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Hoe J, Profyri E, Kemp C, Manela M, Webster L, Anthony J, Costafreda S, Arrojo F, Souris H, Livingston G. Risk assessment for people living with dementia: a systematic review. Int Psychogeriatr 2024; 36:263-288. [PMID: 38053362 DOI: 10.1017/s1041610223004398] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This systematic review identified key components of risk assessment for people with dementia, examined attitudes toward risk identification and risk assessment, and appraised existing risk assessment tools. METHODS Systematic searches of five databases on two platforms (EBSCO, OVID) and gray literature databases (Open Grey, Base) were conducted. Studies were screened for inclusion based on predetermined eligibility criteria and quality assessed using the Mixed Methods Appraisal Tool. Findings were tabulated and synthesized using thematic synthesis. RESULTS Our review found people with dementia, their family carers, and healthcare professionals differed in how risk is conceptualized, with views being shaped by media perceptions, personal experiences, socio-cultural influences, dementia knowledge, and dementia severity. We found that mobilization (causing falls inside and getting lost outside) is the most frequently identified risk factor. Our findings show people with dementia are generally risk-tolerant, while healthcare professionals may adopt risk-averse approaches because of organizational requirements. We found factors that disrupt daily routines, living and caring arrangements, medication management, and unclear care pathways contribute toward adverse risk events. We discovered that most studies about risk and risk assessment scales did not consider insight of the person with dementia into risks although this is important for the impact of a risk. No risk instrument identified had sufficient evidence that it was useful. CONCLUSION Accurate risk assessment and effective communication strategies that include the perspectives of people with dementia are needed to enable risk-tolerant practice. No risk instrument to date was shown to be widely acceptable and useful in practice.
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Affiliation(s)
- Juanita Hoe
- Geller Institute of Ageing and Memory, University of West London, London, UK
- School of Health Sciences, University of London, London, UK
| | - Elena Profyri
- School of Health Sciences, University of London, London, UK
| | - Charlotte Kemp
- School of Health Sciences, University of London, London, UK
| | - Monica Manela
- UCL Division of Psychiatry, University College London, Maple House, London, UK
| | - Lucy Webster
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Justine Anthony
- School of Health Sciences, University of London, London, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Sergi Costafreda
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Frank Arrojo
- Alzheimer's Society Research Network, Alzheimer's Society, London, UK
| | - Helen Souris
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Dementia Clinical Network, NHS England and NHS Improvement (London Region, London, UK
| | - Gill Livingston
- UCL Division of Psychiatry, University College London, Maple House, London, UK
- Camden, and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
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Rand S, Towers AM, Allan S, Webster L, Palmer S, Carroll R, Gordon A, Akdur G, Goodman C. Exploratory factor analysis and Rasch analysis to assess the structural validity of the Adult Social Care Outcomes Toolkit Proxy version (ASCOT-Proxy) completed by care home staff. Qual Life Res 2024:10.1007/s11136-024-03631-1. [PMID: 38507142 DOI: 10.1007/s11136-024-03631-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Rasch analysis and exploratory factor analysis (EFA) were used to evaluate the structural validity of the ASCOT-Proxy measures completed by staff on behalf of older adults resident in care homes, by comparison to the ASCOT-SCT4, the measure of social care-related quality of life (SCRQoL) from which the ASCOT-Proxy was developed. METHODS EFA was conducted on the ASCOT-SCT4 and the two ASCOT-Proxy measures (Proxy-Proxy, Proxy-Resident), to determine if they retained the single factor of the original ASCOT-SCT4 measure found in samples of older community-dwelling adults. Rasch analysis was also applied to measures with a single factor structure in the EFA. RESULTS ASCOT-Proxy-Resident had a single factor structure, as did the original ASCOT-SCT4 (also, found in this analysis when completed by care home staff). The ASCOT-Proxy-Proxy had a two factor structure. Rasch analysis of ASCOT-Proxy-Resident and ASCOT-SCT4 had an acceptable model fit, internal consistency and met the assumptions of unidimensionality and local independence. There was evidence of less than optimal distinguishability at some thresholds between responses, and low frequency of rating of the 'high level needs'. CONCLUSION The ASCOT-Proxy-Resident is a valid instrument of SCRQoL for older adults resident in care homes, completed by staff proxies. Due to the two-factor structure, which differs from the original ASCOT-SCT4, we do not recommend the use of the ASCOT-Proxy-Proxy measure, although collecting data as part of the ASCOT-Proxy questionnaire may support its feasibility and acceptability. Further qualitative study of how care home staff complete and perceive the ASCOT-Proxy is encouraged for future studies.
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Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, UK.
| | - Ann-Marie Towers
- Centre for Health Services Studies (CHSS), University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, UK
| | - Lucy Webster
- Centre for Health Services Studies (CHSS), University of Kent, Canterbury, UK
| | - Sinead Palmer
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, UK
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Morriss R, Briley PM, Webster L, Abdelghani M, Barber S, Bates P, Brookes C, Hall B, Ingram L, Kurkar M, Lankappa S, Liddle PF, McAllister-Williams RH, O'Neil-Kerr A, Pszczolkowski S, Suazo Di Paola A, Walters Y, Auer DP. Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial. Nat Med 2024; 30:403-413. [PMID: 38228914 PMCID: PMC10878976 DOI: 10.1038/s41591-023-02764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
Disruption in reciprocal connectivity between the right anterior insula and the left dorsolateral prefrontal cortex is associated with depression and may be a target for neuromodulation. In a five-center, parallel, double-blind, randomized controlled trial we personalized resting-state functional magnetic resonance imaging neuronavigated connectivity-guided intermittent theta burst stimulation (cgiTBS) at a site based on effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. We tested its efficacy in reducing the primary outcome depression symptoms measured by the GRID Hamilton Depression Rating Scale 17-item over 8, 16 and 26 weeks, compared with structural magnetic resonance imaging (MRI) neuronavigated repetitive transcranial magnetic stimulation (rTMS) delivered at the standard stimulation site (F3) in patients with 'treatment-resistant depression'. Participants were randomly assigned to 20 sessions over 4-6 weeks of either cgiTBS (n = 128) or rTMS (n = 127) with resting-state functional MRI at baseline and 16 weeks. Persistent decreases in depressive symptoms were seen over 26 weeks, with no differences between arms on the primary outcome GRID Hamilton Depression Rating Scale 17-item score (intention-to-treat adjusted mean, -0.31, 95% confidence interval (CI) -1.87, 1.24, P = 0.689). Two serious adverse events were possibly related to TMS (mania and psychosis). MRI-neuronavigated cgiTBS and rTMS were equally effective in patients with treatment-resistant depression over 26 weeks (trial registration no. ISRCTN19674644).
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Affiliation(s)
- Richard Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Paul M Briley
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Webster
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mohamed Abdelghani
- Clinical Neuromodulation Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Peter Bates
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Cassandra Brookes
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Beth Hall
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Luke Ingram
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Micheal Kurkar
- Pennine Care TMS Service, Pennine Care NHS Foundation Trust, Oldham, UK
| | - Sudheer Lankappa
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Peter F Liddle
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - R Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander O'Neil-Kerr
- Centre for Neuromodulation, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Stefan Pszczolkowski
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Yvette Walters
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Dorothee P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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Rapaport P, Amador S, Adeleke M, Banerjee S, Barber J, Charlesworth G, Clarke C, Connell C, Espie C, Gonzalez L, Horsley R, Hunter R, Kyle SD, Manela M, Morris S, Pikett L, Raczek M, Thornton E, Walker Z, Webster L, Livingston G. Clinical and cost-effectiveness of DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives) for people living with dementia and their carers: a study protocol for a parallel multicentre randomised controlled trial. BMJ Open 2024; 14:e075273. [PMID: 38307536 PMCID: PMC10836385 DOI: 10.1136/bmjopen-2023-075273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Many people living with dementia experience sleep disturbance and there are no known effective treatments. Non-pharmacological treatment options should be the first-line sleep management. For family carers, relatives' sleep disturbance leads to interruption of their sleep, low mood and breakdown of care. Our team developed and delivered DREAMS START (Dementia RElAted Manual for Sleep; STrAtegies for RelaTives), a multimodal non-pharmacological intervention, showing it to be feasible and acceptable. The aim of this randomised controlled trial is to establish whether DREAMS START is clinically cost-effective in reducing sleep disturbances in people living with dementia living at home compared with usual care. METHODS AND ANALYSIS We will recruit 370 participant dyads (people living with dementia and family carers) from memory services, community mental health teams and the Join Dementia Research Website in England. Those meeting inclusion criteria will be randomised (1:1) either to DREAMS START or to usual treatment. DREAMS START is a six-session (1 hour/session), manualised intervention delivered every 1-2 weeks by supervised, non-clinically trained graduates. Outcomes will be collected at baseline, 4 months and 8 months with the primary outcome being the Sleep Disorders Inventory score at 8 months. Secondary outcomes for the person with dementia (all proxy) include quality of life, daytime sleepiness, neuropsychiatric symptoms and cost-effectiveness. Secondary outcomes for the family carer include quality of life, sleep disturbance, mood, burden and service use and caring/work activity. Analyses will be intention-to-treat and we will conduct a process evaluation. ETHICS AND DISSEMINATION London-Camden & Kings Cross Ethics Committee (20/LO/0894) approved the study. We will disseminate our findings in high-impact peer-reviewed journals and at national and international conferences. This research has the potential to improve sleep and quality of life for people living with dementia and their carers, in a feasible and scalable intervention. TRIAL REGISTRATION NUMBER ISRCTN13072268.
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Affiliation(s)
- Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Mariam Adeleke
- Department of Statistical Science, University College London, London, UK
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Georgina Charlesworth
- Division of Psychology and Language Sciences, University College London, London, UK
- North East London NHS Foundation Trust, Rainham, UK
| | | | | | - Colin Espie
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Lina Gonzalez
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Monica Manela
- Division of Psychiatry, University College London, London, UK
| | - Sarah Morris
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Liam Pikett
- Division of Psychiatry, University College London, London, UK
| | - Malgorzata Raczek
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Emma Thornton
- Tees Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Zuzana Walker
- Division of Psychiatry, University College London, London, UK
| | - Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
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Chu F, LaJoie AL, Keenan BD, Webster L, Langendorf SJ, Gilmore MA. Experimental Measurements of Ion Diffusion Coefficients and Heating in a Multi-Ion-Species Plasma Shock. Phys Rev Lett 2023; 130:145101. [PMID: 37084442 DOI: 10.1103/physrevlett.130.145101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 10/12/2022] [Accepted: 03/06/2023] [Indexed: 05/03/2023]
Abstract
Collisional plasma shocks generated from supersonic flows are an important feature in many astrophysical and laboratory high-energy-density plasmas. Compared to single-ion-species plasma shocks, plasma shock fronts with multiple ion species contain additional structure, including interspecies ion separation driven by gradients in species concentration, temperature, pressure, and electric potential. We present time-resolved density and temperature measurements of two ion species in collisional plasma shocks produced by head-on merging of supersonic plasma jets, allowing determination of the ion diffusion coefficients. Our results provide the first experimental validation of the fundamental inter-ion-species transport theory. The temperature separation, a higher-order effect reported here, is valuable for advancements in modeling HED and ICF experiments.
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Affiliation(s)
- F Chu
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A L LaJoie
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - B D Keenan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L Webster
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - S J Langendorf
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M A Gilmore
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, New Mexico 87131, USA
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Webster L, Boutry C, Gledhill J, Willis A, Bates P, Morriss R. To have and to hold: An exploratory qualitative study exploring why research participants with treatment-resistant depression undergoing transcranial magnetic stimulation treatment requested copies of their research brain MRI scans. J Med Imaging Radiat Sci 2023; 54:S95-S103. [PMID: 37019815 DOI: 10.1016/j.jmir.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE There has been little research providing an in-depth exploration of the reasons behind research participants, particularly in mental health settings, requesting copies of their research data, such as magnetic resonance imaging (MRI) scans. BRIGhTMIND is a large double blind randomised controlled trial using functional and structural magnetic resonance imaging to create personalised targets for transcranial magnetic stimulation delivery, and a number of trial participants requested copies of these scans. METHODS Seven participants involved in the BRIGhTMIND trial completed semi-structured interviews exploring their reasons behind their request for copies of their MRI scans. The qualitative data was co-analysed between researchers and patient and public involvement and engagement representatives using inductive thematic analysis. RESULTS The interviews produced consistent themes concerning curiosity to visualise their MRI scans, and the hope that their participation would result in a better understanding of the nature and future treatment of depression. Concerns around the rights to access their own personal health data emerged as a clear theme as did their own ability to interpret any radiological information. DISCUSSION This study provides insight into the reasons why research participants with depression would like to retain copies of their MRI scans and the perceived role that such techniques may have for improving research and neuromodulation treatments in depression. Such first-hand experiential accounts emphasises the importance of listening to participants perspectives and lived experience, in order to improve research and health outcomes. Future research could aim to provide greater verbal and written information for participants, including details about the accessibility to their MRI scans, the difference between research and clinical MRI scans, and educational materials to help with the interpretation of MRI images.
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Webster L, Amador S, Rapaport P, Mukadam N, Sommerlad A, James T, Javed S, Roche M, Lord K, Bharadia T, Rahman-Amin M, Lang I, Livingston G. Tailoring STrAtegies for RelaTives for Black and South Asian dementia family carers in the United Kingdom: A mixed methods study. Int J Geriatr Psychiatry 2023; 38:e5868. [PMID: 36642866 PMCID: PMC10107806 DOI: 10.1002/gps.5868] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We culturally adapted STrAtegies for RelaTives (START), a clinically and cost-effective intervention for dementia family carers, for Black and South Asian families. It had previously been delivered to family carers around the time of diagnosis, when most people with dementia had very mild, mild or moderate dementia. METHODS We interviewed a maximum variation sample of family carers (phase one; n = 15 South Asian; n = 11 Black) about what aspect of START, required cultural adaptation, then analysed it thematically using the Cultural Treatment Adaptation Framework then adapted it in English and into Urdu. Facilitators then delivered START individually to carers (phase two; n = 13 South Asian; n = 8 Black). We assessed acceptability and feasibility through the number of sessions attended, score for fidelity to the intervention and interviewing family carers about their experiences. We used the Hospital Anxiety and Depression Scale. to examine whether immediate changes in family carers' mental health were in line with previous studies. RESULTS In phase one we made adaptations to peripheral elements of START, clarifying language, increasing illustrative vignettes numbers, emphasising privacy and the facilitator's cultural competence and making images ethnically diverse. In phase two 21 family carers consented to receive the adapted intervention; 12 completed ≥5/8 sessions; four completed fewer sessions and five never started. Baseline HADS score (n = 21) was 14.4 (SD = 9.8) but for those who we were able to follow up was 12.3 (SD 8.1) and immediately post-intervention was 11.3 (n = 10; SD = 6.1). Family carers were positive about the adapted START and continued to use elements after the intervention. CONCLUSIONS Culturally adapted START was acceptable and feasible in South Asian and Black UK-based family carers and changes in mental health were in line with those in the original clinical trial. Our study shows that culturally inclusive START was also acceptable. Changes made in adaptations were relevant to all populations. We now use the adapted version for all family carers irrespective of ethnicity.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, UCL, London, UK.,Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Penny Rapaport
- Division of Psychiatry, UCL, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Naaheed Mukadam
- Division of Psychiatry, UCL, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Andrew Sommerlad
- Division of Psychiatry, UCL, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | - Kathryn Lord
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Trishna Bharadia
- Patient and Public Representative & Patient Author, Buckinghamshire, UK
| | | | - Iain Lang
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Gill Livingston
- Division of Psychiatry, UCL, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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Koren T, Fisher E, Webster L, Livingston G, Rapaport P. Prevalence of sleep disturbances in people with dementia living in the community: A systematic review and meta-analysis. Ageing Res Rev 2023; 83:101782. [PMID: 36356799 DOI: 10.1016/j.arr.2022.101782] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to systematically review and meta-analyse the prevalence of sleep disturbances in people with dementia and examine demographic predictors and whether overall prevalence has changed over time. We searched Embase, MEDLINE and PsycINFO for studies reporting the prevalence of sleep disturbances in people with dementia living at home. We meta-analysed the data and calculated the pooled prevalence of sleep disturbances in people with dementia overall and in dementia subtypes. We used meta-regressions to investigate the effects of study characteristics, publication dates and participant demographics. Eleven studies fulfilled the inclusion criteria. The pooled prevalence of any symptoms of sleep disturbance was 26 % (95 % confidence intervals, CI: 23-30 %; n = 2719) and of clinically significant sleep disturbance 19 % (13-25 %; n = 2753). The pooled prevalence of sleep disturbance symptoms was significantly lower among people with Alzheimer's disease (24 %; 16-33 %, n = 310) than Lewy body dementia (49 %; 37-61 %, n = 65). Meta-regression analysis did not find that publication year, participant's age, sex and study quality predicted prevalence. Sleep disturbances are common among people with dementia living in the community, especially in Lewy body dementia. There was no change in prevalence according to publication dates, suggesting treatment has not improved over time.
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Affiliation(s)
- Tala Koren
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Emily Fisher
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London WC1H 0AP, UK.
| | - Lucy Webster
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Gill Livingston
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Penny Rapaport
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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Webster L, Norman C, Jones G, Marriott M. Mediating role for metacognitive processes in the relationship between schizotypy and anxiety and depression symptoms. Cogn Neuropsychiatry 2022; 27:393-410. [PMID: 35975632 DOI: 10.1080/13546805.2022.2108388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Depression and anxiety symptoms are highly prevalent in schizophrenia-spectrum disorders and are commonly associated with schizotypy in non-clinical samples. However, it remains unclear what factors could be contributing to the relationships between schizotypy and anxiety and depression symptoms. Using path analysis, we explored the complex interplay between schizotypy, metacognitive beliefs, cognitive insight, and symptoms of emotional distress.Methods: Self-report data of schizotypy, metacognitive beliefs, cognitive insight, depression, and anxiety symptoms were collected from 344 participants from a predominantly student sample.Results: Path analysis confirmed unique associations between schizotypy dimensions, metacognitive beliefs, and cognitive insight. Furthermore, negative beliefs about worry mediated the link between the schizotypy dimensions, unusual experiences, cognitive disorganisation, and introvertive anhedonia and both depression and anxiety symptoms. Lack of cognitive confidence also mediated the relationship between cognitive disorganisation and depression symptoms. Finally, the cognitive insight subcomponent self-reflectiveness mediated the relationship between unusual experiences and cognitive disorganisation and anxiety.Conclusions: This study significantly furthers our understanding of the complex relationship between schizotypy, metacognitive processes, and emotional distress. Our findings also provide support for interventions which modify metacognitive beliefs and self-reflectiveness, which may prove beneficial for treatment in clinical settings.
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Affiliation(s)
- Lucy Webster
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Christine Norman
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Gary Jones
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Mike Marriott
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Webster L, Costafreda SG, Powell K, Livingston G. How do care home staff use non-pharmacological strategies to manage sleep disturbances in residents with dementia: The SIESTA qualitative study. PLoS One 2022; 17:e0272814. [PMID: 35944055 PMCID: PMC9362920 DOI: 10.1371/journal.pone.0272814] [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: 09/20/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Sleep disturbances affect 38% of care home residents living with dementia. They are often treated with medication, but non-pharmacological interventions may be safer and effective yet more difficult to implement. In the SIESTA study (Sleep problems In dEmentia: interviews with care home STAff) we explored care home staffs’ experience of managing sleep disturbances in their residents living with dementia. Methods We conducted one-to-one semi-structured interviews in four UK care homes, and purposively recruited a maximum variation sample of 18 nurses and care assistants, who were each interviewed once. We used a topic guide and audio-recorded the interviews. Two researchers independently analysed themes from transcribed interviews. Results Staff used a range of techniques that often worked in improving or preventing residents’ sleep disturbance. During the daytime, staff encouraged residents to eat well, and be physically active and stimulated to limit daytime sleep. In the evening, staff settled residents into dark, quiet, comfortable bedrooms often after a snack. When residents woke at night, they gave them caffeinated tea or food, considered possible pain and discomfort, and reassured residents they were safe. If residents remained unsettled, staff would engage them in activities. They used telecare to monitor night-time risk. Staff found minimising daytime napping difficult, described insufficient staffing at night to attend to reorient and guide awake residents and said residents frequently did not know it was night-time. Conclusions Some common techniques, such as caffeinated drinks, may be counterproductive. Future non-pharmacological interventions should consider practical difficulties staff face in managing sleep disturbances, including struggling to limit daytime napping, identifying residents’ night-time needs, day-night disorientation, and insufficient night-time staffing.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, UCL, London, United Kingdom
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Sergi G. Costafreda
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | | | - Gill Livingston
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- * E-mail:
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11
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Briley PM, Webster L, Boutry C, Cottam WJ, Auer DP, Liddle PF, Morriss R. Resting-state functional connectivity correlates of anxiety co-morbidity in major depressive disorder. Neurosci Biobehav Rev 2022; 138:104701. [PMID: 35598819 DOI: 10.1016/j.neubiorev.2022.104701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/17/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
Major depressive disorder (MDD) is frequently co-morbid with anxiety disorders. The co-morbid state has poorer functional outcomes and greater resistance to first line treatments, highlighting the need for novel treatment targets. This systematic review examined differences in resting-state brain connectivity associated with anxiety comorbidity in young- and middle-aged adults with MDD, with the aim of identifying novel targets for neuromodulation treatments, as these treatments are thought to work partly by altering dysfunctional connectivity pathways. Twenty-one studies met inclusion criteria, including a total of 1292 people with MDD. Only two studies included people with MDD and formally diagnosed co-morbid anxiety disorders; the remainder included people with MDD with dimensional anxiety measurement. The quality of most studies was judged as fair. Results were heterogeneous, partly due to a focus on a small set of connectivity relationships within individual studies. There was evidence for dysconnectivity between the amygdala and other brain networks in co-morbid anxiety, and an indication that abnormalities of default mode network connectivity may play an underappreciated role in this condition.
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Affiliation(s)
- P M Briley
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK; Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
| | - L Webster
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - C Boutry
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - W J Cottam
- NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - D P Auer
- NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - P F Liddle
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - R Morriss
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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12
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Huddart R, Hafeez S, Omar A, Choudhury A, Birtle A, Syndikus I, Hindson B, Varughese M, Henry A, McLaren D, Foroud F, Webster A, McNair H, Tolentino A, Webster L, Gribble H, Philipps L, Nikapota A, Parikh O, Alonzi R, Mahmood R, Hilman S, Rimmer Y, Griffin C, Hall E. OC-0513 Acute toxicity of hypo- and conventionally-fractionated radiosensitised bladder radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Webster L, Costafreda Gonzalez S, Stringer A, Lineham A, Budgett J, Kyle S, Barber J, Livingston G. Measuring the prevalence of sleep disturbances in people with dementia living in care homes: a systematic review and meta-analysis. Sleep 2021; 43:5601416. [PMID: 31633188 PMCID: PMC7157185 DOI: 10.1093/sleep/zsz251] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Study Objectives Sleep disturbances are a feature in people living with dementia, including getting up during the night, difficulty falling asleep, and excessive daytime sleepiness and may precipitate a person with dementia moving into residential care. There are varying estimates of the frequency of sleep disturbances, and it is unknown whether they are a problem for the individual. We conducted the first systematic review and meta-analysis on the prevalence and associated factors of sleep disturbances in the care home population with dementia. Methods We searched Embase, MEDLINE, and PsycINFO (29/04/2019) for studies of the prevalence or associated factors of sleep disturbances in people with dementia living in care homes. We computed meta-analytical estimates of the prevalence of sleep disturbances and used meta-regression to investigate the effects of measurement methods, demographics, and study characteristics. Results We included 55 studies of 22,780 participants. The pooled prevalence on validated questionnaires of clinically significant sleep disturbances was 20% (95% confidence interval, CI 16% to 24%) and of any symptom of sleep disturbance was 38% (95% CI 33% to 44%). On actigraphy using a cutoff sleep efficiency of <85% prevalence was 70% (95% CI 55% to 85%). Staff distress, resident agitation, and prescription of psychotropic medications were associated with sleep disturbances. Studies with a higher percentage of males had a higher prevalence of sleep disturbance. Conclusions Clinically significant sleep disturbances are less common than those measured on actigraphy and are associated with residents and staff distress and the increased prescription of psychotropics. Actigraphy appears to offer no benefit over proxy reports in this population.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
- Corresponding author. Lucy Webster, Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Sergi Costafreda Gonzalez
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Amy Lineham
- University College London Medical School, London, UK
| | - Jessica Budgett
- Division of Psychiatry, University College London, London, UK
| | - Simon Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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14
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SMITH P, Clark K, Bramham K, Seed P, Bass J, Nelson-Piercy C, Chappell L, Webster L. POS-186 AMLODIPINE AS AN ALTERNATIVE ANTIHYPERTENSIVE IN PREGNANCY: A SYSTEMATIC REVIEW. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.198] [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] Open
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15
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Webster L, Martin A, Livingston G. The minimum clinically important difference on the sleep disorders inventory for people with dementia. Int J Geriatr Psychiatry 2020; 35:1418-1423. [PMID: 32725642 DOI: 10.1002/gps.5384] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/05/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Sleep disturbances in dementia causes distress to people with dementia and their family carers and are associated with care home admission. The Sleep Disorders Inventory (SDI) is a validated questionnaire of sleep disturbances in dementia often used to measure treatment effectiveness, but the minimum clinically important difference (MCID) is unknown. METHODS We triangulated three investigative methods to determine the MCID of the SDI. Using data on SDI from a randomised controlled trial (RCT) with 62 participants in an intervention for sleep disorders in dementia, we (1) calculated distribution-based values where MCID = 0.33 of a SD (SD) (2) an anchor based approach using quality of life (measured using DEMQOL-Proxy) as an anchor. We also employed a Delphi consensus process asking 12 clinicians, sleep researchers and family carers to rate which changes on vignettes were equivalent to a MCID. RESULTS We found that 0.33 SD in the SDI = 4.86. Reduction in SDI total score was not significantly correlated with improvement in DEMQOL-Proxy (Pearson's correlation = -0.01; P = 0.96) score. The Delphi consensus required two rounds to reach a consensus and concluded that changes equivalent to three points on the SDI equated to the MCID. CONCLUSIONS Taking into account both the distribution-based values and the Delphi process we used a whole number at the midpoint and judged the minimum clinically important difference MCID to be equal to four points. We note the clinicians and carers opinions from the Delphi process determined the MCID to be lower at three points.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, London, UK
| | - Alice Martin
- Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, London, UK
| | - Gill Livingston
- Division of Psychiatry, Faculty of Brain Sciences, UCL, Maple House, London, UK
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Hurrell A, Beardmore-Gray A, Duhig K, Webster L, Chappell LC, Shennan AH. Placental growth factor in suspected preterm pre-eclampsia: a review of the evidence and practicalities of implementation. BJOG 2020; 127:1590-1597. [PMID: 32701207 DOI: 10.1111/1471-0528.16425] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 11/29/2022]
Abstract
Despite extensive research, the pathophysiology and prevention of pre-eclampsia remain elusive, diagnosis is challenging, and pre-eclampsia remains associated with adverse maternal and perinatal outcomes. Angiogenic biomarkers, including placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1), have been identified as valuable biomarkers for preterm pre-eclampsia, accelerating diagnosis and reducing maternal adverse outcomes by risk stratification, with enhanced surveillance for high-risk women. PlGF-based testing is increasingly being implemented in clinical practice in several countries. This review provides healthcare providers with an understanding of the evidence for PlGF-based testing and describes the practicalities and challenges to implementation. TWEETABLE ABSTRACT: Placental growth factor in pre-eclampsia: evidence and implementation of testing.
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Affiliation(s)
- A Hurrell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A Beardmore-Gray
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - K Duhig
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L Webster
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - L C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Morriss R, Webster L, Abdelghani M, Auer DP, Barber S, Bates P, Blamire A, Briley PM, Brookes C, Iwabuchi S, James M, Kaylor-Hughes C, Lankappa S, Liddle P, McAllister-Williams H, O'Neill-Kerr A, Pszczolkowski Parraguez S, Suazo Di Paola A, Thomson L, Walters Y. Connectivity guided theta burst transcranial magnetic stimulation versus repetitive transcranial magnetic stimulation for treatment-resistant moderate to severe depression: study protocol for a randomised double-blind controlled trial (BRIGhTMIND). BMJ Open 2020; 10:e038430. [PMID: 32641367 PMCID: PMC7342821 DOI: 10.1136/bmjopen-2020-038430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The BRIGhTMIND study aims to determine the clinical effectiveness, cost-effectiveness and mechanism of action of connectivity guided intermittent theta burst stimulation (cgiTBS) versus standard repetitive transcranial magnetic stimulation (rTMS) in adults with moderate to severe treatment resistant depression. METHODS AND ANALYSIS The study is a randomised double-blind controlled trial with 1:1 allocation to either 20 sessions of (1) cgiTBS or (2) neuronavigated rTMS not using connectivity guidance. A total of 368 eligible participants with a diagnosis of current unipolar major depressive disorder that is both treatment resistant (defined as scoring 2 or more on the Massachusetts General Hospital Staging Score) and moderate to severe (scoring >16 on the 17-item Hamilton Depression Rating Scale (HDRS-17)), will be recruited from primary and secondary care settings at four treatment centres in the UK. The primary outcome is depression response at 16 weeks (50% or greater reduction in HDRS-17 score from baseline). Secondary outcomes include assessments of self-rated depression, anxiety, psychosocial functioning, cognition and quality of life at 8, 16 and 26 weeks postrandomisation. Cost-effectiveness, patient acceptability, safety, mechanism of action and predictors of response will also be examined. ETHICS AND DISSEMINATION Ethical approval was granted by East Midlands Leicester Central Research Ethics Committee (ref: 18/EM/0232) on 30 August 2018. The results of the study will be published in relevant peer-reviewed journals, and then through professional and public conferences and media. Further publications will explore patient experience, moderators and mediators of outcome and mechanism of action. TRIAL REGISTRATION NUMBER ISRCTN19674644.
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Affiliation(s)
| | - Lucy Webster
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, Nottingham, UK
| | | | - Dorothee P Auer
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, Nottinghamshire, UK
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Shaun Barber
- University of Leicester, Leicester, Leicestershire, UK
| | | | - Andrew Blamire
- University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, UK
| | - Paul M Briley
- University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Cassandra Brookes
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | | | - Marilyn James
- School of Medicine, University of Nottingham, nottingham, UK
| | | | - Sudheer Lankappa
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, Nottingham, UK
| | - Peter Liddle
- University of Nottingham, Nottingham, Nottinghamshire, UK
| | | | - Alex O'Neill-Kerr
- Northamptonshire Healthcare NHS Foundation Trust, Kettering, Northamptonshire, UK
| | | | | | | | - Yvette Walters
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
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18
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Zhao X, Shah D, Gandhi K, Wei W, Dwibedi N, Webster L, Sambamoorthi U. Clinical, humanistic, and economic burden of osteoarthritis among noninstitutionalized adults in the United States. Osteoarthritis Cartilage 2019; 27:1618-1626. [PMID: 31299387 DOI: 10.1016/j.joca.2019.07.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/18/2019] [Accepted: 07/02/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the burden of osteoarthritis (OA) among noninstitutionalized adults (≥18 years of age) in the US. DESIGN Weighted nationally representative data from the 2015 Medical Expenditure Panel Survey were used to estimate OA prevalence in noninstitutionalized adults and compare adults with OA to those without OA for clinical (pain interference with activities [PIA], functional limitations), humanistic (health-related quality-of-life [HRQoL]) and economic outcomes (healthcare costs, wage loss). Productivity/wage loss was estimated among employed working-age adults (18-64 years). Multivariable regression analyses examined the associations between OA and outcomes. RESULTS In 2015, 10.5% (25.6 million) of noninstitutionalized US adults reported having any OA. Regression analyses indicated that adults with OA were significantly more likely than those without OA to report moderate (adjusted odds ratios [AOR] 1.99; 95% confidence interval [CI] 1.65-2.40] or severe PIA (AOR 2.59; 95% CI 2.21-3.04), any functional limitation (AOR 2.51; 95% CI 2.21-2.85), and poorer HRQoL on the SF-12 version 2 Physical Component Summary score (adjusted beta [standard error] -3.88 [0.357]; P < 0.001). Adjusted incremental annual total healthcare costs and lost wages among adults with OA relative to those without OA were $1778 and $189 per person, respectively, resulting in estimated national excess costs of $45 billion and $1.7 billion, respectively. CONCLUSIONS OA affects approximately 10% of noninstitutionalized adults in the US, resulting in substantial clinical, humanistic, and economic burdens.
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Affiliation(s)
- X Zhao
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA.
| | - D Shah
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA.
| | - K Gandhi
- Teva Pharmaceutical Industries, Frazer, PA, USA.
| | - W Wei
- Regeneron Pharmaceuticals, Tarrytown, NY, USA.
| | - N Dwibedi
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA.
| | - L Webster
- PRA Health Sciences, Salt Lake City, UT, USA.
| | - U Sambamoorthi
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA.
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19
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Agate FT, Wong RE, Gordon I, Webster L, Karr J, Garcia-Barrera MA. Emotional Control is Predicted by Brain Reward Processing in Athletes with Previous Concussions. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz026.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
Limited research examines how electrophysiological markers of reward sensitivity in athletes with concussion history may relate to corresponding executive behavior. Therefore, the present study aimed to examine the relationship between event-related brain potentials (ERPs) elicited during a reward-processing task, and self-report of emotional control and initiation problems in athletes with and without a history of concussion.
Methods
A total of 38 collegiate athletes (53% females, ages 18-27 years) completed a reward task in a “virtual T-maze” environment, as well as the BRIEF-A. The reward positivity (RewP), an ERP component associated with reward processing, was regressed on endorsement of emotional control and initiation problems in athletes with a history of concussion (n=16) and in athletes with no concussion history (n=22).
Results
A multiple regression analysis showed that in the concussion group, RewP peak amplitude explained a significant proportion of variance in emotional control, r2=.36, F(1,13)=6.76, p=.02, but did not for initiation, r2=.05, F(1,13)=.60, p>.05. For athletes with no history of concussion, RewP peak amplitude did not explain a significant proportion of variance in either emotional control, r2=.003, F(1,21)=.05, p>.05, or initiation, r2=.11, F(1,21)=2.49, p=.13.
Conclusion
Results indicate that for athletes with a history of concussion, a lower electrophysiological response to reward may predict greater problems concerning emotional control. Potential implications are discussed for how decision-making, an integral cognitive process driven by reward processing, might impact emotional regulation following concussion.
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20
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Wadman R, Webster L, Mawn L, Stain H. Adult attachment, psychological distress and help-seeking in university students: Findings from a cross-sectional online survey in England. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mhp.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kinnunen KM, Rapaport P, Webster L, Barber J, Kyle SD, Hallam B, Cooper C, Horsley R, Pickett JA, Vikhanova A, Espie CA, Livingston G. A manual-based intervention for carers of people with dementia and sleep disturbances: an acceptability and feasibility RCT. Health Technol Assess 2018; 22:1-408. [PMID: 30538021 DOI: 10.3310/hta22710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been estimated that between 25% and 40% of people living with dementia suffer from sleep disturbances, and there are currently no known effective treatments. Sleep disturbances may be the direct result of dementia or due to other comorbidities, such as pain and limited mobility. If carers' sleep is also disturbed, carers too can become tired and stressed, and this sometimes results in the breakdown of care in the home. OBJECTIVES To design an evidence-based manualised non-pharmacological therapy for sleep disturbances and test it for feasibility and acceptability. DESIGN A single-blind, randomised, parallel-group feasibility trial, with participants randomised 2 : 1 to intervention or treatment as usual (TAU). SETTING Five memory services in two London NHS trusts and Join Dementia Research (JDR). PARTICIPANTS The study recruited people with dementia and sleep disturbances (who scored ≥ 4 on at least one question on the Sleep Disorders Inventory) and their primary family carers. INTERVENTION All participants were given an Actiwatch (CamNtech Ltd, Cambridge, UK) to wear to record their sleep patterns for 2 weeks before randomisation. The intervention group received Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS START). This was designed as a six-session, manual-based intervention for carers of people with dementia, delivered by trained and clinically supervised psychology graduates, based on evidence about managing sleep disturbance in people with dementia. It uses the structure of a previous manual-based treatment, STrAtegies for RelaTives (START). Family carers were consulted about structure, content and design. Sessions were interactive, and each involved techniques, tasks to practise between sessions, relaxation and a recapitulation on the previous session. The sessions covered understanding sleep and dementia, making a plan (incorporating information from Actiwatch read-outs and a light box to increase light), daytime activity and routine, difficult night-time behaviours, taking care of your own (carer's) sleep and using the strategies in the future. Carers kept their own manual, light box and relaxation recordings post intervention. RANDOMISATION AND BLINDING A statistician created an electronic randomisation list, stratified by site, using random permuted blocks. Those assessing the outcome were blinded to allocation; participants were not blinded. MAIN OUTCOME MEASURES Outcomes were assessed at 3 months. (1) Feasibility, defined as the percentage of eligible people who consented to the study recruitment, with an expected value of 50% [95% confidence interval (CI) 41% to 59%]. (2) Acceptability, defined as the percentage of intervention group participants attending ≥ 4 intervention sessions, with an expected value of 75% (95% CI 59% to 87%). The predetermined criterion for progression to the main trial was acceptability of ≥ 70%. RESULTS Of 95 eligible patients referred, 63 (66%, 95% CI 56% to 76%) consented between 4 August 2016 and 24 March 2017: 61 from memory clinics and two from JDR. Of these, 62 participants (65%, 95% CI 55% to 75%) were randomised: 42 to the intervention arm and 20 to the TAU arm. Thirty-seven out of 42 participants (88%, 95% CI 75% to 96%) adhered to the intervention. CONCLUSIONS The results show that the randomised controlled trial is feasible and that the intervention is acceptable. A higher than expected proportion of eligible patients referred consented to the study and adhered to the intervention. LIMITATIONS Participants were not blinded and were recruited only in London. FUTURE WORK The results of this trial indicate that a future efficacy trial is warranted. TRIAL REGISTRATION Current Controlled Trials ISCTRN36983298. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 71. See the NIHR Journals Library website for further project information. Funding was also provided by Camden and Islington NHS Foundation Trust and Barnet, Enfield and Haringey Mental Health NHS Trust to pay for excess treatment costs from therapist training and supervision and intervention delivery.
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Affiliation(s)
- Kirsi M Kinnunen
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Lucy Webster
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, Faculty of Mathematical & Physical Sciences, University College London, London, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Brendan Hallam
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Claudia Cooper
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.,Services for Ageing and Mental Health, Camden and Islington NHS Foundation Trust, London, UK
| | | | | | - Anastasia Vikhanova
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gill Livingston
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK.,Services for Ageing and Mental Health, Camden and Islington NHS Foundation Trust, London, UK
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22
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Rapaport P, Webster L, Horsley R, Kyle SD, Kinnunen KM, Hallam B, Pickett J, Cooper C, Espie CA, Livingston G. An intervention to improve sleep for people living with dementia: Reflections on the development and co-production of DREAMS:START (Dementia RElAted Manual for Sleep: STrAtegies for RelaTives). Dementia 2018; 17:976-989. [DOI: 10.1177/1471301218789559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many people living with dementia experience sleep disturbances yet there are currently no known effective, safe and acceptable treatments. Working with those affected by dementia to co-produce interventions is increasingly promoted to ensure that approaches are fit for purpose and meet the specific needs of target groups. Our aim here is to outline and reflect upon the co-production of Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS:START), an intervention to improve sleep for people living with dementia. Our co-production team brought together experts in the development and testing of manualised interventions in dementia care and cognitive behavioural interventions for sleep disorders, with Alzheimer’s Society research network volunteers (ASRNVs) whose lives had been affected by dementia. Here we present the process of intervention development. We worked with (ASRNVs) at each stage of the process bringing together ‘experts by training’ and ‘experts by experience’. (ASRNVs)shared their experiences of sleep disturbances in dementia and how they had managed these difficulties, as well as suggestions for how to overcome barriers to putting the intervention into practice; making (DREAMS:START) more accessible and usable for those in need. In this paper we discuss both the benefits and challenges to this process and what we can learn for future work. Collaborating with ‘experts by experience’ caring for a relative with sleep difficulties helped us to develop a complex intervention in an accessible and engaging way which we have tested and found to be feasible and acceptable in a randomised controlled trial.
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23
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Webster L, Russell M, Shepherd N, Packer G, Dalgarno EJ, Neat F. Monitoring of Polycyclic Aromatic Hydrocarbons (PAHs) in Scottish Deepwater environments. Mar Pollut Bull 2018; 128:456-459. [PMID: 29571396 DOI: 10.1016/j.marpolbul.2018.01.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs) were measured in environmental samples (sponges, fish and sediment) collected in 2014 and 2016 from the Faroe-Shetland Channel and Rosemary Bank Seamount. These data could be used to provide a baseline against which any changes can be assessed in the event of an oil spill and contribute to any environmental impact assessment. Concentrations in all samples were low, often below the detection limits, and were typical of reference sites. Sponges can be used as an alternative indicator species to mussels for monitoring PAHs in the marine environment as they can accumulate PAHs from both the dissolved and particulate phase. PAH concentrations in marine sponges from Scottish waters have not previously been reported. Concentrations were low, but contained a higher proportion of heavier 4- to 6-ring PAHs compared to the fish samples.
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Affiliation(s)
- L Webster
- Marine Scotland Science, Marine Laboratory, 375 Victoria Road, Aberdeen AB11 9DB, United Kingdom.
| | - M Russell
- Marine Scotland Science, Marine Laboratory, 375 Victoria Road, Aberdeen AB11 9DB, United Kingdom
| | - N Shepherd
- Marine Scotland Science, Marine Laboratory, 375 Victoria Road, Aberdeen AB11 9DB, United Kingdom
| | - G Packer
- Marine Scotland Science, Marine Laboratory, 375 Victoria Road, Aberdeen AB11 9DB, United Kingdom
| | - E J Dalgarno
- Marine Scotland Science, Marine Laboratory, 375 Victoria Road, Aberdeen AB11 9DB, United Kingdom
| | - F Neat
- Marine Stewardship Council, Marine House, 1 Snow Hill, London EC1A 2DH, United Kingdom
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Webster L, Groskreutz D, Grinbergs-Saull A, Howard R, O’Brien JT, Mountain G, Banerjee S, Woods B, Perneczky R, Lafortune L, Roberts C, McCleery J, Pickett J, Bunn F, Challis D, Charlesworth G, Featherstone K, Fox C, Goodman C, Jones R, Lamb S, Moniz-Cook E, Schneider J, Shepperd S, Surr C, Thompson-Coon J, Ballard C, Brayne C, Burns A, Clare L, Garrard P, Kehoe P, Passmore P, Holmes C, Maidment I, Robinson L, Livingston G. Core outcome measures for interventions to prevent or slow the progress of dementia for people living with mild to moderate dementia: Systematic review and consensus recommendations. PLoS One 2017; 12:e0179521. [PMID: 28662127 PMCID: PMC5491018 DOI: 10.1371/journal.pone.0179521] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 11/16/2016] [Accepted: 05/31/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There are no disease-modifying treatments for dementia. There is also no consensus on disease modifying outcomes. We aimed to produce the first evidence-based consensus on core outcome measures for trials of disease modification in mild-to-moderate dementia. METHODS AND FINDINGS We defined disease-modification interventions as those aiming to change the underlying pathology. We systematically searched electronic databases and previous systematic reviews for published and ongoing trials of disease-modifying treatments in mild-to-moderate dementia. We included 149/22,918 of the references found; with 81 outcome measures from 125 trials. Trials involved participants with Alzheimer's disease (AD) alone (n = 111), or AD and mild cognitive impairment (n = 8) and three vascular dementia. We divided outcomes by the domain measured (cognition, activities of daily living, biological markers, neuropsychiatric symptoms, quality of life, global). We calculated the number of trials and of participants using each outcome. We detailed psychometric properties of each outcome. We sought the views of people living with dementia and family carers in three cities through Alzheimer's society focus groups. Attendees at a consensus conference (experts in dementia research, disease-modification and harmonisation measures) decided on the core set of outcomes using these results. Recommended core outcomes were cognition as the fundamental deficit in dementia and to indicate disease modification, serial structural MRIs. Cognition should be measured by Mini Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale. MRIs would be optional for patients. We also made recommendations for measuring important, but non-core domains which may not change despite disease modification. LIMITATIONS Most trials were about AD. Specific instruments may be superseded. We searched one database for psychometric properties. INTERPRETATION This is the first review to identify the 81 outcome measures the research community uses for disease-modifying trials in mild-to-moderate dementia. Our recommendations will facilitate designing, comparing and meta-analysing disease modification trials in mild-to-moderate dementia, increasing their value. TRIAL REGISTRATION PROSPERO no. CRD42015027346.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, United Kingdom
| | - Derek Groskreutz
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | | | - Rob Howard
- Division of Psychiatry, University College London, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Gail Mountain
- ScHARR, University of Sheffield, Sheffield, United Kingdom
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, United Kingdom
| | - Robert Perneczky
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Jenny McCleery
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, United Kingdom
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Katie Featherstone
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, United Kingdom
| | - Roy Jones
- Research Institute for the Care of Older People (RICE), University of Bath, Bath, United Kingdom
| | - Sarah Lamb
- Warwick Clinical Trials Research Unit, University of Warwick, Warwick, United Kingdom
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, University of Hull, Hull, United Kingdom
| | - Justine Schneider
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claire Surr
- School of Health & Community Studies, Leeds Beckett University, Leeds, United Kingdom
| | - Jo Thompson-Coon
- PenCLAHRC, University of Exeter Medical School, Exeter, United Kingdom
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, United Kingdom
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Linda Clare
- PenCLAHRC, University of Exeter Medical School, Exeter, United Kingdom
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Peter Garrard
- Neuroscience Research Centre, St. George's, University of London, London, United Kingdom
| | - Patrick Kehoe
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Clive Holmes
- School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ian Maidment
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, United Kingdom
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
- North Thames CLAHRC, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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Webster L, Groskreutz D, Grinbergs-Saull A, Howard R, O'Brien JT, Mountain G, Banerjee S, Woods B, Perneczky R, Lafortune L, Roberts C, McCleery J, Pickett J, Bunn F, Challis D, Charlesworth G, Featherstone K, Fox C, Goodman C, Jones R, Lamb S, Moniz-Cook E, Schneider J, Shepperd S, Surr C, Thompson-Coon J, Ballard C, Brayne C, Burke O, Burns A, Clare L, Garrard P, Kehoe P, Passmore P, Holmes C, Maidment I, Murtagh F, Robinson L, Livingston G. Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations. Health Technol Assess 2017; 21:1-192. [PMID: 28625273 PMCID: PMC5494514 DOI: 10.3310/hta21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 02/06/2023] Open
Abstract
BACKGROUND There is currently no disease-modifying treatment available to halt or delay the progression of the disease pathology in dementia. An agreed core set of the best-available and most appropriate outcomes for disease modification would facilitate the design of trials and ensure consistency across disease modification trials, as well as making results comparable and meta-analysable in future trials. OBJECTIVES To agree a set of core outcomes for disease modification trials for mild to moderate dementia with the UK dementia research community and patient and public involvement (PPI). DATA SOURCES We included disease modification trials with quantitative outcomes of efficacy from (1) references from related systematic reviews in workstream 1; (2) searches of the Cochrane Dementia and Cognitive Improvement Group study register, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Latin American and Caribbean Health Sciences Literature and PsycINFO on 11 December 2015, and clinical trial registries [International Standard Randomised Controlled Trial Number (ISRCTN) and clinicaltrials.gov] on 22 and 29 January 2016; and (3) hand-searches of reference lists of relevant systematic reviews from database searches. REVIEW METHODS The project consisted of four workstreams. (1) We obtained related core outcome sets and work from co-applicants. (2) We systematically reviewed published and ongoing disease modification trials to identify the outcomes used in different domains. We extracted outcomes used in each trial, recording how many used each outcome and with how many participants. We divided outcomes into the domains measured and searched for validation data. (3) We consulted with PPI participants about recommended outcomes. (4) We presented all the synthesised information at a conference attended by the wider body of National Institute for Health Research (NIHR) dementia researchers to reach consensus on a core set of outcomes. RESULTS We included 149 papers from the 22,918 papers screened, referring to 125 individual trials. Eighty-one outcomes were used across trials, including 72 scales [31 cognitive, 12 activities of daily living (ADLs), 10 global, 16 neuropsychiatric and three quality of life] and nine biological techniques. We consulted with 18 people for PPI. The conference decided that only cognition and biological markers are core measures of disease modification. Cognition should be measured by the Mini Mental State Examination (MMSE) or the Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog), and brain changes through structural magnetic resonance imaging (MRI) in a subset of participants. All other domains are important but not core. We recommend using the Neuropsychiatric Inventory for neuropsychiatric symptoms: the Disability Assessment for Dementia for ADLs, the Dementia Quality of Life Measure for quality of life and the Clinical Dementia Rating scale to measure dementia globally. LIMITATIONS Most of the trials included participants with Alzheimer's disease, so recommendations may not apply to other types of dementia. We did not conduct economic analyses. The PPI consultation was limited to members of the Alzheimer's Society Research Network. CONCLUSIONS Cognitive outcomes and biological markers form the core outcome set for future disease modification trials, measured by the MMSE or ADAS-Cog, and structural MRI in a subset of participants. FUTURE WORK We envisage that the core set may be superseded in the future, particularly for other types of dementia. There is a need to develop an algorithm to compare scores on the MMSE and ADAS-Cog. STUDY REGISTRATION The project was registered with Core Outcome Measures in Effectiveness Trials [ www.comet-initiative.org/studies/details/819?result=true (accessed 7 April 2016)]. The systematic review protocol is registered as PROSPERO CRD42015027346. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Lucy Webster
- Division of Psychiatry, University College London, London, UK
| | - Derek Groskreutz
- Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Rob Howard
- Division of Psychiatry, University College London, London, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gail Mountain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sube Banerjee
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Bob Woods
- Dementia Services Development Centre Wales, Bangor University, Bangor, UK
| | - Robert Perneczky
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, UK
| | | | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Georgina Charlesworth
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | | | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Roy Jones
- Research Institute for the Care of Older People, University of Bath, Bath, UK
| | - Sallie Lamb
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Justine Schneider
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Surr
- School of Health & Community Studies, Leeds Beckett University, Leeds, UK
| | - Jo Thompson-Coon
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter, Exeter, UK
| | - Clive Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Orlaith Burke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alistair Burns
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Clare
- Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter, Exeter, UK
- School of Psychology, University of Exeter, Exeter, UK
- Centre for Research in Ageing and Cognitive Health, University of Exeter Medical School, Exeter, UK
| | - Peter Garrard
- Neuroscience Research Centre, St George's, University of London, UK
| | - Patrick Kehoe
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Clive Holmes
- School of Medicine, University of Southampton, Southampton, UK
| | - Ian Maidment
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - Fliss Murtagh
- Cicely Saunders Institute, King's College London, London, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
- North Thames Collaboration for Leadership in Applied Health Research and Care, London, UK
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Nunez DJ, Yao X, Lin J, Walker A, Zuo P, Webster L, Krug-Gourley S, Zamek-Gliszczynski MJ, Gillmor DS, Johnson SL. Glucose and lipid effects of the ileal apical sodium-dependent bile acid transporter inhibitor GSK2330672: double-blind randomized trials with type 2 diabetes subjects taking metformin. Diabetes Obes Metab 2016; 18:654-62. [PMID: 26939572 DOI: 10.1111/dom.12656] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/10/2016] [Accepted: 02/27/2016] [Indexed: 12/15/2022]
Abstract
AIMS To investigate the pharmacodynamics, pharmacokinetics and safety/tolerability of blocking reuptake of bile acids using the inhibitor GSK2330672 (GSK672) in patients with type 2 diabetes (T2D). METHODS Subjects with T2D taking metformin were enrolled in two studies in which they took metformin 850 mg twice daily for 2 weeks prior to and during the randomized treatment periods. In the first crossover study (n = 15), subjects received GSK672 45 mg, escalating to 90 mg, twice daily, or placebo for 7 days. The second parallel-group study (n = 75) investigated GSK672 10-90 mg twice daily, placebo or sitagliptin for 14 days. RESULTS In both studies, GSK672 reduced circulating bile acids and increased serum 7-α-hydroxy-4-cholesten-3-one (C4), an intermediate in the hepatic synthesis of bile acids. Compared with placebo, in the parallel-group study 90 mg GSK672 twice daily reduced fasting plasma glucose [FPG; -1.21 mmol/l; 95% confidence interval (CI) -2.14, -0.28] and weighted-mean glucose area under the curve (AUC)0-24 h (-1.33 mmol/l; 95% CI -2.30, -0.36), as well as fasting and weighted-mean insulin AUC0 -24 h . GSK672 also reduced cholesterol (LDL, non-HDL and total cholesterol) and apolipoprotein B concentrations; the maximum LDL cholesterol reduction was ∼40%. There was no change in HDL cholesterol but there was a trend towards increased fasting triglyceride levels in the GSK672 groups compared with placebo. In both studies, the most common adverse events associated with GSK672 were gastrointestinal, mostly diarrhoea (22-100%), which appeared to be independent of dose. CONCLUSIONS In subjects with T2D on metformin, GSK672 improved glucose and lipids, but there was a high incidence of gastrointestinal adverse events.
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Affiliation(s)
- D J Nunez
- GlaxoSmithKline plc, Research Triangle Park, NC and Collegeville, PA, USA
| | - X Yao
- Alexion Pharmaceuticals, Inc., Cambridge, MA, USA
| | - J Lin
- Grifols Therapeutics Inc., Research Triangle Park, NC, USA
| | - A Walker
- GlaxoSmithKline plc, Research Triangle Park, NC and Collegeville, PA, USA
| | - P Zuo
- Parexel International, Durham, NC, USA
| | | | - S Krug-Gourley
- GlaxoSmithKline plc, Research Triangle Park, NC and Collegeville, PA, USA
| | | | - D S Gillmor
- Pharmaceutical Product Development LLC, Morrisville, NC, USA
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27
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Negretti GS, Amin R, Webster L, Egan CA. Does delay in referral of proliferative diabetic retinopathy from the diabetic eye screening programme lead to visual loss? Eye (Lond) 2016; 30:873-6. [PMID: 27055673 DOI: 10.1038/eye.2016.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/02/2016] [Indexed: 11/09/2022] Open
Abstract
AimsTo ascertain the effect on visual acuity (VA) of a delay in Hospital Eye Service (HES) consultation for patients referred with proliferative diabetic retinopathy (PDR; R3) from the Diabetic Eye Screening Programme (DESP).MethodsAll patients referred to Moorfields Eye Hospital from DESP between April and December 2013 with a referral diagnosis of PDR in at least one eye were eligible. Screening programme VA was compared with VA at first HES appointment and final follow-up appointment. Reasons for any VA loss were noted.ResultsA total of 86 patients were included. Of these, 28 (33%) were seen in more than 4 weeks after their DESP referral. At first HES appointment, 39 (45%) patients were graded as having active PDR in at least one eye. Delay in referral did not significantly predict the likelihood of vision loss in all patients referred (χ(2), P=0.49) or in just those patients with a definitive HES diagnosis of active PDR (χ(2), P=1.00). In only 3 patients with active PDR was a delay in presentation thought to have led directly to VA loss.ConclusionsThere may be minimal short-term visual consequence in several weeks of delayed referral for many patients with a diagnosis of R3. However, the national guidance remains important. This is due to the occasional patient at very high risk of vision loss and the many gains for the patients in terms of time to properly assess medical and ocular conditions and counsel and consent them for treatment where necessary.
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Affiliation(s)
- G S Negretti
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - R Amin
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - L Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - C A Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Webster L, Nagata T, Yamada T, Arjona Ferreira J. (479) A phase 2a, randomized, double-blind, placebo-controlled, single ascending-dose study to evaluate the safety and efficacy of naldemedine in patients with chronic non-cancer pain and opioid-induced bowel dysfunction. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Griffin M, Seed PT, Webster L, Myers J, MacKillop L, Simpson N, Anumba D, Khalil A, Denbow M, Sau A, Hinshaw K, von Dadelszen P, Benton S, Girling J, Redman CWG, Chappell LC, Shennan AH. Diagnostic accuracy of placental growth factor and ultrasound parameters to predict the small-for-gestational-age infant in women presenting with reduced symphysis-fundus height. Ultrasound Obstet Gynecol 2015; 46:182-190. [PMID: 25826778 PMCID: PMC4744762 DOI: 10.1002/uog.14860] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 11/27/2014] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH). METHODS This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) < 10(th) centile, umbilical artery Doppler pulsatility index > 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination. RESULTS Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3(rd) centile (n = 78), EFW < 10(th) centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value (NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%); in combination, PlGF and EFW < 10(th) centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10(th) centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination. CONCLUSIONS For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3(rd) centile. PlGF performed no better than EFW < 10(th) centile in determining delivery of a SGA infant.
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Affiliation(s)
- M. Griffin
- Women's Health Academic CentreKing's College LondonLondonUK
| | - P. T. Seed
- Women's Health Academic CentreKing's College LondonLondonUK
| | - L. Webster
- Women's Health Academic CentreKing's College LondonLondonUK
| | - J. Myers
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
| | | | - N. Simpson
- Section of Obstetrics & Gynaecology, Institute of Biochemical & Clinical SciencesUniversity of LeedsLeedsUK
| | - D. Anumba
- Academic Unit of Reproductive and Developmental MedicineUniversity of SheffieldSheffieldUK
| | - A. Khalil
- St George's Hospital Medical SchoolUniversity of LondonLondonUK
| | | | - A. Sau
- University HospitalLewishamLondonUK
| | | | - P. von Dadelszen
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - S. Benton
- Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
| | - J. Girling
- West Middlesex University HospitalIsleworthMiddlesexUK
| | - C. W. G. Redman
- Nuffield Department of Obstetrics and GynaecologyUniversity of OxfordOxfordUK
| | - L. C. Chappell
- Women's Health Academic CentreKing's College LondonLondonUK
| | - A. H. Shennan
- Women's Health Academic CentreKing's College LondonLondonUK
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Bond M, Schoedel K, Rabinovich-Guilatt L, Gasior M, Malamut R, Ma M, Webster L. (425) Evaluation of the relative intranasal abuse potential of a hydrocodone extended-release tablet formulated with abuse-deterrence technology in nondependent, recreational opioid users. The Journal of Pain 2015. [DOI: 10.1016/j.jpain.2015.01.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hezelgrave NL, Anderson-Knight H, Webster L, Shennan AH. Commentary on ‘A multicentre randomised controlled trial comparing elective and selective caesarean section for the delivery of the preterm breech infant’. BJOG 2014; 121 Suppl 7:54-7. [DOI: 10.1111/1471-0528.13155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- NL Hezelgrave
- Division of Women's Health; King's College; London UK
| | | | - L Webster
- Division of Women's Health; King's College; London UK
| | - AH Shennan
- Division of Women's Health; King's College; London UK
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Webster L, Chey WD, Tack J, Lappalainen J, Diva U, Sostek M. Randomised clinical trial: the long-term safety and tolerability of naloxegol in patients with pain and opioid-induced constipation. Aliment Pharmacol Ther 2014; 40:771-9. [PMID: 25112584 DOI: 10.1111/apt.12899] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/12/2014] [Accepted: 07/14/2014] [Indexed: 12/08/2022]
Abstract
BACKGROUND Opioid-induced constipation (OIC) is a common adverse effect of opioid therapy. AIM To evaluate the long-term safety and tolerability of naloxegol, an oral, peripherally acting μ-opioid receptor antagonist (PAMORA), in patients with noncancer pain and OIC. METHODS A 52-week, multicenter, open-label, randomised, parallel-group phase 3 study was conducted in out-patients taking 30-1000 morphine-equivalent units per day for ≥4 weeks. Patients were randomised 2:1 to receive naloxegol 25 mg/day or usual-care (UC; investigator-chosen laxative regimen) treatment for OIC. RESULTS The safety set comprised 804 patients (naloxegol, n = 534; UC, n = 270). Mean exposure duration was 268 days with naloxegol and 297 days with UC. Frequency of adverse events (AEs) was 81.8% with naloxegol and 72.2% with UC. Treatment-emergent AEs occurring more frequently for naloxegol vs. UC were abdominal pain (17.8% vs. 3.3%), diarrhoea (12.9% vs. 5.9%), nausea (9.4% vs. 4.1%), headache (9.0% vs. 4.8%), flatulence (6.9% vs. 1.1%) and upper abdominal pain (5.1% vs. 1.1%). Most naloxegol-emergent gastrointestinal AEs occurred early, resolving during or after naloxegol discontinuation and were mild or moderate in severity; 11 patients discontinued due to diarrhoea and nine patients owing to abdominal pain. Pain scores and mean daily opioid doses remained stable throughout the study; no attributable opioid withdrawal AEs were observed. Two patients in each group had an adjudicated major adverse cardiovascular event unrelated to study drug; no AEs were reported nor adjudicated as bowel perforations. CONCLUSION In patients with noncancer pain and opioid-induced constipation, naloxegol 25 mg/day up to 52 weeks was generally safe and well tolerated.
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Affiliation(s)
- L Webster
- PRA Health Sciences, Salt Lake City, UT, USA
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Weber MF, Chiew M, Feletto E, Kahn C, Sitas F, Webster L. Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study. Int J Environ Res Public Health 2014; 11:8251-66. [PMID: 25153460 PMCID: PMC4143860 DOI: 10.3390/ijerph110808251] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 12/23/2022]
Abstract
Over 25% of the Australian population are immigrants, and are less active participants in cancer screening programmes. Most immigrants live in urban areas of Australia, but a significant proportion (~20%), live in regional areas. This study explored differences in cancer screening participation by place of birth and residence. Self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests was obtained from 48,642 immigrants and 141,275 Australian-born participants aged 50 years or older in the 45 and Up Study (New South Wales, Australia 2006-2010). Poisson regression was used to estimate relative risks of test use, adjusting for key socio-demographic characteristics. Overall, immigrants from Asia and Europe were less likely to have had any of the tests in the previous two years than Australian-born participants. Regional Australian-born participants were more likely to have had any of the tests than those living in urban areas. Regional immigrant participants were more likely to have had an FOBT or PSA test than those living in urban areas, but there were no differences in mammograms. This report identifies key immigrant groups in urban and regional areas that policymakers and healthcare providers should target with culturally appropriate information to promote cancer screening.
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Affiliation(s)
- Marianne F Weber
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - May Chiew
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Clare Kahn
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Freddy Sitas
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Lucy Webster
- School of Biomedical Sciences, Charles Sturt University, Boorooma Street, Wagga Wagga, NSW 2650, Australia.
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Webster P, Wardle A, Bramham K, Webster L, Nelson-Piercy C, Lightstone L. Tacrolimus is an effective treatment for lupus nephritis in pregnancy. Lupus 2014; 23:1192-6. [DOI: 10.1177/0961203314540353] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lupus nephritis during pregnancy increases morbidity and mortality for mother and baby. Flares are difficult to treat as many therapeutic options are teratogenic or fetotoxic. Steroids alone may be unable to control disease activity and are associated with higher rates of preterm delivery, sepsis and gestational diabetes. Reports of using tacrolimus to treat lupus nephritis in pregnancy are limited. We describe the pregnancies of nine women in whom tacrolimus was successfully used to treat lupus nephritis flare (six patients) or maintain stable disease (three patients). Introduction or dose escalation of oral steroids was avoided in five of the patients who developed active disease and steroid dose was rapidly reduced in the sixth patient. All women with disease flare attained partial or complete remission after starting tacrolimus. None of the women on maintenance treatment developed active disease. We propose tacrolimus as an effective adjuvant or alternative therapy to steroids for treating lupus nephritis flare or maintaining stable disease during pregnancy.
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Affiliation(s)
- P Webster
- Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK
| | - A Wardle
- Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK
| | - K Bramham
- Division of Women’s Healthy, Women’s Health Academic Centre, King's College London, UK
| | - L Webster
- Division of Women’s Healthy, Women’s Health Academic Centre, King's College London, UK
| | - C Nelson-Piercy
- Division of Women’s Healthy, Women’s Health Academic Centre, King's College London, UK
| | - L Lightstone
- Imperial College Healthcare NHS Trust Lupus Centre, Hammersmith Hospital, London, UK
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Wallace M, Webster L, Rauck R, Rosenblum S, Hokett S, Alvarez-Horine S, Vanhove G. (393) Effect of concomitant antidepressant and anticonvulsant use on adverse events in patients receiving intrathecal ziconotide in a long-term extension study. The Journal of Pain 2014. [DOI: 10.1016/j.jpain.2014.01.304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Murphy R, Ekers D, Webster L. An update to depression case management by practice nurses in primary care: a service evaluation. J Psychiatr Ment Health Nurs 2014; 21:827-33. [PMID: 24673912 DOI: 10.1111/jpm.12153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
Abstract
There is a recognized need to enhance non-pharmaceutical interventions in a way that is more accessible to the primary care population. Collaborative care has been shown to have a positive impact upon depression symptoms and a core element of the collaborative care approach is the case manager. This paper is a service evaluation of a collaborative care intervention that uses primary care nurses as the depression case manager and is a follow-up to the service audit carried out by Ekers and Wilson. The results support the notion that primary care nurses are ideally placed for delivering care to depressed patients; especially in cases were a patient also has a comorbid long-term medical condition. There is a recognized need to enhance non-pharmaceutical interventions for depression in the primary care. This service evaluation of collaborative care for depression by primary care practice nurses is an update of Ekers and Wilson (2008), reporting outcomes 5 years following initial training. From an initial 13 trained practice nurses, three provided anonymized data. Mean post-treatment Patient Health Questionnaire-9 (PHQ9) score was 8 [standard deviation (SD) 6.53, n = 185], indicating a mean positive change in depression symptom level of 8.9 [SD 7.01, 95% confidence interval (CI) 7.89-9.93, P < 0.001]. Subgroup analysis for patients identified with a comorbid long-term conditions (LTC) mean post-treatment PHQ9 score was 9 (SD 7.72, n = 33), indicating a mean positive change in depression symptom level of 8.1 (SD 5.79, 95% CI 6.04-10.41, P < 0.001). Nurses provided feedback on the intervention showing potential areas that would benefit from further detailed qualitative review. It was concluded that primary care practice nurses would be ideally placed to deliver collaborative care to depression patients with comorbid LTCs.
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Affiliation(s)
- R Murphy
- School of Medicine Pharmacy & Health, University of Durham/Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
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Bruce-Low SS, Burnet S, Arber K, Price D, Webster L, Stopforth M. Interactive mobile learning: a pilot study of a new approach for sport science and medical undergraduate students. Adv Physiol Educ 2013; 37:292-297. [PMID: 24292904 DOI: 10.1152/advan.00004.2013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Mobile learning has increasingly become interwoven into the fabric of learning and teaching in the United Kingdom higher education sector, and as technological issues become addressed, this phenomena has accelerated. The aim of the study was to examine whether learning using a mobile learning device (Samsung NC10 Netbook) loaded with interactive exercises promoted learning compared with a traditional library exercise. Using a randomized trial, 55 students from an undergraduate sports science course (n = 28) and medical course (n = 27) volunteered to participate in this study. A mixed-model design ANOVA was used to examine the percent change in test score after a 3-wk intervention. Results showed that there was a significant difference between the two courses (P < 0.001), methods (P = 0.01), and trials (P < 0.001). The findings suggested that both methods augmented student knowledge and understanding in sports science and medical students. The sports science group demonstrated proportionally greater increases in test performance when exposed to the mobile interactive intervention compared with the traditional library approach. Qualitative data suggest an increased level of engagement with the Netbooks due to the stimulating interactive content. In conclusion, the Netbooks were an effective additional learning tool, significantly enhancing knowledge and understanding in students. Further research should ensure that participants are assessed for preferred learning styles, the subjective task value of expectancy value, and readiness for mobile learning to ascertain if this has an effect on the potential for using mobile learning and interactivity.
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Affiliation(s)
- S S Bruce-Low
- Southampton Solent University, Southampton, Hampshire, United Kingdom; and
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Vickery R, Li Y, Schwertschlag U, Singla N, Webster L, Canafax D. TD-1211 demonstrates a durable increase in bowel movement frequency and return toward normal bowel function in a 5-week Ph2b Opioid-Induced Constipation (OIC) study. The Journal of Pain 2013. [DOI: 10.1016/j.jpain.2013.01.651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dart R, Severtson S, Patrick J, Webster L. Abuse, misuse, and diversion of hydromorphone since the introduction of the extended-release formulation (EXALGO®). The Journal of Pain 2013. [DOI: 10.1016/j.jpain.2013.01.659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McIntosh AD, Fryer RJ, Webster L, Cundy AB. Long-term fate of polycyclic aromatic hydrocarbons (PAH) in sediments from Loch Leven after closure of an aluminium smelter. J Environ Monit 2012; 14:1335-1344. [PMID: 22510879 DOI: 10.1039/c2em11006g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An aluminium smelter discharged polycyclic aromatic hydrocarbons (PAHs) into Loch Leven on the west of Scotland from 1907 until it closed in 2000, resulting in elevated PAH concentrations in the sediment. A temporal monitoring programme to investigate any recovery in sediment concentrations began in 2004, with sampling each year until 2008 and again in 2010. Cores were also collected to investigate temporal trends over a longer time scale and to estimate the sedimentation rate in the loch. The loch is divided into two basins, and PAH concentrations were significantly higher in the upper basin, closer to the smelter, than in the lower basin. The PAH distribution and concentration ratios were consistent with a pyrolytic source of PAHs, with a high proportion of heavier parent PAHs. There was no evidence of any recovery in PAH concentrations, perhaps due to the mixing and disturbances of the sediment, and the persistence of PAHs. Concentrations of all PAHs were above the Background Assessment Concentrations (BACs) in both basins. In the lower basin only the 5- and 6-ring PAHs were above the Effects Range Low (ERL) values, but in the upper basin all but naphthalene were above the ERLs. There is therefore still an unacceptable risk of chronic effects in marine species. Concentrations decreased down the cores, falling below BACs in the deepest sections. However, ERLs were exceeded as far down the core as 30 cm for some PAHs.
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Affiliation(s)
- A D McIntosh
- Marine Scotland Science, Marine Laboratory, PO Box 101, 375 Victoria Road, Aberdeen, UK
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41
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Hassman H, Glass S, Webster L. P-37 - The effect of pharmacokinetic parameters on euphoria, drug liking following different oral hydromorphone formulations in opioid-experienced, non-dependent, recreational drug users. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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42
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Vickery R, Li Y, Bourdet D, Ou Y, Beattie D, Kohler R, Webster L, Singla N, Daniels O. Pharmacokinetics and constipation relieving effects of TD-1211 in patients with opioid-induced constipation. The Journal of Pain 2011. [DOI: 10.1016/j.jpain.2011.02.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Couto JE, Webster L, Romney MC, Leider HL, Linden A. Use of an algorithm applied to urine drug screening to assess adherence to a hydrocodone regimen. J Clin Pharm Ther 2010; 36:200-7. [DOI: 10.1111/j.1365-2710.2010.01236.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Michelakis ED, Sutendra G, Dromparis P, Webster L, Haromy A, Niven E, Maguire C, Gammer TL, Mackey JR, Fulton D, Abdulkarim B, McMurtry MS, Petruk KC. Metabolic Modulation of Glioblastoma with Dichloroacetate. Sci Transl Med 2010; 2:31ra34. [DOI: 10.1126/scitranslmed.3000677] [Citation(s) in RCA: 531] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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45
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Moran C, Webster L, Colquhoun I, Kirk A. Malignancy After Cardiac Transplantation. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.064] [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: 10/18/2022]
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46
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Webster L, Russell M, Walsham P, Phillips LA, Packer G, Hussy I, Scurfield JA, Dalgarno EJ, Moffat CF. An assessment of persistent organic pollutants (POPs) in wild and rope grown blue mussels (Mytilius edulis) from Scottish coastal waters. ACTA ACUST UNITED AC 2009; 11:1169-84. [DOI: 10.1039/b901012b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The unique metabolism of most solid tumours (aerobic glycolysis, i.e., Warburg effect) is not only the basis of diagnosing cancer with metabolic imaging but might also be associated with the resistance to apoptosis that characterises cancer. The glycolytic phenotype in cancer appears to be the common denominator of diverse molecular abnormalities in cancer and may be associated with a (potentially reversible) suppression of mitochondrial function. The generic drug dichloroacetate is an orally available small molecule that, by inhibiting the pyruvate dehydrogenase kinase, increases the flux of pyruvate into the mitochondria, promoting glucose oxidation over glycolysis. This reverses the suppressed mitochondrial apoptosis in cancer and results in suppression of tumour growth in vitro and in vivo. Here, we review the scientific and clinical rationale supporting the rapid translation of this promising metabolic modulator in early-phase cancer clinical trials.
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Affiliation(s)
- E D Michelakis
- Department of Medicine, University of Alberta, Edmonton, Canada.
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48
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Webster L, Russell M, Adefehinti F, Dalgarno EJ, Moffat CF. Preliminary assessment of polybrominated diphenyl ethers (PBDEs) in the Scottish aquatic environment, including the Firth of Clyde. ACTA ACUST UNITED AC 2008; 10:463-73. [PMID: 18385867 DOI: 10.1039/b718687h] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This paper presents preliminary data on polybrominated diphenyl ethers (PBDEs) in the Scottish aquatic environment. Sediment and biota (fish liver, fish muscle and mussels) from a number of locations around Scotland were analysed for PBDEs with samples being from both remote and from potentially contaminated areas such as the former sewage sludge dump site at Garroch Head in the Clyde. PBDEs were measured in both cultivated, rope grown mussels and wild mussels collected from 5 sites around Scotland in 2006. Total PBDE concentrations (sum of tri- to hepta-BDEs) ranged from <limit of detection (LoD) to 2.36 microg kg(-1) wet weight, with the highest concentrations being found in mussels close to Aberdeen harbour. Most PBDE congeners were below detection limits but where they were detected, BDE47 and BDE99 were the main congeners. PBDEs were detected at low concentrations in flatfish muscle from 11 localities around Scotland, with total PBDE concentrations ranging from <LoD to 1.67 microg kg(-1) wet weight, with BDE47 being the dominant congener. Total PBDEs concentrations ranged from <LoD to 1.22 microg kg(-1) wet weight in brown trout muscle from 4 mountain lochs with the highest in fish from Lochnagar, a high level loch in the eastern Cairngorms. In contrast to the marine fish, BDE99 was the main congener in the brown trout. PBDEs were also measured in fish liver collected from the former sewage sludge dump site at Garroch Head in the Clyde, with total PBDE concentrations ranging from 4.1-536.1 microg kg(-1) wet weight. Concentrations were highest prior to the cessation of sewage sludge dumping in 1998. Total PBDE concentrations (sum of tri- to hepta-BDEs) in sediment cores collected in 2003 from Garroch Head and at a site 2.3 km south of Garroch Head ranged from <LoD to 23.4 microg kg(-1) dry weight. BDE209 was found at very high concentrations in the cores (2.3 to 98 125 microg kg(-1) dry weight). Highest PBDE concentrations were found in the top 4 cm of all cores, reflecting their more recent use.
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Affiliation(s)
- L Webster
- Fisheries Research Services Marine Laboratory, 375 Victoria Road, Aberdeen, Scotland, UK, AB11 9DB
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Russell M, Webster L, Walsham P, Packer G, Dalgarno EJ, McIntosh AD, Fryer RJ, Moffat CF. Composition and concentration of hydrocarbons in sediment samples from the oil producing area of the East Shetland Basin, Scotland. ACTA ACUST UNITED AC 2008; 10:559-69. [DOI: 10.1039/b715765g] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Millward MJ, House C, Bowtell D, Webster L, Olver IN, Gore M, Copeman M, Lynch K, Yap A, Wang Y, Cohen PS, Zalcberg J. The multikinase inhibitor midostaurin (PKC412A) lacks activity in metastatic melanoma: a phase IIA clinical and biologic study. Br J Cancer 2006; 95:829-34. [PMID: 16969355 PMCID: PMC2360547 DOI: 10.1038/sj.bjc.6603331] [Citation(s) in RCA: 42] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Midostaurin (PKC412A), N-benzoyl-staurosporine, potently inhibits protein kinase C alpha (PKCalpha), VEGFR2, KIT, PDGFR and FLT3 tyrosine kinases. In mice, midostaurin slows growth and delays lung metastasis of melanoma cell lines. We aimed to test midostaurin's safety, efficacy and biologic activity in a Phase IIA clinical trial in patients with metastatic melanoma. Seventeen patients with advanced metastatic melanoma received midostaurin 75 mg p.o. t.i.d., unless toxicity or disease progression supervened. Patient safety was assessed weekly, and tumour response was assessed clinically or by CT. Tumour biopsies and plasma samples obtained at entry and after 4 weeks were analysed for midostaurin concentration, PKC activity and multidrug resistance. No tumour responses were seen. Two (12%) patients had stable disease for 50 and 85 days, with minor response in one. The median overall survival was 43 days. Seven (41%) discontinued treatment with potential toxicity, including nausea, vomiting, diarrhoea and/or fatigue. One patient had >50% reduction in PKC activity. Tumour biopsies showed two PKC isoforms relatively insensitive to midostaurin, out of three patients tested. No modulation of multidrug resistance was demonstrated. At this dose schedule, midostaurin did not show clinical or biologic activity against metastatic melanoma. This negative trial reinforces the importance of correlating biologic and clinical responses in early clinical trials of targeted therapies.
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Affiliation(s)
- M J Millward
- Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
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