1
|
MAPK and mTOR Inhibition Improves Childhood RASopathy-Associated Hypertrophic Cardiomyopathy. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
|
2
|
Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
Collapse
|
3
|
In situ differences in nitrogen cycling related to presence of submerged aquatic vegetation in a Gulf of Mexico estuary. Ecosphere 2022. [DOI: 10.1002/ecs2.4290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
4
|
MAPK AND AKT/MTOR INHIBITION IMPROVES CHILDHOOD RASOPATHY-ASSOCIATED CARDIOMYOPATHY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
5
|
Models help set ecosystem service baselines for restoration assessment. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 317:115411. [PMID: 35751248 DOI: 10.1016/j.jenvman.2022.115411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Coastal suburban watersheds are under heavy pressure from human activity. This pressure has yielded an extensive effort to protect, mitigate, and restore watershed ecosystem services. Assessment of restoration investments would be greatly improved by a standard approach for estimating change in ecosystem service production combined with a well-defined baseline for assessment of restoration effects. Here we take a model-based approach to both objectives by applying two established ecosystem service models in a representative coastal watershed. This watershed has undergone extensive suburbanization resulting in a loss of ecosystem services, which has resulted in heavy restoration investments. We used models to estimate loss of the ecosystem services; clean air, clean water, stable climate, and water storage resulting from suburbanization. We then applied these model-based estimates as a baseline for assessment of restoration focusing on the appropriate restoration scale and considering downstream watershed impacts. The results suggest that losses of ecosystem services, such as flood water storage, from suburbanization have been extensive since 2001, but a comparison of restoration value suggests that restoration has been effective in recouping ecosystem services in some but not all local regions suggesting there are trade-offs to be made in these efforts. These benefits were most evident for the services of clean water and water storage. Models can inform decisions by clarifying what has been lost and estimating what can be regained through restoration action. The former sets a baseline for the latter and allows for a functional equivalency approach to assessment.
Collapse
|
6
|
Season-Long Changes in the Body Composition Profiles of Competitive Female Rugby Union Players Assessed via Dual Energy X-Ray Absorptiometry. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2022; 93:601-607. [PMID: 34653342 DOI: 10.1080/02701367.2021.1886226] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 02/02/2021] [Indexed: 06/13/2023]
Abstract
Background: Reference data for the body composition values of female athletes are limited to very few sports, with female Rugby Union players having mostly been omitted from such analyses.Methods: Using dual energy X-ray absorptiometry (DXA) scans, this study assessed the body composition profiles (body mass, bone mineral content; BMC, fat mass; FM, lean mass; LM, bone mineral density; BMD) of 15 competitive female Rugby Union players before and after the 2018/19 competitive season. Total competitive match-play minutes were also recorded for each player.Results: Body mass (73.7 ± 9.6 kg vs 74.9 ± 10.2 kg, p ≤ 0.05, d = 0.13) and BMC (3.2 ± 0.4 kg vs 3.3 ± 0.4 kg, p ≤ 0.05, d = 0.15) increased pre- to post-season for all players. Conversely, FM (21.0 ± 8.8 kg), LM (50.7 ± 3.9 kg), and BMD (1.31 ± 0.06 g·cm-2) were similar between time-points (all p > .05). Accounting for position, body mass (rpartial(12) = 0.196), FM (rpartial(12) = -0.013), LM (rpartial(12) = 0.351), BMD (rpartial(12) = 0.168) and BMC (rpartial(12) = -0.204) showed no correlation (all p > .05) against match-play minutes.Conclusion: The demands of the competitive season influenced specific body composition indices (i.e., body mass, BMC) in female Rugby Union players; a finding which was unrelated to the number of minutes played in matches. While the causes of such differences remain unclear, practitioners should be cognizant of the body composition changes occurring throughout a female Rugby Union competitive season and, where necessary, consider modifying variables associated with adaptation and recovery accordingly.
Collapse
|
7
|
Deposition of methamphetamine residues produced by simulated smoking. Forensic Sci Int 2022; 338:111407. [PMID: 35908336 DOI: 10.1016/j.forsciint.2022.111407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
Abstract
In New Zealand, many concerns have been raised over the presence of methamphetamine contamination in households, especially when its provenance is unknown. Previous research found that contamination levels on household surfaces were higher after the premises had been used as a clandestine laboratory. It is believed that the levels of contamination produced from smoking methamphetamine are much less than those produced through manufacture. This study's aim was to determine the amount of methamphetamine contamination produced, after simulated smoking, on a range of common, smooth surface types. Accumulation over time was also investigated. The experiment, comprising four simulated smoking events (referred to as 'smokes') of 0.2 g followed by a fifth simulated smoking event of 1.2 g (a cumulative total of 2 g) of methamphetamine hydrochloride, was carried out in a shipping container. Subsequent swabs were taken from squares of 100 cm2, following the NIOSH 9111 method. Results were quantified using LC-MS/MS. The methamphetamine concentrations measured gave a range from an overall mean of 0.91 µg/100 cm2 after the first smoke and 15.9 µg/100 cm2 after the final smoke. A rate of accumulation for each surface type was established, as well as an order of surfaces showing the most to least observed contamination. A significant reduction in the level of contamination was observed over a short period of time, although a clear rate was not established. Finally, a relationship between the recovered amounts of methamphetamine and amphetamine produced through the pyrolysis (smoking) process was also determined.
Collapse
|
8
|
POS1228 IMPACT OF COVID-19 ON THE PRESCRIPTION OF BIOLOGIC DMARDs: A POPULATION-LEVEL STUDY IN ENGLAND. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere has been considerable uncertainty about the impact of biologic DMARDs (bDMARDs) on COVID-19 morbidity and vaccine efficacy, which may have influenced prescribing during the pandemic.ObjectivesTo assess trends in the prescription of three commonly used bDMARDs with different modes of action - adalimumab (ADA), rituximab (RTX) and tocilizumab (TOC) - in England before and during the COVID-19 pandemic.MethodsThe National Health Service (NHS) Secondary Care Medicines dataset was utilised to analyse temporal trends in bDMARD prescriptions issued by all NHS hospital pharmacies in England. Monthly averages of prescriptions issued for ADA, RTX and TOC for combined indications, standardised using WHO Defined Daily Doses (DDD), were described from January 2019 to November 2021. Interrupted time-series analyses (ITSA) were used to estimate the effect of the pandemic on prescription trends for ADA, RTX and TOC; Newey-West standard errors with lags were used to account for autocorrelation between observation periods in these models.ResultsTemporal trends in ADA, RTX and TOC prescriptions are shown in Figure 1. A 46% decrease in RTX prescriptions was observed between March and April 2020, from 1,338,300 DDD to 718,900 DDD, respectively, coinciding with the worsening COVID-19 pandemic in England. RTX prescriptions increased after May 2020, reflected in the positive prescription trend observed in ITSA models (Table 1); however, RTX prescriptions remained below pre-pandemic levels, before decreasing again between November 2020 and February 2021. This coincided with increasing COVID-19 case numbers in England.Table 1.Trends in prescriptions issued for ADA, RTX and TOC in England before and after the onset of the COVID-19 pandemic, assessed using interrupted time-series analyses. The absolute change in prescriptions issued in March 2020, relative to April 2020, is shown.RituximabAdalimumabTocilizumabPrescription trend before March 2020-0.23% per year(95% CI -0.97 to 0.52)+2.94% per year(95% CI 2.14 to 3.73)+0.04% per year(95% CI -0.07 to 1.53)Absolute change in prescriptions in March 2020-46.3%+15.5%+10.7%Prescription trend after March 2020+2.11% per year(95% CI 0.52 to 3.70)+3.24% per year(95% CI 2.02 to 4.46)+0.64% per year(95% CI 0.38 to 0.90)Difference in trends post vs. pre-March 2020+2.33% per year(95% CI 0.51 to 4.17)P=0.014+0.30% per year(95% CI -1.03 to 1.63)P=0.65+0.60% per year(95% CI 0.31 to 0.90)P<0.001Figure 1.Temporal trends in prescriptions for ADA, RTX and TOC in England between January 2019 and November 2021. Monthly averages of prescriptions for combined disease indications are shown, standardised using WHO Defined Daily Doses.For ADA, the pre-pandemic trend of increasing prescriptions continued during the pandemic, with no differences in prescription trends seen in ITSA models (Table 1). A 22% decrease in ADA prescriptions was observed between September and October 2020, from 2,037,800 DDD to 1,587,500 DDD, respectively, before rebounding to above pre-pandemic levels. Prescriptions for TOC increased during the pandemic, driven primarily by a 76% increase in prescriptions between December 2020 and January 2021, from 241,800 DDD to 425,000 DDD, respectively.ConclusionPrescriptions for RTX in England halved during the early COVID-19 pandemic, and remain below pre-pandemic levels as of November 2021. This likely reflects concerns about RTX use and increased COVID-19 mortality and reduced vaccine efficacy.1,2 In contrast, prescriptions for ADA have continued to increase during the pandemic, while prescriptions for TOC surged in December 2020, coinciding with the more widespread use of TOC for the treatment of severe COVID-19.References[1]Strangfeld A, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2021;80:930-942[2]Boekel L, Wolbink GJ. Rituximab during the COVID-19 pandemic: time to discuss treatment options with patients. Lancet Rheumatol. 2021 Dec 23Disclosure of InterestsMark Russell Speakers bureau: Lilly; Menarini, Sathiyaa Balachandran: None declared, Sam Norton: None declared, Edward Alveyn: None declared, Deepak Nagra: None declared, Maryam Adas: None declared, James Galloway Speakers bureau: Abbvie, Biovitrum, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB
Collapse
|
9
|
POS0285 SUB-STANDARD CARE FOR PATIENTS WITH GOUT, DESPITE UPDATED GUIDELINES: A UK-WIDE, POPULATION-BASED COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTreat-to-target urate-lowering therapy (ULT) is highly effective at preventing flares and improving quality of life for patients with gout.1 However, in 2012, only 27% of patients with gout in UK primary care received prescriptions for ULT within 12 months of diagnosis.2 Since then, EULAR and BSR gout management guidelines have been updated, to recommend that all patients with gout should have ULT discussed and offered to them, with uptitration of dosing until target urate levels are achieved. We investigated whether gout management has improved in recent years.ObjectivesTo assess temporal trends in the initiation of ULT and attainment of serum urate targets following new gout diagnoses in UK primary care from 2004 to 2020.MethodsThe Clinical Practice Research Datalink (CPRD) Gold database was used to assess the management of patients with index diagnostic codes for gout in UK primary care between January 2004 and October 2020. We analysed the proportion of patients with the following outcomes within 12 months of diagnosis: i) initiation of ULT (allopurinol, febuxostat, benzbromarone, probenecid or sulfinpyrazone); ii) serum urate ≤360 µmol/L; iii) serum urate ≤300 µmol/L; iv) treat-to-target urate monitoring (defined as two or more serum urate levels performed within 12 months of diagnosis and/or one or more urate ≤300 µmol/L). Interrupted time-series analyses (ITSA) were used to estimate the impact of updated EULAR and BSR gout management guidelines on these outcomes. Multivariate logistic regression was used to analyse predictors of ULT prescription and target attainment following new gout diagnoses.Results129,972 patients had index gout diagnoses between January 2004 and October 2020, of whom only 37,529 (28.9%) had ULT initiated within 12 months of diagnosis. ULT initiation improved modestly over the study period, from 26.8% for those diagnosed in 2004 to 36.6% in 2019, decreasing to 34.7% in 2020 (Figure 1). Of patients diagnosed in 2020 who had a serum urate performed within 12 months of diagnosis, 36.0% attained a urate ≤360 µmol/L, while 17.1% attained a urate ≤300 µmol/L. Of all participants, 18.9% received treat-to-target urate monitoring. In ITSA models, no statistically significant improvements in ULT prescription or urate target attainment were observed after publication of updated EULAR (2016) or BSR (2017) gout management guidelines, relative to before publication of these guidelines. In multivariate logistic regression models, comorbidities including chronic kidney disease, heart failure and obesity, and diuretic use were associated with increased odds of ULT initiation but decreased odds of attaining target urate levels by 12 months.Figure 1.Proportion of patients newly diagnosed with gout who: i) were initiated on urate-lowering therapy (ULT) within 12 months of diagnosis (black line); ii) had a serum urate performed and attained a level ≤360 µmol/L (light blue) or ≤300 µmol/L (dark blue) within 12 months of diagnosis.ConclusionIn this UK-wide study, we demonstrate that the initiation of ULT and attainment of serum urate targets following new gout diagnoses remain poor, despite the introduction of updated management guidelines. If the evidence-practice gap in gout management is to be bridged successfully, strategies to implement best practice gout care are urgently needed.References[1]Doherty M, et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 2018;392(10156):1403-12[2]Kuo CF, et al. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis 2015;74(4):661-7AcknowledgementsThis work is independent research supported by the National Institute for Health Research (NIHR) Doctoral Fellowship, Dr Mark Russell, NIHR300967. This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency.Disclosure of InterestsMark Russell Speakers bureau: Lilly; Menarini, Andrew Rutherford: None declared, Benjamin Ellis: None declared, Sam Norton: None declared, Abdel Douiri: None declared, Martin Gulliford: None declared, Andrew Cope: None declared, James Galloway Speakers bureau: Abbvie, Biovitrum, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB
Collapse
|
10
|
POS0565 WORSE OUTCOMES LINKED TO ETHNICITY FOR EARLY INFLAMMATORY ARTHRITIS IN ENGLAND AND WALES: A NATIONAL COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients from ethnic minority backgrounds suffer considerable health inequality, with generally poorer health outcomes relative to the rest of the population.1 Further exploration of these differences is essential if we are to deliver the best care for all, and close the health gap for our patients.ObjectivesWe used the National Early Inflammatory Arthritis Audit (NEIAA) to assess variability in care quality and treatment outcomes across ethnicities for patients diagnosed with early inflammatory arthritis (EIA) in England and Wales.MethodsNEIAA is an observational cohort design. Data were from adult patients newly diagnosed with EIA, and seen by rheumatology in England and Wales between May 2018 and March 2020. Quality of care outcomes were assessed against six metrics contained within the National Institute for Health and Clinical Excellence (NICE) Quality Standard for Rheumatoid Arthritis.2 Clinical outcomes were measured using DAS28. Outcomes were compared between ethnic groups (White, Black, Asian, Mixed, Other), and adjusted for confounders (age, sex, smoking, comorbidity, seropositivity and disease severity at presentation) using Logistic regression models with multiple imputation for missing data.ResultsData for 35,807 eligible patients were analysed, of whom 30,643 (85.6%) were White and 5,164 (14.6%) were from ethnic minority backgrounds: 1,035 (2.8%) Black; 2,617 (7.3%) Asian; 238 (0.6%) Mixed; 1,274 (3.5%) Other. A total of 12,955 patients had confirmed EIA. Of those, 11,315 were White and 1,640 were from ethnic minority backgrounds: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other.Of 35,160 eligible patients who had data available, 14,803 (42.1%) were assessed by rheumatology within three weeks of referral. Of 9,900 EIA-eligible patients with data available, 5,642 (57.0%) started treatment within six weeks of referral. There were no significant differences in these outcomes by ethnicity. Ethnic minority patients did, however, have lower odds of disease remission at three months, relative to patients of White ethnicity (adjusted odds ratio 0.79; 95% CI: 0.65-0.96; p=0.02). This difference was due to lower odds of disease remission in Black and Asian patients, relative to White patients (Table 1). Ethnic minority patients were significantly less likely to receive initial treatment with methotrexate (0.68; 95% CI: 0.52-0.90; p=0.008) or with glucocorticoids (0.63, 95% CI: 0.49-0.80; p< 0.001).Table 1.Associations between ethnicity and disease remission at three months in EIA patientsModelOdds ratio95% CIP-valueUnadjustedAll ethnic minority0.76(0.62,0.93)0.01backgroundsBlack0.48(0.34,0.67)<0.001Asian0.74(0.59,0.93)0.01Mixed0.61(0.28,1.35)0.22Other1.09(0.71,1.68)0.67Age and sex-adjustedAll ethnic minority0.78(0.63,0.96)0.01backgroundsBlack0.49(0.35,0.69)0.00Asian0.75(0.60,0.94)0.01Mixed0.63(0.28,1.39)0.25Other1.11(0.71,1.71)0.63Fully-adjustedAll ethnic minority0.79(0.65,0.96)0.02backgroundsBlack0.57(0.41,0.79)0.001Asian0.76(0.62,0.93)0.009Mixed0.63(0.27,1.46)0.29Other1.04(0.71,1.54)0.80ConclusionThe results from this large cohort demonstrate that some minority ethnic groups are less likely to reach disease remission in the early months following an EIA diagnosis. Our results are not explained by delays in referral or treatment. Intitial treatment strategies varied across ethnic groups. These data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.References[1]Greenberg JD, Spruill TM, Shan Y, Reed G, Kremer JM, Potter J, et al. Racial and ethnic disparities in disease activity in patients with rheumatoid arthritis. Am J Med. 2013;126(12):1089-98.[2]NICE quality standard for rheumatoid arthritis in over 16s. Nice.org.uk. 2013 [cited 25 January 2022]. Available from: https://www.nice.org.uk/guidance/qs33/documents/previous-version-of-quality-standard.Disclosure of InterestsMaryam Adas: None declared, Sathiyaa Balachandran: None declared, Sam Norton: None declared, Edward Alveyn: None declared, Mark Russell Speakers bureau: Has received speaker fees and educational grants from Janssen, Lilly, Menarini, Pfizer and UCB, Tom Esterine Speakers bureau: Patient review of P.I.S and consent form into lay language for KCL that was linked to Pharma company., Paul Amlani-Hatcher: None declared, Sarah Oyebanjo: None declared, Heidi Lempp: None declared, Jo Ledingham: None declared, Kanta Kumar Speakers bureau: Has received training form Pfizer and speaker fees 2021 from Janssen., Paid instructor for: Has received training form Pfizer, James Galloway Speakers bureau: Has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB., Shirish Dubey: None declared.
Collapse
|
11
|
OP0253 COVID-19 ADMISSIONS AND MORTALITY IN PATIENTS WITH EARLY INFLAMMATORY ARTHRITIS: RESULTS FROM A NATIONAL COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThere has been a major concern about the impact of COVID-19 in patients with inflammatory arthritis during the pandemic, with recommendations from governments for patients to shield.ObjectivesOur aim was to describe the risk factors for COVID-19 hospitalisation and mortality amongst patients recruited to the National Early Inflammatory Arthritis Audit (NEIAA) in England.MethodsAn observational cohort study design was used. The population included adults in England with new diagnoses of inflammatory arthritis between May 2018 and March 2021 who enrolled in NEIAA. The outcomes were hospitalisation due to COVID-19 (primary admission reason or nosocomial acquisition) and death due to COVID-19 (COVID-19 stated on a death certificate), identified via linkage with secondary care records. Hazard ratios were calculated using Cox proportional hazards models, with adjustment for patient factors (age, gender, smoking status, and comorbidity) and disease factors (seropositivity, 28-joint disease activity score, patient-reported disability (HAQ), and functional impact (MSK-HQ)) recorded at baseline. Individuals were considered at risk from the date of diagnosis or February 2020 (whichever was later) and censored at a COVID-19 event, death or May 2021 (whichever was sooner).Results14,127 patients were included. The mean age was 57 years; 62% were female; 19% were current smokers, while 29% were ex-smokers. The frequency of comorbidities at baseline were: hypertension (19%), diabetes mellitus (9%), and lung disease (9%). Overall, 20% had two or more comorbidities. Rheumatoid factor or CCP antibodies were positive in 56%. At presentation, mean scores for DAS28 were 4.6 (+/- 1.5), 1.1 (+/- 0.7) for HAQ, and 25 (+/- 11) for MSK-HQ. Initial DMARD therapy was known for 13,682/14,127 patients: methotrexate was the most common (54%), followed by hydroxychloroquine (23%), and sulfasalazine (11%).There were 143 COVID-19 hospital admissions and 47 deaths, corresponding to incidence rates per 100 person-years for hospitalisation: 0.94 [95% CI: 0.79-1.10] and death: 0.31 [95% CI: 0.23-0.41]. Increasing age, male gender, diabetes, hypertension, lung disease and smoking status all predicted COVID-19 hospitalisation and death. Higher baseline DAS28 predicted COVID-19 hospitalisation (HR 1.24 [95% CI: 1.10-1.39]) and mortality (HR 1.33 [95% CI: 1.09-1.63]). Higher HAQ predicted both COVID-19 hospitalisation and death. Seropositivity was not a significant predictor of any COVID-19 event, nor was MSK-HQ. In unadjusted models, corticosteroids associated with COVID-19 death (HR 2.29 [95% CI: 1.02-5.13], and sulfasalazine monotherapy associated with COVID-19 hospitalisation (HR 1.93 [95% CI: 1.04-3.56]. In adjusted models, associations for corticosteroids and sulfasalazine were no longer significant. Only age, smoking status, and comorbidities independently predicted COVID-19 events.ConclusionThe burden of COVID-19 amongst early arthritis patients was substantial during the pandemic, with concerns about the use of csDMARDs and corticosteroids.1,2 Patient characteristics and rheumatoid disease severity at diagnosis appear to be the more important predictors of COVID-19 events than initial treatment strategy. An important limitation is that we have not looked at treatment changes over time, and must acknowledge that many patients, especially those recruited in 2019, may have changed therapy prior to the pandemic.References[1]Strangfeld A, Schäfer M, Gianfrancesco MA, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Annals of the Rheumatic Diseases. 2021;80(7):930-942.[2]D’Silva KM, Wallace ZS. COVID-19 and Disease-Modifying Anti-rheumatic Drugs. Curr Rheumatol Rep. 2021;23(5):28-28.Disclosure of InterestsMaryam Adas: None declared, Mark Russell Speakers bureau: has received speaker fees and educational grants from Janssen, Lilly, Menarini, Pfizer and UCB., Emma Cook: None declared, Edward Alveyn: None declared, Sarah Oyebanjo: None declared, Paul Amlani-Hatcher: None declared, Jo Ledingham: None declared, Sam Norton: None declared, James Galloway Speakers bureau: Has received honoraria from AbbVie, Celgene, Chugai, Gilead, Janssen, Eli Lilly, Pfizer, Roche and UCB
Collapse
|
12
|
AKT/mTOR and MAPK Inhibition Improves Childhood RASopathic Cardiomyopathy. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Nile Red staining for detecting microplastics in biota: Preliminary evidence. MARINE POLLUTION BULLETIN 2021; 172:112888. [PMID: 34454386 DOI: 10.1016/j.marpolbul.2021.112888] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
Nile Red is a lipophilic, metachromatic and solvatochromic dye used as an alternative or complementary method to aid identification of microplastics in routine analysis of biological samples. It was rarely used in biota since organic residues after the digestion step can be co-stained with possible overestimation of microplastics. The limits of using Nile Red in biota were investigated in marine mussels experimentally contaminated with low-density polyethylene (LDPE) microplastics. Stained particles were detected through magnified images obtained by stitching together thirty photographs of the filter surface of each sample. LDPE particles appeared yellowish and fluorescent and could be confused with certain organic residues. The smaller the fragments, the greater the difficulty in recognizing them. In particular, it was difficult to recognize LDPE particles based on their fluorescence if <180 μm in size. Regardless of the size, fluorescence of the items aids the operator in LDPE particles identification also in biota.
Collapse
|
14
|
COVID-19 surveillance robot: rapid innovation for public health pandemic management. Eur J Public Health 2021. [PMCID: PMC8574586 DOI: 10.1093/eurpub/ckab164.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
COVID-19 surveillance added a significant workload to the eight HSE-Departments of Public Health in Ireland. HSE-HPSC rapidly developed a fit-for-purpose robot to navigate the national infectious disease reporting system (CIDR) to automate three manual processes; laboratory records, notifications and contact-tracing data; which takes a surveillance scientist 26 minutes per case on average.
Methods
HSE-HPSC managed and delivered a multidisciplinary project team to develop the rapid solution. The robot was designed to operate the CIDR system using an agreed set of rules, developed through business process analyses of the ‘first wave', stakeholder engagement and technical collaboration. Development began in April 2020, and went live in August 2020 after phases of testing, piloting, and hyper-care.
Results
Successful integration: The robot aligned COVID-19 surveillance data across three national HSE information systems. Degree of automation: The robot processed greater than 80% of cases just like a human. The remaining 20% are flagged by the robot for data quality checks by the regional public health teams. Time-saving: The robot operates quicker than a human, 3.3minutes per case compared to 26minutes. Therefore for every 100 cases, the robot saves 38hours per day. Out-of-hours capacity: Robots currently operate for 22hours per day, resulting in overtime cost-savings for the HSE. Surge capacity: The automation was expanded to 42 robots for ‘third-wave' surge capacity. Sustainable change in surveillance system: Robots can be expanded for surveillance of other notifiable diseases.
Conclusions
The robot:
delivered a fit-for-purpose pandemic resource relieved the underfunded public health system of the administrative burden of COVID-19 surveillance delivered timely data for epidemiological reporting by the HSE-HPSC to the National Public Health Emergency Team.
Key messages
Through rapid collaboration, the robot successfully delivered a fit-for-purpose public health resource that aligned COVID-19 data across HSE information systems and achieved time/cost savings. The robot strengthened the public health surveillance response in Ireland.
Collapse
|
15
|
Establishing likelihood ratios for evaluating opposing propositions concerning the activity causing methamphetamine contamination: Smoking or manufacture? Forensic Sci Int 2021; 326:110939. [PMID: 34365024 DOI: 10.1016/j.forsciint.2021.110939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022]
Abstract
In New Zealand, concerns have been raised over the presence of methamphetamine contamination in households, especially when the activity causing the contamination is unknown. The cause of contamination is also a contentious issue in clandestine laboratory cases concerning charges in relation to "Use of Premises" (Section 12: Misuse of Drugs Act 1975, New Zealand). Regardless of the cause, other than scientific opinion, there is currently no analytical technique that can satisfactorily address the provenance of methamphetamine residues. For several years, approximate methamphetamine contamination levels have been collected from suspected clandestine laboratories in New Zealand, where methamphetamine is believed to have been manufactured. This study used this data and compared it to similar data from properties where the drug is suspected to have been used (smoked) to model likelihood ratios (LR). It is well documented that the LR forms the backbone to a Bayesian method of interpreting forensic evidence. As such, this data has the potential to underpin a novel Bayesian approach in the evaluation of clandestine laboratory evidence.
Collapse
|
16
|
Longitudinal evidence of the impact of dog ownership and dog walking on mental health. J Public Health (Oxf) 2021; 43:e145-e152. [PMID: 31690938 DOI: 10.1093/pubmed/fdz094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emerging evidence supports the physical health and social benefits of dog ownership. This study examined the longitudinal effect of dog ownership and dog walking on mental health. METHODS Data from a cohort of 1023 participants taking part in the RESIDential Environments project, in Perth, Western Australia were collected over a 2 year period (baseline and follow-up). Self-report survey items measured mental health (stress and depression), dog ownership status and weekly minutes of dog walking. Logistic regression models accounted for potential confounding factors including socio-demographic, self-rated health and baseline mental health. RESULTS Overall, no statistically significant effects were observed over time between dog ownership and stress (adjusted OR: 1.20; 95% CI: 0.79, 1.81) or depression (adjusted OR: 1.51; 95% CI: 0.72, 3.16). There was a small inverse but non-significant association between weekly minutes of dog walking and stress over time (adjusted OR: 0.85; 95% CI: 0.60, 1.22). CONCLUSION There was little evidence of prospective associations between dog ownership or dog walking and mental health. Further research is required to confirm longitudinal relationships between dog ownership and dog walking and mental health and investigate dog-related factors, such as a person's attachment to their dog.
Collapse
|
17
|
POS0959 DIAGNOSTIC DELAY IN AXIAL SPONDYLOARTHRITIS: RESULTS FROM THE NATIONAL EARLY INFLAMMATORY ARTHRITIS AUDIT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Diagnostic delay is a significant problem in axial spondyloarthritis (axSpA), and there is a growing body of evidence showing that delayed axSpA diagnosis is associated with worse clinical, humanistic and economic outcomes.1 International guidelines have been published to inform referral pathways and improve standards of care for patients with axSpA.2,3Objectives:To describe the sociodemographic and clinical characteristics of newly-referred patients with axSpA in England and Wales in the National Early Inflammatory Arthritis Audit (NEIAA), with rheumatoid arthritis (RA) and mechanical back pain (MBP) as comparators.Methods:The NEIAA captures data on all new patients over the age of 16 referred with suspected inflammatory arthritis to rheumatology departments in England and Wales.4 We describe baseline sociodemographic and clinical characteristics of axSpA patients (n=784) recruited to the NEIAA between May 2018 and March 2020, compared with RA (n=9,270) and MBP (n=370) during the same period.Results:Symptom duration prior to initial rheumatology assessment was significantly longer in axSpA than RA patients (p<0.001), and non-significantly longer in axSpA than MBP patients (p=0.062): 79.7% of axSpA patients had symptom durations of >6 months, compared to 33.7% of RA patients and 76.0% of MBP patients; 32.6% of axSpA patients had symptom durations of >5 years, compared to 3.5% of RA patients and 24.6% of MBP patients (Figure 1A). Following referral, median time to initial rheumatology assessment was longer for axSpA than RA patients (36 vs. 24 days; p<0.001), and similar to MBP patients (39 days; p=0.30). The proportion of axSpA patients assessed within 3 weeks of referral increased from 26.7% in May 2018 to 34.7% in March 2020; compared to an increase from 38.2% to 54.5% for RA patients (Figure 1B). A large majority of axSpA referrals originated from primary care (72.4%) or musculoskeletal triage services (14.1%), with relatively few referrals from gastroenterology (1.9%), ophthalmology (1.4%) or dermatology (0.4%).Of the subset of patients with peripheral arthritis requiring EIA pathway follow-up, fewer axSpA than RA patients had disease education provided (77.5% vs. 97.8%; p<0.001), and RA patients reported a better understanding of their condition (p<0.001). HAQ-DI scores were lower at baseline in axSpA EIA patients than RA EIA patients (0.8 vs 1.1, respectively; p=0.004), whereas baseline Musculoskeletal Health Questionnaire (MSK-HQ) scores were similar (25 vs. 24, respectively; p=0.49). The burden of disease was substantial across the 14 domains comprising MSK-HQ in both axSpA and RA (Figure 1C).Conclusion:We have shown that diagnostic delay remains a major challenge in axSpA, despite improved disease understanding and updated referral guidelines. Patient education is an unmet need in axSpA, highlighting the need for specialist clinics. MSK-HQ scores demonstrated that the functional impact of axSpA is no less than for RA, whereas HAQ-DI may underrepresent disability in axSpA.References:[1]Yi E, Ahuja A, Rajput T, George AT, Park Y. Clinical, economic, and humanistic burden associated with delayed diagnosis of axial spondyloarthritis: a systematic review. Rheumatol Ther. 2020;7:65-87.[2]NICE. Spondyloarthritis in over 16s: diagnosis and management. 2017.[3]van der Heijde D, Ramiro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978-91.[4]British Society for Rheumatology. National Early Inflammatory Arthritis Audit (NEIAA) Second Annual Report. 2021.Acknowledgements:The National Early Inflammatory Arthritis Audit is commissioned by the Healthcare Quality Improvement Partnership, funded by NHS England and Improvement, and the Welsh Government, and carried out by the British Society for Rheumatology, King’s College London and Net Solving.Disclosure of Interests:Mark Russell Grant/research support from: UCB, Pfizer, Fiona Coath: None declared, Mark Yates Grant/research support from: UCB, Abbvie, Katie Bechman: None declared, Sam Norton: None declared, James Galloway Grant/research support from: Abbvie, Celgene, Chugai, Gilead, Janssen, Lilly, Pfizer, Roche, UCB, Jo Ledingham: None declared, Raj Sengupta Grant/research support from: AbbVie, Biogen, Celgene, Lilly, MSD, Novartis, Pfizer, Roche, UCB, Karl Gaffney Grant/research support from: AbbVie, Biogen, Cellgene, Celltrion, Janssen, Lilly, Novartis, Pfizer, Roche, UCB.
Collapse
|
18
|
Microplastics in sea surface waters around Scotland. MARINE POLLUTION BULLETIN 2021; 166:112210. [PMID: 33740658 DOI: 10.1016/j.marpolbul.2021.112210] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
This is the first regional, multi-annual assessment of floating microplastics in Scotland's seas. Sea surface samples were collected from 2014 to 2020, using a catamaran swimmer body/neuston net trawl and evaluated for the presence of microplastics. Microplastics were present in the surface waters of all Scottish Marine Regions (SMR) and Offshore Marine Regions (OMR) though almost 35% of sample sites contained no microplastics. Concentrations ranged from 0 to 91,128 microplastics km-2 sea surface. Potential hotspots were identified in the Clyde (0-77,168 microplastics km-2), Forth & Tay (0-83,729 microplastics km-2) and the Solway (607-91,128 microplastics km-2). Fragmented plastics accounted for almost 50% of the microplastics recovered and this may suggest that the microplastics in Scotland's seas are predominantly from the breakdown of larger items. Due to the variable geographic and temporal extents of the data it was not possible to carry out a trend assessment.
Collapse
|
19
|
Sudden Cardiac Death and ICD Use in Rasopathy-Associated Hypertrophic Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
20
|
Abstract
Changing patterns of land use, temperature, and precipitation are expected to impact ecosystem services, including water quality and quantity, buffering of extreme events, soil quality, and biodiversity. Scenario analyses that link such impacts on ecosystem services to human well-being may be valuable in anticipating potential consequences of change that are meaningful to people living in a community. Ecosystem services provide numerous benefits to community well-being, including living standards, health, cultural fulfillment, education, and connection to nature. Yet assessments of impacts of ecosystem services on human well-being have largely focused on human health or monetary benefits (e.g. market values). This study applies a human well-being modelling framework to demonstrate the potential impacts of alternative land use scenarios on multi-faceted components of human well-being through changes in ecosystem services (i.e., ecological benefits functions). The modelling framework quantitatively defines these relationships in a way that can be used to project the influence of ecosystem service flows on indicators of human well-being, alongside social service flows and economic service flows. Land use changes are linked to changing indicators of ecosystem services through the application of ecological production functions. The approach is demonstrated for two future land use scenarios in a Florida watershed, representing different degrees of population growth and environmental resource protection. Increasing rates of land development were almost universally associated with declines in ecosystem services indicators and associated indicators of well-being, as natural ecosystems were replaced by impervious surfaces that depleted the ability of ecosystems to buffer air pollutants, provide habitat for biodiversity, and retain rainwater. Scenarios with increases in indicators of ecosystem services, however, did not necessarily translate into increases in indicators of well-being, due to covarying changes in social and economic services indicators. The approach is broadly transferable to other communities or decision scenarios and serves to illustrate the potential impacts of changing land use on ecosystem services and human well-being.
Collapse
|
21
|
Mitoxantrone in relapsing-remitting and rapidly progressive multiple sclerosis: Ten-year clinical outcomes post-treatment with mitoxantrone. Mult Scler Relat Disord 2020; 44:102330. [PMID: 32599468 DOI: 10.1016/j.msard.2020.102330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mitoxantrone (MTX) has been used as an effective disease modifying treatment (DMT) in multiple sclerosis (MS). Evidence from studies demonstrates benefits of reduced relapse rates, MRI disease activity and disability progression in patients treated with MTX. While effective, MTX use has been limited due to potential adverse effects (AE) ranging from mild to potentially life-threatening AEs such as cardiotoxicity, bone marrow suppression and hematological malignancies. In this study we aimed to review the long-term clinical efficacy, tolerability, and AE profile of treatment with MTX in patients both with relapsing-remitting and rapidly progressive MS over a 10-year follow-up period. METHODS We collected prospective data of 70 patients with relapsing-remitting and rapidly progressive MS treated with MTX and followed-up over a 10-year period. Expanded disability status scale (EDSS) scores and annualized relapse rates (ARR) were assessed 1 year prior to MTX treatment, and at different time points (1, 2, 3, 5 and 10 years) during follow-up. We recorded the time to first relapse and 0.5-point EDSS increase to assess efficacy. We also obtained frequency data on AEs and patients withdrawn from treatment. RESULTS 70 patients were started on treatment with MTX with 53 patients (34 relapsing-remitting MS, 19 progressive disease) completing the course. Mean EDSS progressed from 5.5 to 6.5 in the relapsing-remitting group and 6.7 to 9.0 in the progressive group over the study period. ARR in the RRMS group reduced at all time points from 2.2 prior to MTX to 0.3 by year 10. We reported 3 significant AEs, one chicken pox and subsequent acute promyelocytic leukemia, one left ventricular systolic dysfunction, one pancytopenia. The commonest AE reported was nausea/vomiting in 28 (40%) patients. Seventeen patients (5 relapsing-remitting, 12 progressive disease) stopped treatment. In fifteen (87%) of these this was due to lack of efficacy. In the remaining 2 patients, MTX was stopped due to one patient developing chicken pox and the other developing first-degree heart block. CONCLUSION Our study demonstrated that MTX is an effective disease modifying treatment for relapsing-remitting MS with a well-established risk profile. While MTX is now used less frequently, many MS and neurology services continue to follow-up patients who have been treated with MTX previously. Therefore, understanding the long-term effects risks and benefits remains relevant in this patient group. MTX is also a low-cost treatment in comparison to other high efficacy MS disease-modifying treatments and this may be beneficial in low resource settings.
Collapse
|
22
|
THU0438 INADEQUATE CARE FOR PATIENTS HOSPITALISED WITH GOUT: EVIDENCE THAT EULAR GUIDANCE IS NOT UTILISED. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Hospitalisations due to gout have increased over the last decade, in direct contrast to declining admissions for other inflammatory arthritides including RA [1]. Gout is a treatable condition with recently published EULAR guidelines [2, 3]. Admissions could be avoided with effective use of urate-lowering therapies (ULT).Objectives:We hypothesised that the majority of patients attending hospital with acute gout attacks would not be on ULT. Furthermore, we hypothesised that the majority of patients would not be provided with a plan for ULT commencement and/or uptitration on discharge, leaving them at risk of further hospitalisations.Methods:We retrospectively analysed electronic health records for all patients presenting acutely with a primary admission diagnosis of gout (ICD-10 code: M10) at two hospitals in London, UK, from January – December 2017. Analyses of in-hospital gout management were performed for these patients, including to ascertain the number and proportion of patients who: i) had a known history of gout; ii) were receiving ULT at time of attendance; iii) were provided with a discharge plan for ULT commencement and/or uptitration.Results:Over a 12-month period, there were 234 emergency attendances for gout in 225 individuals. 80% were male, with a mean age of 58 years. 70/234 (30%) attendances resulted in admission to hospital (mean length of stay: 2 days; range: 0-31 days). 211 patients had routinely captured clinical data available for further analysis. 90/211 (43%) patients had prior diagnoses of gout, of whom 38% were on ULT at presentation (32 allopurinol, 2 febuxostat). 38% of patients were discharged with a plan for ULT commencement and/or uptitration. 20 patients re-presented to hospital with acute gout within 12 months (17/20 were not receiving ULT).Conclusion:Most patients hospitalised with gout were not receiving ULT, even those with a prior history of gout attacks. Few were provided with a ULT plan, leaving them at risk of re-admission to hospital. Hospital admissions are unpleasant for patients and incur a high economic burden for health services; if they are to be prevented, there must be a concerted effort to implement and follow gout management guidelines to ensure patients receive ULT at appropriate doses.References:[1]Russell M,et al. Return of the King: Rising Incidence of Acute Hospital Admissions due to Gout. J Rheum 2019 Sep 15.[2]Richette P, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29-42.[3]Richette P, et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2020;79:31-38.Disclosure of Interests: :None declared
Collapse
|
23
|
Abstract
Estuary management is limited by lack of consensus on operational tools for handling multiple conflicting management objectives. One critical step to this goal is a shift from individual problems to a focus on maintaining ecosystem functions that benefit humans. If function is maintained, then the ecosystem is said to be functionally equivalent to its unimpacted state, which is sufficient for management. We propose an adaptation of a functional equivalency (FE) assessment approach from marine fishery management and use a case study demonstration to address how this approach can be integrated into existing ecosystem assessment tools. The functional equivalency framework has three components for implementation: definition of target ecosystem functions, measurable metrics of ecosystem functions, and policy-based thresholds for each metric that indicate when functional equivalency is lost and must be restored. Each case study is an application of available data, models, and management policy to define these ecosystem function components. We intend to foster discussion and future work on integrating the FE approach into existing ecosystem assessment tools. Data requirements are high, as is the necessary integration between science and policy. The results can be a more integrated management approach focused on maintenance of ecosystem functions most beneficial to humans.
Collapse
|
24
|
The effect of training order on neuromuscular, endocrine and mood response to small-sided games and resistance training sessions over a 24-h period. J Sci Med Sport 2020; 23:866-871. [PMID: 32061525 DOI: 10.1016/j.jsams.2020.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study examined the acute effect of small-sided-game (SSG) and resistance training sequence on neuromuscular, endocrine and mood response over a 24-h (h) period. DESIGN Repeated measures. METHODS Fourteen semi-professional soccer players performed SSG-training (4vs4+goalkeepers; 6×7-min, 2-min inter-set recovery) followed by resistance training 2h later (back-squat, Romanian deadlift, barbell-hip-thrust; 4×4 repetitions, 4-min inter-set recovery; 85% 1 rep-max) (SSG+RES), and on a separate week reversed the session order (RES+SSG). Physical demands of SSG's were monitored using global positioning systems (GPS) and ratings of perceived exertion (RPE). Countermovement-jump (CMJ; peak power output; jump height) and brief assessment of mood were collected before (pre), during (0h) and after (+24h) both protocols. Salivary testosterone and cortisol concentrations were obtained at the same time-points but with the inclusion of a measure immediately prior to the second training session (+2h). RESULTS GPS outputs and RPE were similar between SSG-training during both protocols. Between-protocol comparisons revealed no significant differences at +24h in CMJ performance, mood, and endocrine markers. Testosterone was higher at 0h during RES+SSG in comparison to SSG+RES (moderate-effect; +21.4±26.7pgml-1; p=0.010), yet was similar between protocols by +2h. CONCLUSIONS The order of SSG and resistance training does not appear to influence the physical demands of SSG's with sufficient recovery between two sessions performed on the same day. Session order did not influence neuromuscular, endocrine or mood responses at +24h, however a favourable testosterone response from the resistance first session may enhance neuromuscular performance in the second session of the day.
Collapse
|
25
|
Crude Fat, Diethyl Ether Extraction, in Feed, Cereal Grain, and Forage (Randall/Soxtec/Submersion Method): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.888] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A method for determining crude fat in animal feed, cereal grain, and forage (plant tissue) was collaboratively studied. Crude fat was extracted from the animal feed, cereal grain, or forage material with diethyl ether by the Randall method, also called the Soxtec method or the submersion method. The proposed submersion method considerably decreases the extraction time required to complete a batch of samples. The increase in throughput is very desirable in the quest for faster turnaround times and the greater efficiency in the use of labor. In addition, this method provides for reclamation of the solvent as a step of the method. The submersion method for fat extraction was previously studied for meat and meat products and was accepted as AOAC Official Method 991.36. Fourteen blind samples were sent to 12 collaborators in the United States, Sweden, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.09 to 9.26% for crude fat. Among-laboratory (including within) relative standard deviation (reproducibility) ranged from 1.0 to 21.0%. The method is recommended for Official First Action.
Collapse
|
26
|
Determination of Crude Protein in Animal Feed, Forage, Grain, and Oilseeds by Using Block Digestion with a Copper Catalyst and Steam Distillation into Boric Acid: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.2.309] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was conducted to evaluate the repeatability and reproducibility of an extension of AOAC Official Method 991.20, Nitrogen (Crude) in Milk, to animal feed, forage (plant tissue), grain, and oilseed materials. Test portions are digested in an aluminum block at 420°C in sulfuric acid with potassium sulfate and a copper catalyst. Digests are cooled and diluted, and concentrated sodium hydroxide is added to neutralize the acid and make the digest basic; the liberated ammonia is distilled by using steam distillation. The liberated ammonia is trapped in a weak boric acid solution and titrated with a stronger standardized acid, hydrochloric acid; colorimetric endpoint detection is used. Fourteen blind samples were sent to 13 collaborators in the United States, Denmark, Sweden, Germany, and the United Kingdom. Recoveries of nitrogen from lysine, tryptophan, and acetanilide were 86.8, 98.8, and 100.1%, respectively. The within-laboratory relative standard deviation (RSDr, repeatability) ranged from 0.40 to 2.38% for crude protein. The among-laboratories (including within-) relative standard deviation (RSDR, reproducibility) ranged from 0.44 to 2.38%. It is recommended that the method be adopted First Action by AOAC INTERNATIONAL. A lower concentration (1% H3BO3) of trapping solution was compared with the concentration specified in the original protocol (4% H3BO3) and was found comparable for use in an automatic titration system in which titration begins automatically as soon as distillation starts. The Study Directors recommend that 1% H3BO3 as an optional alternative to 4% boric acid trapping solution be allowed for automatic titrators that titrate throughout the distillation.
Collapse
|
27
|
Crude Fat, Hexanes Extraction, in Feed, Cereal Grain, and Forage (Randall/Soxtec/Submersion Method): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.5.899] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A method for determining crude fat in animal feed, cereal grain, and forage (plant tissue) was collaboratively studied. Crude fat was extracted from the animal feed, cereal grain, or forage material with hexanes by the Randall method, also called the Soxtec method or the submersion method. The use of hexanes provides for an alternative to diethyl ether for fat extractions. The proposed submersion method considerably decreases the extraction time required to complete a batch of samples compared to Soxhlet. The increase in throughput is very desirable in the quest for faster turnaround times and the greater efficiency in the use of labor. In addition, this method provides for reclamation of the solvent as a step of the method. The submersion method for fat extraction was previously studied for meat and meat products and was accepted as AOAC Official Method 991.36. Fourteen blind samples were sent to 14 collaborators in the United States, Sweden, Canada, and Germany. The within-laboratory relative standard deviation (repeatability) ranged from 1.23 to 5.80% for crude fat. Among-laboratory (including within) relative standard deviation (reproducibility) ranged from 1.88 to 14.1%. The method is recommended for Official First Action.
Collapse
|
28
|
Assessment of contamination levels in methamphetamine-tested properties in New Zealand. Forensic Sci Int 2019; 304:109971. [DOI: 10.1016/j.forsciint.2019.109971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
|
29
|
Docetaxel for hormone-naïve prostate cancer (PCa): Results from long-term follow-up of non-metastatic (M0) patients in the STAMPEDE randomised trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.008a] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
The neuromuscular, endocrine and mood responses to a single versus double training session day in soccer players. J Sci Med Sport 2019; 23:69-74. [PMID: 31526664 DOI: 10.1016/j.jsams.2019.08.291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/17/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study profiled the 24h neuromuscular, endocrine and mood responses to a single versus a double training day in soccer players. DESIGN Repeated measures. METHODS Twelve semi-professional soccer players performed small-sided-games (SSG's; 4 vs 4+goalkeepers; 6×7-min, 2-min inter-set recovery) with neuromuscular (peak-power output, PPO; jump height, JH), endocrine (salivary testosterone, cortisol), and mood measures collected before (pre) and after (0h, +24h). The following week, the same SSG protocol was performed with an additional lower body strength training session (back-squat, Romanian deadlift, barbell hip thrust; 4×4 repetitions, 4-min inter-set recovery; 85% 1 rep-max) added at 2h after the SSG's. RESULTS Between-trial comparisons revealed possible to likely small impairments in PPO (2.5±2.2Wkg-1; 90% Confidence Limits: ±2.2Wkg-1), JH (-1.3; ±2.0cm) and mood (4.6; ±6.1AU) in response to the double versus single sessions at +24h. Likely to very likely small favourable responses occurred following the single session for testosterone (-15.2; ±6.1pgml-1), cortisol (0.072; ±0.034ugdl-1) and testosterone/cortisol ratio (-96.6; ±36.7AU) at +24h compared to the double session trial. CONCLUSIONS These data highlight that performance of two training sessions within a day resulted in possible to very likely small impairments of neuromuscular performance, mood score and endocrine markers at +24h relative to a single training session day. A strategy of alternating high intensity explosive training days containing multiple sessions with days emphasising submaximal technical/tactical activities may be beneficial for those responsible for the design and delivery of soccer training programs.
Collapse
|
31
|
Firearms and lead. THE NEW ZEALAND MEDICAL JOURNAL 2019; 132:69-71. [PMID: 31170136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
32
|
Asthma prevalence and control levels among Special Olympics athletes, and asthma-related knowledge of their coaches. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:338-345. [PMID: 30569576 DOI: 10.1111/jir.12579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The prevalence of asthma among athletes with intellectual disabilities, and the asthma knowledge levels of their coaches, is unknown. METHODS Special Olympics Canada athletes completed a demographic questionnaire (n = 208). Athletes who identified as having ever or current asthma completed the Asthma Control Questionnaire and the Mini Asthma Quality of Life Questionnaire and were measured for height, weight and lung function (n = 73). National level coaches (n = 27) completed a questionnaire pertaining to asthma knowledge. RESULTS The prevalence of ever and current asthma were 35.5% (n = 73) and 21.1% (n = 44), respectively. Athletes with asthma reported that they had inadequately controlled asthma, but good quality of life. Coaches correctly answered 43% true/false questions on the survey, indicating suboptimal asthma knowledge. CONCLUSIONS Athletes with intellectual disabilities appear to have a greater prevalence of asthma than the general population; however, coaches of these athletes appear to have limited knowledge pertaining to asthma and exercise-induced asthma.
Collapse
|
33
|
The role of abiraterone acetate plus prednisone/prednisolone in high- and low-risk metastatic hormone sensitive prostate cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Cost-Effectiveness of Short Course Radiation Therapy Versus Long-Course Chemoradiation for Locally Advanced Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
GEROFIT PREHABILITATION TO IMPROVE POST-OPERATIVE OUTCOMES IN AN OLDER/AT-RISK POPULATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
The effect of lower limb occlusion on recovery following sprint exercise in academy rugby players. J Sci Med Sport 2018; 21:1095-1099. [DOI: 10.1016/j.jsams.2018.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/04/2018] [Accepted: 02/22/2018] [Indexed: 01/28/2023]
|
37
|
Effects of abiraterone acetate plus prednisone/prednisolone in high and low risk metastatic hormone sensitive prostate cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
38
|
Monitoring of Polycyclic Aromatic Hydrocarbons (PAHs) in Scottish Deepwater environments. MARINE POLLUTION BULLETIN 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] [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.
Collapse
|
39
|
A Keyword Approach to Finding Common Ground in Community-Based Definitions of Human Well-Being. HUMAN ECOLOGY 2017; 45:809-821. [PMID: 34326559 PMCID: PMC8318119 DOI: 10.1007/s10745-017-9940-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ecosystem-based management involves the integration of ecosystem services and their human beneficiaries into decision making. This can occur at multiple scales; addressing global issues such as climate change down to local problems such as flood protection and maintaining water quality. At the local scale it can be challenging to achieve a consistent and sustainable outcome across multiple communities, particularly when they differ in resource availability and management priorities. A key requirement for consistent decision support at the community level is to identify common community objectives, as these can form the basis for readily transferable indices of ecosystem benefit and human well-being. We used a keyword-based approach to look for common terminology in community fundamental objectives as a basis for transferable indices of human well-being and then compared those commonalities to community demographics, location, and type. Analysis centered on strategic planning documents readily available from coastal communities in the conterminous United States. We examined strategic planning documents based on eight domains of human well-being, and found that Living Standards and Safety and Security were the most commonly addressed domains, and Health and Cultural Fulfillment were the least. In comparing communities, regional differences were observed in only one well-being domain, Safety and Security, while community type yielded significant differences in five of the eight domains examined. Community type differences followed an urban to rural trend with urban communities focusing on Education and Living Standards, and more rural communities focused on Social Cohesion and Leisure Time. Across all eight domains multivariate analysis suggested communities were distributed along two largely orthogonal gradients; one between Living Standards and Leisure Time and or Connection to Nature, and a second between Safety and Security and Social Priorities (Education/Health/Culture/Social Cohesion). Overall these findings demonstrate the use of automated keyword analysis for obtaining information from community strategic planning documents. Moreover, the results indicate measures and perceptions of well-being at the local scale differ by community type. This information could be used in management of ecosystem services and development of indices of community sustainability that are applicable to multiple communities with similar demographics, regional location, and type.
Collapse
|
40
|
The uptake of macroplastic & microplastic by demersal & pelagic fish in the Northeast Atlantic around Scotland. MARINE POLLUTION BULLETIN 2017; 122:353-359. [PMID: 28705632 DOI: 10.1016/j.marpolbul.2017.06.073] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/23/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
This study reports plastic ingestion in various fish found from coastal and offshore sites in Scottish marine waters. Coastal samples consisted of three demersal flatfish species (n=128) collected from the East and West coasts of Scotland. Offshore samples consisted of 5 pelagic species and 4 demersal species (n=84) collected from the Northeast Atlantic. From the coastal fish sampled, 47.7% of the gastrointestinal tracts contained macroplastic and microplastic. Of the 84 pelagic and demersal offshore fish, only 2 (2.4%) individuals from different species had ingested plastic identified as a clear polystyrene fibre and a black polyamide fibre. The average number of plastic items found per fish from all locations that had ingested plastic was 1.8 (±1.7) with polyamide (65.3%), polyethylene terephthalate (14.4%) and acrylic (14.4%) being the three most commonly found plastics. This study adds to the existing data on macroplastic and microplastic ingestion in fish species.
Collapse
|
41
|
Adding abiraterone for patients (pts) with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Outcomes in non-metastatic (M0) patients from STAMPEDE (NCT00268476). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
42
|
Adding abiraterone acetate plus prednisolone (AAP) or docetaxel for patients (pts) with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Directly randomised data from STAMPEDE (NCT00268476). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
43
|
Education Coupled With In-Situ High Fidelity Simulation Improves Medical-Surgical RN Code Blue Comfort Levels. THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY 2017; 113:222-224. [PMID: 30383343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pediatric, cardiopulmonary arrest is a rare event outside intensive care units in children's hospitals. Medical-surgical RNs rarely are involved in code situations and are often uncomfortable in performing necessary tasks. We implemented a multi-disciplinary educational plan, coupled with in-situ high-fidelity simulation, aimed at improving medical-surgical, RN comfort levels during codes. 260 medical surgical RNs on 10 separate hospital units parficipated. Pre and post intervention surveys were collected and compared. Results revealed a significant increase in the proportion of RNs responding "very comfortable" in all categories. Education, coupled with in-situ high-fidelity simulation, is an effective tool to increase RN comfortable levels during codes.
Collapse
|
44
|
A de novo splice site mutation inCASKcauses FG syndrome-4 and congenital nystagmus. Am J Med Genet A 2017; 173:611-617. [DOI: 10.1002/ajmg.a.38069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/14/2016] [Indexed: 11/07/2022]
|
45
|
Construct Validity of Four Frailty Measures in an Older Australian Population: A Rasch Analysis. J Frailty Aging 2016; 5:78-81. [PMID: 27224497 DOI: 10.14283/jfa.2016.83] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Individuals identified as frail have been shown to be at an increased risk of adverse health outcomes. However, there is no gold standard frailty measure and frailty status can vary depending on the measure used, suggesting the measures perform differently. Construct validity can be used to assess a measure's performance. This study aimed to examine the construct validity of four frailty measures in an Australian older population using Rasch analysis. Frailty status among the 2087 participants aged 65 years and above from the Australian Longitudinal Study of Ageing (ALSA) was assessed using: frailty phenotype--FP, simplified frailty phenotype--SFP, frailty index--FI, and prognostic frailty score--PFS. Rasch analysis was used to assess the unidimensionality of the measures, which is the extent to which the underlying characteristic of frailty is assessed. The criteria for unidimensionality from principal component analysis of the residuals was when 50% or more of the raw variance was explained by the measures, and less than 5% was unexplained variance. Only FI meet the unidimensionality criteria with 74% of explained variance and 2.1% of unexplained variance. SFP did not show a unidimensional construct with 13.3% of explained variance and 47.1% of unexplained variance. FP and PFS had 39.6%, 18.1% and 46.5%, 8.7% of explained and unexplained variance, respectively. Our findings showed that FI has better construct validity than the other three measures in assessing frailty among the Australian older population.
Collapse
|
46
|
|
47
|
Basal Ganglia Iron in Patients with Multiple Sclerosis Measured with 7T Quantitative Susceptibility Mapping Correlates with Inhibitory Control. AJNR Am J Neuroradiol 2016; 37:439-46. [PMID: 26611996 DOI: 10.3174/ajnr.a4599] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/31/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE T2 hypointensity in the basal ganglia of patients with MS has been associated with clinical progression and cognitive decline. Our objectives were the following: 1) to compare signal in T2WI, R2 (ie, 1/T2), and R2* (ie, 1/T2*) relaxation rates and quantitative susceptibility mapping; and 2) to investigate the associations among MR imaging, clinical scores, and cognitive measures of inhibitory control linked to basal ganglia functioning. MATERIALS AND METHODS Twenty-nine patients with MS underwent a battery of neuropsychological tests including the Flanker and Stroop tasks. 7T MR imaging included 3D gradient-echo and single-echo multishot spin-echo EPI. Quantitative susceptibility mapping images were calculated by using a Wiener filter deconvolution algorithm. T2WI signal was normalized to CSF. R2 and R2* were calculated by log-linear regression. Average MR imaging metrics for the globus pallidus, putamen, and caudate were computed from manually traced ROIs including the largest central part of each structure. RESULTS Marked spatial variation was consistently visualized on quantitative susceptibility mapping and T2/T2*WI within each basal ganglia structure. MR imaging metrics correlated with each other for each basal ganglia structure individually. Notably, caudate and putamen quantitative susceptibility mapping metrics were similar, but the putamen R2 was larger than the caudate R2. This finding suggests that tissue features contribute differently to R2 and quantitative susceptibility mapping. Caudate and anterior putamen quantitative susceptibility mapping correlated with the Flanker but not Stroop measures; R2 did not correlate with inhibitory control measures. Putamen quantitative susceptibility mapping and caudate and putamen R2 correlated with the Expanded Disability Status Scale. CONCLUSIONS Our study showed that quantitative susceptibility mapping and R2 may be complementary indicators for basal ganglia tissue changes in MS. Our findings are consistent with the hypothesis that decreased performance of basal ganglia-reliant tasks involving inhibitory control is associated with increased quantitative susceptibility mapping.
Collapse
|
48
|
Relationships between match activities and peak power output and Creatine Kinase responses to professional reserve team soccer match-play. Hum Mov Sci 2015; 45:96-101. [PMID: 26615476 DOI: 10.1016/j.humov.2015.11.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
The specific movement demands of soccer that are linked to post-match recovery and readiness to train are unclear. Therefore, we examined the relationship between Global Positioning System (GPS) variables and the change (Δ; from baseline) in Creatine Kinase (CK) concentrations and peak power output (PPO; during the countermovement jump) at 24h and 48h post-match. Fifteen English Premier League reserve team players were examined over 1-4 matches. Measurements of CK and PPO were taken before (24h prior to match-play) and after (+24h and +48h) each game during which movement demands were quantified using 10Hz GPS data. High intensity distance covered (r=0.386, p=0.029; r=-0.349; p=0.050), high intensity distance covered⋅min(-1) (r=0.365, p=0.040; r=-0.364, p=0.040), high speed running distance (r=0.363, p=0.041; r=-0.360, p=0.043) and the number of sprints⋅min(-1) (r=0.410, p=0.020; r=-0.368, p=0.038) were significantly related to ΔCK and ΔPPO at +24h post-match, respectively. No relationships were observed between any match variables and ΔCK and ΔPPO after +48h of recovery. These findings highlight that high intensity match activities are related to ΔCK and ΔPPO in the 24h, but not 48h, following soccer match-play. Such information is likely of interest to those responsible for the design of soccer player's training schedules in the days following a match.
Collapse
|
49
|
Dynamic modulation of electronic properties of graphene by localized carbon doping using focused electron beam induced deposition. NANOSCALE 2015; 7:14946-14952. [PMID: 26302897 DOI: 10.1039/c5nr04063a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report on the first demonstration of controllable carbon doping of graphene to engineer local electronic properties of a graphene conduction channel using focused electron beam induced deposition (FEBID). Electrical measurements indicate that an "n-p-n" junction on graphene conduction channel is formed by partial carbon deposition near the source and drain metal contacts by low energy (<50 eV) secondary electrons due to inelastic collisions of long range backscattered primary electrons generated from a low dose of high energy (25 keV) electron beam (1 × 10(18) e(-) per cm(2)). Detailed AFM imaging provides direct evidence of the new mechanism responsible for dynamic evolution of the locally varying graphene doping. The FEBID carbon atoms, which are physisorbed and weakly bound to graphene, diffuse towards the middle of graphene conduction channel due to their surface chemical potential gradient, resulting in negative shift of Dirac voltage. Increasing a primary electron dose to 1 × 10(19) e(-) per cm(2) results in a significant increase of carbon deposition, such that it covers the entire graphene conduction channel at high surface density, leading to n-doping of graphene channel. Collectively, these findings establish a unique capability of FEBID technique to dynamically modulate the doping state of graphene, thus enabling a new route to resist-free, "direct-write" functional patterning of graphene-based electronic devices with potential for on-demand re-configurability.
Collapse
|
50
|
Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study. J Nurs Manag 2015; 24:366-75. [PMID: 26370219 DOI: 10.1111/jonm.12330] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 11/29/2022]
Abstract
AIMS To explore the experiences of senior charge nurses provided with 'increased supervisory hours'. BACKGROUND Designated supervisory time is essential for senior charge nurses to provide effective clinical leadership. It is important to explore the impact arises of such an increase. METHODS An online questionnaire collected exploratory data from senior charge nurses (n = 60). Semi-structured interviews gathered in-depth qualitative data (n = 12). Findings were analysed for common themes associated with implementation of the increased senior charge nurse supervisory role. RESULTS The majority of senior charge nurses were unable to use their full allocation of supervisory time. They struggled to accomplish leadership goals because of managing staffing levels, increased workload, time constraints and limited support. Factors that facilitated the role included preparation and support, adequate staff capacity, effective leadership skills and availability of supervisory time. The senior charge nurses took pride in providing clinical leadership, promoting staff development and delivering patient care. Support, in terms of preparation, capacity building and ongoing mentoring, was a key factor for achieving senior charge nurse goals. CONCLUSION Senior charge nurses should be supported to maximise supervisory time through the provision of an induction programme, formal coaching and ongoing training and development. IMPLICATIONS FOR NURSING MANAGEMENT Preparation and support is essential for senior charge nurses to deliver enhanced clinical leadership through increased supervisory time.
Collapse
|