gas in sheep. In all experiments, we fed a complete pelleted diet that contained 17.5% crude protein and 24.5% acid detergent fiber. In an 8-wk study, feeding up to 66 ppm (dry matter basis) of 9,10 anthraquinone had no adverse effects on blood metabolites including indicators of normal enzyme function, mineral concentrations, and hematological measurements. Feeding 9,10 anthraquinone had no effect on average daily gain, although sheep fed a diet containing 66 ppm of 9,10 anthraquinone numerically gained the least weight. The ruminal molar proportions of acetic acid were decreased (P < 0.05) and the molar proportions of propionic acid were increased (P < 0.05) in sheep fed 1.5 and 66 ppm 9,10 anthraquinone when compared to those fed an unsupplemented diet. In a digestion trial, 9,10 anthraquinone (33 and 66 ppm) had no effect on the apparent digestion of nutrients in the total gastrointestinal tract. In a metabolism study, ruminal gasses were collected by rumenocentesis and analyzed for methane and hydrogen concentrations. Feeding 500 ppm of 9,10 anthraquinone to sheep resulted in a decrease (P < 0.07) in the concentration of methane, but an increase (P < 0.05) in hydrogen concentration of ruminal gas throughout the 19 d of feeding. There was no indication of ruminal adaptation throughout this time. These results are the first to show that 9,10 anthraquinone can partially inhibit in vivo rumen methanogenesis, which supports previous in vitro findings. In addition, at the concentrations used in this study, 9,10 anthraquinone was not toxic to ruminants.
Collapse
Affiliation(s)
- L Kung
- Department of Animal and Food Sciences, College of Agriculture and Natural Resources, University of Delaware, Newark 19717-1303, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Smith KA, Ploghaus A, Cowen PJ, McCleery JM, Goodwin GM, Smith S, Tracey I, Matthews PM. Cerebellar responses during anticipation of noxious stimuli in subjects recovered from depression. Functional magnetic resonance imaging study. Br J Psychiatry 2002; 181:411-5. [PMID: 12411267 DOI: 10.1192/bjp.181.5.411] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subjects recovered from depression have a substantial risk for recurrence of depression, suggesting persistent abnormalities in brain activity. AIMS To test whether women recovered from depression show abnormal brain activity in functional magnetic resonance imaging (fMRI) during a conditioning paradigm with a noxious pain stimulus. METHOD Ten unmedicated women who had recovered from major depression and eight healthy control women each received either noxious hot or non-noxious warm stimuli, the onset of which was signalled by a specific coloured light during 3-tesla echo planar imaging-based fMRI. RESULTS Similar patterns of brain activation were found during painful stimulation for both patients and healthy controls. However, relative to healthy controls, subjects recovered from depression showed a reduced response in the cerebellum during anticipation of the noxious stimulus compared with anticipation of the non-noxious stimulus. CONCLUSIONS Our data suggest that abnormal cerebellar function could be a marker of vulnerability to recurrent depression. This could provide a new target for therapeutic interventions.
Collapse
Affiliation(s)
- K A Smith
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Murphy FC, Smith KA, Cowen PJ, Robbins TW, Sahakian BJ. The effects of tryptophan depletion on cognitive and affective processing in healthy volunteers. Psychopharmacology (Berl) 2002; 163:42-53. [PMID: 12185399 DOI: 10.1007/s00213-002-1128-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2001] [Accepted: 04/08/2002] [Indexed: 11/26/2022]
Abstract
RATIONALE Cognitive impairment is a common feature of depressive illness. While accumulating evidence suggests that brain serotonin (5-HT) pathways play an important role in the neurobiology of depression, the extent to which altered 5-HT function is responsible for the associated changes in cognition and emotion remains unclear. OBJECTIVE The present study examined the effects of acute dietary depletion of tryptophan (TRP) on cognitive and affective processing in healthy volunteers and explored the putative role of 5-HT in the neuropsychology of depression. METHODS We administered computerised cognitive tests to healthy control participants following ingestion of TRP-free and nutritionally balanced amino acid drinks in a double-blind, placebo-controlled, crossover design. RESULTS The TRP-free amino acid mixture significantly lowered plasma total and free TRP concentrations relative to baseline values and produced selective deficits similar to those observed previously in cases of clinical depression. In particular, TRP depletion increased response times for happy but not sad targets in an affective go/no-go task and slowed responding in a visual discrimination and reversal learning task. These deficits were not due to a global sedative effect, as planning ability was unimpaired. CONCLUSIONS The present data indicate that serotonergic factors may be more involved in the disrupted inhibitory and emotional processing characteristic of depression than in other aspects of executive function, such as planning ability. These findings support the recent proposal that serotonergic manipulation may have greater effects on tasks mediated by frontal circuitry that includes the orbitofrontal cortex than by dorsolateral prefrontal cortex circuitry.
Collapse
Affiliation(s)
- F C Murphy
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 2EF, UK
| | | | | | | | | |
Collapse
|
50
|
Abstract
With the advent of highly active anti-retroviral therapy (HAART) in 1997, most investigators felt that HIV infection would be cured with a few years of antiviral therapy. It is now clear that antiviral drugs alone cannot cure the infection, even when applied within a few weeks of initial symptoms. There are now several reports of the discontinuation of HAART after several years of effective suppression of detectable plasma virus. Relapse occurs universally within a few weeks. More promising results have been reported if HAART is initiated early after infection. However, even in this instance, most patients suffer a relapse within a few weeks. If diagnostic treatment interruptions are performed, some individuals appear to control plasma virus concentrations at low levels - <5000 HIV RNA molecules/ml. We have similar results from subjects who were infected chronically before HAART was initiated, so that it is clear that the previous dogma that HIV-specific immune reactivity is absent in individuals who are chronically infected is incorrect. Immune reactivity to HIV does exist, and is detectable in vivo, even when the infection becomes chronic before therapy is initiated. Consequently, we are now faced with a new therapeutic dilemma: how can a cure of this infection be achieved? This review is focused on the rationale and methods to design clinical trials directed towards achieving a cure of HIV infection.
Collapse
Affiliation(s)
- K A Smith
- The Division of Immunology, Department of Medicine, Weill Medical College, Cornell University, New York, NY 10021, USA.
| |
Collapse
|