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Gibson M, Leske S, Ward R, Weir B, Russell K, Kolves K. Aboriginal and Torres Strait Islander youth suicide mortality and previous mental health, suicidality and service use in Queensland, Australia, from 2001 to 2021. J Affect Disord 2024; 354:55-61. [PMID: 38484672 DOI: 10.1016/j.jad.2024.03.013] [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] [Received: 07/13/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The current study aimed to compare current suicide rates, trends, previous treatment, suicidality and mental health diagnoses for First Nations and non-Indigenous young people who died by suicide. METHODS Age-specific suicide rates (ASSRs) were calculated per 100,000 persons/year using suicides aged 10-19 years in the Queensland Suicide Register. Rate Ratios (RRs) and 95 % CIs compared ASSRs for First Nations and non-Indigenous youth dying by suicide in Queensland, Australia, from 2001 to 2018. Risk ratios (RiskR) with 95 % CIs compared characteristics between First Nations and non-Indigenous youth suicides. Joinpoint regression was used to identify any changes in trends and annual percentage change (APC) in suicides with 95 % CIs. RESULTS The First Nations youth ASSR was 24.71 deaths per 100,000 persons/year, 4.5 times the non-Indigenous ASSR (95 % CI = 3.74-5.38, p < 0.001). Both non-Indigenous and First Nations suicide trends were stable with no joinpoints (APC: 0.3 %, 95 % CI: -1.6-2.2, p = 0.78; APC: 0.9 %, 95 % CI: -0.2-2.1, p = 0.11). Less than a quarter (23.9 %) of First Nations young people had ever received mental health treatment, significantly fewer than non-Indigenous youth (RiskR = 0.80, 95 % CI = 0.71-0.90, p < 0.001). Similarly, in the three months preceding their death, only 14.5 % of First Nations young people had received mental health treatment (RiskR = 0.89, 95 % CI = 0.83-97, p = 0.015). LIMITATIONS Reported mental illness, suicidality and help-seeking could be underreported due to concealment from family or police. CONCLUSIONS The current study finds no change in the gap between the First Nations and Non-Indigenous youth suicide rates nor evidence of decrease in the First Nations youth suicide rate. There is a need for alternative approaches to Indigenous youth suicide prevention, such as assertive outreach models outside of traditional triage and mental health systems to proactively build trusting relationships with young people in communities to identify young people needing support.
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Affiliation(s)
- M Gibson
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia.
| | - S Leske
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia; UQ Poche Centre for Indigenous Health, The University of Queensland, Toowong, Queensland, Australia
| | - R Ward
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia; Institute for Resilient Regions, Knowledge Broker First Nations Engagement Southern Queensland & Northern NSW Drought Resilience Adoption & Innovation Hub, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - B Weir
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - K Russell
- Beyond the Pale Aboriginal and Torres Strait youth mental health support services, Australia
| | - K Kolves
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Stempien J, Gibson M, Harrison A. "We want to change the system": a qualitative study on emergency medicine physician leadership. CAN J EMERG MED 2024; 26:266-270. [PMID: 38520497 DOI: 10.1007/s43678-024-00667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/31/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE The significance of physician leadership to help transform the healthcare system has been increasingly discussed. This study looked at the qualities of emergency medicine (EM) physicians that support or inhibit their work as healthcare leaders. METHODS Through an iterative process of semi-structured interviews and then focus groups, we examined why EM physicians pursue leadership roles, the strengths they bring and the frustrations they encounter. Thematic analysis identified factors that facilitate and inhibit the work of EM physicians as they enter leadership roles. RESULTS These findings can be summarized in four key themes. (1) A desire to improve the wider health system was often a prime motivator for entering a leadership role. (2) EM physicians' clinical skills such as confident decision-making, relationship building through communication, and comfort with uncertainty supported their successful transition to leadership. (3) EM physician leaders perceived shiftwork as both a potential benefit and a challenge in their leadership role and felt it needed to be carefully managed to ensure personal wellness and success. And (4) participants were not driven to take on leadership positions by financial remuneration but stated that the discrepancy between EM clinical and leadership compensation was a point of stress. CONCLUSION As physician leadership is explored as a mechanism to support the healthcare system's success, this project provides insights into the realities experiences by EM physicians and considerations for healthcare professionals as they encourage physicians into leadership positions.
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Affiliation(s)
- J Stempien
- University of Saskatchewan College of Medicine, Saskatoon, SK, Canada.
| | - M Gibson
- Department of Sociology, University of Saskatchewan, Saskatoon, SK, Canada
| | - A Harrison
- Royal Roads University, Vancouver, BC, Canada
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Gibson M, Lawrence KE, Balcomb C, Laven RA. The effect of parenteral vitamin B 12 on the growth rate of dairy calves over the summer and autumn on seven farms from the Central Plateau, New Zealand. N Z Vet J 2024; 72:10-16. [PMID: 37675455 DOI: 10.1080/00480169.2023.2254729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
AIMS To investigate the effect of parenteral vitamin B12 supplementation on the growth rate of dairy heifer calves over the summer and autumn on seven farms from the Central Plateau of New Zealand, an area historically associated with low cobalt levels in grazing pasture. METHODS This was a controlled clinical trial conducted on a convenience sample of seven farms with young female calves randomly assigned to three vitamin B12 treatment groups and followed through a grazing season. Two treatment groups received either monthly SC injections of a short-acting (SA) B12 formulation or 3-monthly injections of a long-acting (LA) B12 formulation and the third group received no treatment (NT). No additional parenteral vitamin B12 was given; however, all calves received additional cobalt (0.04-0.4 mg Co/kg liveweight) in the mineralised anthelmintic drenches given orally every month. Liveweight was recorded in December/January and at the end of the trial in May/June/July depending on farm. Pasture cobalt concentrations (mg/kg DM) were measured every month using 500-g herbage samples from 100-m transects in the area about to be grazed by the trial groups. RESULTS There was evidence for a difference in growth rate between groups with mean final weight of 228 (95% CI = 212-243) kg for the LA groups, 224 (95% CI = 209-239) kg for the SA groups and 226 (95% CI = 211-241) kg for the NT groups respectively, (global p-value = 0.014). Calves given SA vitamin B12 were 3.77 (95% CI = 0.71-6.82) kg lighter than calves given LA vitamin B12 (p = 0.011). There was no evidence for a change in pasture cobalt concentrations (p = 0.32). CONCLUSIONS AND CLINICAL RELEVANCE The results of this trial raise the question as to whether the routine use of vitamin B12 supplementation in young cattle from areas traditionally thought to be cobalt deficient is necessary, and further raise the possibility that vitamin B12 supplementation by repeated injection of SA products may negatively impact growth rates.
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Affiliation(s)
| | - K E Lawrence
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - C Balcomb
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - R A Laven
- Tāwharau Ora - School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Montandon S, Win S, Jones S, Bello I, Amin A, Khan S, Biswas S, Aperios G, Gibson M, Yahia G. 1255 IMPROVING COMMUNICATION BETWEEN NEXT OF KIN AND MEDICAL STAFF FOR OUR MOST VULNERABLE PATIENTS: A QUALITY IMPROVEMENT PROJECT. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
This project was completed by a team of junior doctors working across two general medical wards at Queen Alexandra Hospital.
Introduction
Due to persistently high bed occupancy, patients are increasingly subject to multiple moves, increasing the risk of missed or delayed communication (Toye C et al, Clin interv aging, 2019, 14, 2223-2237). Importantly, families who receive good communication from staff are more likely to feel satisfied with the care of their loved one (Ersek M et al, J pain symptom manage, 2021, 62(2), 213–222). Our aim was to increase the occurrence and comprehensiveness of documented discussions between next of kin (NOK) and the medical team, especially in vulnerable patients who may be unable to advocate for themselves.
Methods
We conducted a retrospective, cross-sectional analysis of patient notes across two PDSA cycles. NICE guidelines NG27, NG97 and NG96 provided an audit standard. Patients were identified as at-risk of poor communication if diagnosed with dementia, cognitive impairment, addiction, learning difficulties or needing an interpreter. Targeted intervention prior to re-audit included education of the medical team and introduction of a written prompt within the patient’s notes.
Results
25/55 patients were identified as at-risk in cycle one, with 39/71 patients at-risk in cycle two. Post-intervention, the number of at-risk patients with a documented NOK discussion increased from 74% to 82%. Patient treatment plan discussions increased from 81% to 97%. Discussions, where applicable, regarding escalation of care, Deprivation of Liberty Safeguards (DoLS), capacity and Mental Health Act (MHA) slightly decreased. Conversations regarding patient consent for data sharing were rarely documented.
Conclusion
Our intervention increased the proportion of documented patient discussions; however, it did highlight the need to improve the frequency of documented conversations surrounding escalation of care, DoLS, capacity and MHA. This has provided impetus for further improvement projects.
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Affiliation(s)
- S Montandon
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - S Win
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - S Jones
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - I Bello
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - A Amin
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - S Khan
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - S Biswas
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - G Aperios
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - M Gibson
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
| | - G Yahia
- Queen Alexandra Hospital Department of General Internal Medicine, , Portsmouth
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Oh GY, Gibson M, Khanom S, Jaiswal P, Patel A. Validating low-fidelity arthroscopic simulation in medical students: a feasibility trial. Ann R Coll Surg Engl 2023; 105:28-34. [PMID: 35446721 PMCID: PMC9773295 DOI: 10.1308/rcsann.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION With surgical opportunities becoming increasingly restricted for orthopaedic trainees, simulation training is a valuable alternative at providing sufficient practice. This pilot study aims to assess the potential effectiveness of low-fidelity simulation in teaching medical students basic arthroscopic skills and the feasibility of its incorporation into formal student training programmes. METHODS Twenty-two medical students completed pre- and post-training tests on the Probing (Task 1) and Maze (Task 2) exercises from the Sawbones 'Fundamentals of Arthroscopy Surgery Training' (FAST) programme. Training consisted of practising horizon control, deliberate linear motion and probing within 25min over a period of days. Completion time and error frequency were measured. The difference in performance was assessed using a paired two-tailed t-test. Qualitative data were collected. RESULTS Test completion time decreased significantly by a mean of 83s (±46s, 95% confidence intervals [CI] 37 to 129) for Task 1 (p=0.001) and 105s (±55s, 95% CI 50 to 160) for Task 2 (p=0.0007). Frequency of direct visualisation errors decreased significantly by a mean of 1.0 errors (±1.0 errors, 95% CI 0.1 to 2.0) for Task 1 (p = 0.04) and 0.8 errors (±0.8 errors, 95% CI 0.1 to 1.6) for Task 2 (p = 0.04). At post-training, 82% of participants were willing to incorporate FAST into formal training. CONCLUSIONS Low-fidelity simulators such as FAST can potentially teach basic arthroscopic skills to medical students and are feasible for incorporation into formal training. They also give students a cost-effective and safe basic surgical training experience.
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Affiliation(s)
- GY Oh
- University College London (UCL), UK
| | - M Gibson
- Royal Free London NHS Foundation Trust, UK
| | - S Khanom
- Royal Free London NHS Foundation Trust, UK
| | - P Jaiswal
- Royal Free London NHS Foundation Trust, UK
| | - A Patel
- Royal Free London NHS Foundation Trust, UK
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Pang C, Nisbet R, Gibson M, Evans N, Khalifa M, Papadopoulou A, Tsui J, Hamilton G, Brookes J, Lim CS. 522 Early Follow-Up Quality of Life and Mental Health of Patients with Congenital Vascular Malformations Cared for in a Multi-Disciplinary Specialist Center. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist center
Method
This was a prospective observational study. All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between February 1st 2018 and January 31st 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. P<0.05 were considered significant.
Results
110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolo-sclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.
Conclusions
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
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Affiliation(s)
- C Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - R Nisbet
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - M Gibson
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - N Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - M Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - A Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - J Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - G Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
| | - J Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust , London , United Kingdom
| | - CS Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust , London , United Kingdom
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London , London , United Kingdom
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7
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Pang C, Nisbet R, Gibson M, Evans N, Khalifa M, Papadopoulou A, Tsui J, Hamilton G, Brookes J, Lim CS. O064 Early follow-up quality of life and mental health of patients with congenital vascular malformations cared for in a multi-disciplinary specialist center. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist centre
Methods
All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between 1 February 2018 and 31 January 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. Differences were considered significant at P<0.05.
Results
110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolosclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.
Conclusion
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
Take-home message
The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.
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Affiliation(s)
- C Pang
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - R Nisbet
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - M Gibson
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - N Evans
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
| | - M Khalifa
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust
| | - A Papadopoulou
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust
| | - J Tsui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - G Hamilton
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
| | - J Brookes
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Interventional Radiology, Royal Free London NHS Foundation Trust
| | - CS Lim
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust
- Department of Surgical Biotechnology, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London
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Cheetham M, Atkinson PJ, Gibson M, Katikireddi SV, Moffatt S, Morris S, Munford L, Shenton F, Wickham S, Craig P. Exploring the mental health effects of Universal Credit: a journey of co-production. Perspect Public Health 2022; 142:209-212. [PMID: 35833554 PMCID: PMC9284081 DOI: 10.1177/17579139221103178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- M Cheetham
- Research Fellow, National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR200173), based at Department of Nursing, Midwifery and Health, Northumbria University, Coach Lane Campus East, Room H213, Newcastle-u-Tyne, NE7 7XA, UK
| | | | - M Gibson
- Investigator Scientist, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S V Katikireddi
- Professor of Public Health & Health Inequalities, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Moffatt
- Professor of Social Gerontology, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - S Morris
- Post Doctoral Research Associate, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - L Munford
- Senior Lecturer in Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Social Sciences, University of Manchester, Manchester, UK
| | - F Shenton
- Public Involvement and Community Engagement Manager, National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR200173), based at CNTW NHS Foundation Trust, St Nicholas' Hospital, Newcastle Upon Tyne, NE3 3XT, UK
| | - S Wickham
- Wellcome Trust Research Fellow, Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - P Craig
- Professor of Public Health Evaluation, Inequalities and Health, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Srivastava A, Gibson M, Patel A. 119 The Potential of Low-fidelity Arthroscopic Simulation Training in Trauma and Orthopaedic Surgery: A Systematic Review of Experimental Studies. Br J Surg 2021. [PMCID: PMC8524586 DOI: 10.1093/bjs/znab259.832] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
In an era of budget tightening and work-hour guideline reductions that have significantly reduced surgical exposure, low-fidelity arthroscopic simulators have an essential role to play in surgical training. The COVID-19 pandemic has only further amplified the need for alternative training models, as 91% of orthopaedic trainees have had elective procedures cancelled. The purpose of this systematic review is to synopsise the limited literature regarding the effectiveness of low-fidelity training models in the instruction of novices, and to formulate recommendations for future studies.
Method
The Embase, PubMed, Web of Science and Scopus databases were electronically searched. Studies from any year that described the use of orthopaedic, low-fidelity arthroscopic training models in novice populations were included. Questionnaires, case studies and review studies were excluded. Risk of bias assessments were also conducted for all studies.
Results
16 studies were identified. Using the PRISMA algorithm, 6 studies were deemed relevant. A cross-study comparison revealed low-fidelity arthroscopic simulators reduced time to completion outcomes (P < 0.05), increased ASSET scores (P < 0.01) and confirmed face validity and transfer of skills (cadaver, live patients).
Conclusions
Low-fidelity simulator training significantly improves the arthroscopic performance of novices, without the high setup costs and practical constraints of high-fidelity equivalents. Low-fidelity arthroscopic simulators remain a promising training apparatus in an era of reduced surgical exposure (COVID-19). We have identified the need for consistent outcome measures with greater sample sizes across future studies. We recommend the use of standardised pre-intervention teaching (e.g., ABOS curriculum) and further transference, construct, and face validity evaluations to support future result interpretations.
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Affiliation(s)
- A Srivastava
- School of Medicine, University College London (UCL), London, United Kingdom
| | - M Gibson
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - A Patel
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom
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10
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Gibson M, Yang N, Waller JL, Young L, Bollag WB, Kheda M, Mohammed A, Baer SL. Nocardiosis in renal transplant patients. J Investig Med 2021; 70:36-45. [PMID: 34426458 DOI: 10.1136/jim-2021-001783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/04/2022]
Abstract
Renal transplant patients are immunosuppressed and are at increased risk of opportunistic infections, including Nocardia infection. In renal transplant patients, information on the incidence and risk factors associated with nocardiosis is limited. To address the incidence and risk factors associated with nocardiosis in a large renal transplant population, we used the US Renal Data System (USRDS). Sequelae of allograft failure or rejection after infection were also examined. Demographics, clinical risk factors, Nocardia diagnosis, and allograft failure following Nocardia infection were queried in USRDS renal transplant patients using International Classification of Diseases, Ninth Revision (ICD-9) codes in billing claims and Centers for Medicare and Medicaid Services Form 2728. Generalized linear models were used to determine the risk factors associated with nocardiosis, and Cox proportional hazards models were used to examine the association of risk factors with graft failure among patients with Nocardia infection. Of 203,233 renal transplant recipients identified from 2001 to 2011, 657 (0.32%) were diagnosed with Nocardia infection. Pneumonia was the most frequent presentation (15.2%), followed by brain abscess (8.4%). Numerous factors associated with increased Nocardia infection included age >65 years (OR=2.10, 95% CI 1.71 to 2.59), history of transplant failure (OR=1.28, CI 1.02 to 1.60) or history of rejection (OR=4.83, CI 4.08 to 5.72), receipt of a deceased donor transplant (OR=1.23, CI 1.03 to 1.46), and treatment with basiliximab (OR=1.25, CI 1.00 to 1.55), cyclosporine (OR=1.30, CI 1.03 to 1.65), tacrolimus (OR=2.45, CI 2.00 to 3.00), or thymoglobulin (OR=1.89, CI 1.59 to 2.25). In patients with nocardiosis administration of antithymocyte globulin (HR=2.76), chronic obstructive pulmonary disease (HR=2.47), and presentation of Nocardia infection with brain abscess (HR=1.85) were associated with an increased risk of graft failure. This study provides new information to enhance early recognition and targeted treatment of nocardiosis in renal transplant patients.
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Affiliation(s)
- Maya Gibson
- Department of Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Nianlan Yang
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, USA.,Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer L Waller
- Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, USA
| | - Lufei Young
- College of Nursing, Augusta University, Augusta, Georgia, USA
| | - Wendy B Bollag
- Department of Dermatology, Medical College of Georgia, Augusta, Georgia, USA
| | - Mufaddal Kheda
- Department of Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Azeem Mohammed
- Department of Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Stephanie L Baer
- Department of Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA .,Infection Control and Epidemiology, Augusta VA Medical Center, Augusta, Georgia, USA
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11
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Little MW, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, Davies N, Tayton E, Tavares S, MacGill S, McLaren C, Harrison R. Correction to: Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis. Cardiovasc Intervent Radiol 2021; 44:1153. [PMID: 33884460 PMCID: PMC8496580 DOI: 10.1007/s00270-021-02849-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M W Little
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK. .,University of Reading, Reading, UK.
| | - M Gibson
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - J Briggs
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - A Speirs
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - P Yoong
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - T Ariyanayagam
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - N Davies
- Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - E Tayton
- Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - S Tavares
- Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - S MacGill
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - C McLaren
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
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12
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Gibson M, Scolyer RA, Soyer HP, Ferguson P, McGeechan K, Irwig L, Bell KJL. Estimating the potential impact of interventions to reduce over-calling and under-calling of melanoma. J Eur Acad Dermatol Venereol 2021; 35:1519-1527. [PMID: 33630379 DOI: 10.1111/jdv.17189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/19/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pathologists sometimes disagree over the histopathologic diagnosis of melanoma. 'Over-calling' and 'under-calling' of melanoma may harm individuals and healthcare systems. OBJECTIVES To estimate the extent of 'over-calling' and 'under-calling' of melanoma for a population undergoing one excision per person and to model the impact of potential solutions. METHODS In this epidemiological modelling study, we undertook simulations using published data on the prevalence and diagnostic accuracy of melanocytic histopathology in the U.S. POPULATION We simulated results for 10 000 patients each undergoing excision of one melanocytic lesion, interpreted by one community pathologist. We repeated the simulation using a hypothetical intervention that improves diagnostic agreement between community pathologist and a specialist dermatopathologist. We then evaluated four scenarios for how melanocytic lesions judged to be neither clearly benign (post-test probability of melanoma < 5%), nor clearly malignant (post-test probability of melanoma > 90%) might be handled, before sending for expert dermatopathologist review to decide the final diagnosis. These were (1) no intervention before expert review, (2) formal second community pathologist review, (3) intervention to increase diagnostic agreement and (4) both the intervention and formal second community pathologist review. The main outcomes were the probability of 'over-calling' and 'under-calling' melanoma, and number of lesions requiring expert referral for each scenario. RESULTS For 10 000 individuals undergoing excision of one melanocytic lesion, interpreted by a community pathologist, a hypothetical intervention to improve histopathology agreement reduced the number of benign lesions 'over-called' as melanoma from 308 to 164 and the number of melanomas 'under-called' from 289 to 240. If all uncertain diagnoses were sent for expert review, the number of referrals would decrease from 1500 to 737 cases if formal second community pathologist review was used, and to 701 cases if the hypothetical intervention was additionally used. CONCLUSIONS Interventions to improve histopathology agreement may reduce melanoma 'over-calling' and 'under-calling'.
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Affiliation(s)
- M Gibson
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Department of Dermatology, Royal Prince Alfred Hospital Sydney, Camperdown, NSW, Australia
| | - R A Scolyer
- Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute of Australia, The University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Camperdown, NSW, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - P Ferguson
- Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute of Australia, The University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Camperdown, NSW, Australia
| | - K McGeechan
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - L Irwig
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - K J L Bell
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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13
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Mehta S, Gibson M, Avila J, Villagran C, Fernandez F, Niklitschek S, Vera F, Rocuant R, Cardenas G, Frauenfelder A, Vieira D, Merchant S, Vijayan Y, Tamayo C, Pinos D. Reconfiguring traditional EKG interpretation with artificial intelligence – a reliable, time-saving alternative? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Time and accuracy are key factors that may make or break an efficient triage and management in most medical premises, particularly so when expedited diagnosis saves lives - a not so uncommon scenario in the field of cardiology. By studying the different variables involved in cardiologist-EKG interactions that lead to the identification and management of different cardiovascular entities, we delved into the applications of Artificial Intelligence (AI) algorithms in order to improve upon the classic, but dated, EKG methodology. With this study, we pit our algorithm against cardiologists to perform a thorough analysis of the time invested to diagnose an EKG as Normal, as well as an assessment of the accuracy of said label.
Purpose
To present a faster and reliable AI-guided EKG interpretation methodology that outperforms cardiologists' capabilities in identifying Normal EKG records.
Methods
The International Telemedical System (ITMS) developed and tested an EKG assessing AI algorithm and incorporated it into the workflow of their Telemedicine Integrated Platform, a digital EKG reading program where cardiologists continuously report their findings remotely in real time. During the month of April 2019; 35 ITMS cardiologists reported a grand total of 61,441 EKG records, later subjecting them to the AI algorithm, implemented through the “One Click Report” process. Through this simple 2-step approach, the algorithm provides a suggestion of “Normal” or “Abnormal” to the cardiologist based on the patterns of the fiducial points included in said EKG reports. A comparison of the time of normal EKG diagnosis is made and the correlation between AI and cardiologists is assessed.
Results
On average, our AI algorithm discerned a normal EKG within 30.63s (95% CI 26.51s to 34.75s), in solid contrast with cardiologists' interpretations alone, which amounted to 83.54s (95% CI from 69.43s to 97.65s). This accounts for an overall saving of 52.91s (95% CI 42.45s to 63.83s) by implementing this innovative methodology in a cardiologist practice. In addition, this method correctly reported 23,213 Normal EKG records out of the total 25,013 AI output, reaching a 92.8% correlation between man and machine. The total average time saved in normal EKG readings with AI (23,213) would accrue an approximate of 20,470 minutes (ie, 42 8-hours work shifts worth of time dedicated to diagnosing a normal EKG).
Conclusions
The implementation of automated AI-driven technologies into daily EKG interpretation tasks poses an attractive time-saving alternative for faster and accurate results in a modern cardiology practice. By further expanding on the concept of an intelligent EKG characterization device, a more efficient and patient-centered clinical exercise will ensue.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - M Gibson
- Harvard Medical School, Boston, United States of America
| | - J Avila
- Cardionomous AI, Santiago, Chile
| | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | | | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - S Merchant
- Lumen Foundation, Miami, United States of America
| | - Y Vijayan
- Lumen Foundation, Miami, United States of America
| | - C.J Tamayo
- Lumen Foundation, Miami, United States of America
| | - D Pinos
- Lumen Foundation, Miami, United States of America
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14
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Mehta S, Gibson M, Niklitschek S, Fernandez F, Villagran C, Escobar E, Vera F, Frauenfelder A, Vieira D, Vijayan Y, Quintero S, Vallenilla I, Pinto G, Cardenas J, Merchant S. Maximum artificial intelligence and complete reconstruct of population-based AMI care. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
After creating a behemoth hub and spoke AMI network that encompasses more than 100 million patients in 5 countries, we have begun to incorporate Artificial Intelligence (AI) algorithms into our telemedicine strategy with the goal of creating comprehensive, very early AMI diagnosis and physician-free triage. In doing so, we have replaced door-to-balloon times (d2b) with symptom-to-balloon times (s2b) as an immutable objective.
Purpose
To incorporate AI attributes for very early AMI detection, triage, and management.
Methods
We expanded our effective telemedicine strategy (100 million population; 877,178 telemedicine encounters; 55% overall mortality reduction; $291 million cost savings) with a logistic reset to impact s2b. To do this, we incorporated our Single Lead 1.0 (lead I) and Single Lead 2.0 (lead V2) technology for self-administered AMI detection with our physician-free STEMI diagnosis and triage AI algorithms. Single Lead algorithms and physician-free protocols were generated by utilizing Machine Learning from our mammoth annotated EKG repository.
Results
In addition to three logistic markers of efficiency Time-to-Telemedicine Diagnosis (TTD), Door-In-Door-Out (DIDO) and Transfer Times (TT); we are monitoring s2b. A gradual release of the algorithms and single lead is occurring at the telemedicine spokes. Detailed results will be available at the time of presentation.
Conclusions
Impacting s2b, the Achilles Heel of Primary PCI, may be achieved with the use of patient-administered AMI detection tools. Incorporation of these technologies into AI algorithms will add to telemedicine efficiencies for population-based AMI care.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - M Gibson
- Harvard Medical School, Boston, United States of America
| | | | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - Y Vijayan
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Cardenas
- Lumen Foundation, Miami, United States of America
| | - S Merchant
- Lumen Foundation, Miami, United States of America
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15
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Mehta S, Gibson M, Niklitschek S, Fernandez F, Villagran C, Escobar E, Vera F, Frauenfelder A, Vieira D, Quintero S, Merchant S, Tamayo C, Ceschim M, Vallenilla I, Prieto L. AI and telemedicine: total remote guidance of AMI management. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
For a decade, Latin American Telemedicine Infarct Network (LATIN) Telemedicine has transformed AMI management in Brazil, Colombia, Mexico, Chile, and Argentina. With a hub and spoke strategy, AMI coverage was expanded to 100 million population and 877,177 telemedicine encounters were performed. Cost savings from avoiding unnecessary transfer of patients was $291 million. We are now rapidly escalating on a path to making the telemedicine process “physician-free” by utilizing Artificial Intelligence (AI) protocols.
Purpose
To demonstrate that AI can replace a cardiologist for remote AMI telemedicine guidance.
Methods
The process of total AI guidance focused on both aspects of our telemedicine strategy – accurate AMI diagnosis and tele-guidance of the entire STEMI process. We developed our innovative approach by initially creating AI algorithms for computer-aided diagnosis. Next, we incorporated logistic variables (duration of chest pain, transfer times to LATIN hub, etc) to the algorithm for physician-free triage into thrombolysis, primary PCI and pharmaco-invasive management. The intent of creating AI algorithms was early STEMI detection and triage. After the patient was efficiently transferred to the hub, a final treatment decision was made by the hub cardiologists.
Results
Three crucial areas of telemedicine efficiency are being monitored – Time-to-Telemedicine Diagnosis (TTD), Door-In-Door-Out (DIDO) and Transfer Times (TT). All are showing improvements. Detailed results will be available at the time of presentation.
Conclusions
We are encouraged with the possibility of making the entire telemedicine guidance of AMI management “physician-free”. Next-Gen improvements are being contemplated by including a Single Lead EKG for AMI detection that will impact symptom-to-balloon times.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - M Gibson
- Harvard Medical School, Boston, United States of America
| | | | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - S Merchant
- Lumen Foundation, Miami, United States of America
| | - C.J Tamayo
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
| | - L Prieto
- Lumen Foundation, Miami, United States of America
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16
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Cohen E, Dunn L, Neupane P, Gibson M, Leidner R, Savvides P, Hyland N, Trivedi T, Dudley M, Biswas S, Williams D, Norry E. 976TiP SPEARHEAD-2 trial design: A phase II pilot trial of ADP-A2M4 in combination with pembrolizumab in patients with recurrent or metastatic head and neck cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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17
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Brooks J, Gibson M, Kite K, Czeisler E, Fisher M, Xiao C, Polymeropoulos C, Polymeropoulos M. 1004 Smith-<Magenis Syndrome (SMS) Circadian Abnormalities And Biological Rhythms. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
SMS is a rare neurodevelopmental disorder that manifests with craniofacial abnormalities, behavioral disturbances, and a severe sleep disorder. It has been reported that many SMS patients have an inverted melatonin secretion pattern (peaking during the daytime) although a small minority have near normal patterns. The goal of this study was to better characterize the intra- and inter-patient variability of melatonin secretion patterns and investigate a potential relationship with sleep behavior in SMS patients.
Methods
In this observational study, sleep behaviors of patients (N=8, 1 female, ages: 7 - 35) with SMS were characterized through caretaker surveys. On 3 separate occasions, patients had hourly serum melatonin levels sampled for 36 hours. From these data, peak serum melatonin concentration and time of peak concentration were determined. Inter- and intra-patient variability was characterized by zero lag correlation of the melatonin concentration timeseries across and within patients, respectively. The relationship between peak melatonin concentration, peak time, and sleep latency was analyzed by a generalized linear model, GLM.
Results
Peak melatonin concentrations varied across SMS patients with a range of 3.55pg/ml - 49.65pg/ml (mean 14.18 ± 15.19pg/ml). Time of peak melatonin concentrations ranged from 0400h-2100h (mean 1422 ± 6h). Correlation coefficients characterizing intra-patient variability ranged from -0.0098 to 0.89 (mean 0.55 ± 0.2533). Correlation coefficients characterizing inter-patient variability ranged from -0.75 to 0.79 (mean of 0.18 ± 0.52). Sleep latency ranged from 8.4min - 36.35min (mean of 21.99 ± 9.77 min). GLM analysis demonstrated a significant, positive effect of peak time with sleep latency (p=0.022).
Conclusion
Consistent with previous findings, our study confirms that SMS patients have abnormal circadian rhythms. Our work extends this body of literature by demonstrating a significant degree of inter-patient variability with relatively stable intra-patient variability. Preliminary evidence suggests that the timing of melatonin peak may be related to sleep onset latency.
Support
This work was supported by Vanda Pharmaceuticals Inc.
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Affiliation(s)
- J Brooks
- Vanda Pharmaceuticals Inc., Washington, DC
| | - M Gibson
- Vanda Pharmaceuticals Inc., Washington, DC
| | - K Kite
- Vanda Pharmaceuticals Inc., Washington, DC
| | - E Czeisler
- Vanda Pharmaceuticals Inc., Washington, DC
| | - M Fisher
- Vanda Pharmaceuticals Inc., Washington, DC
| | - C Xiao
- Vanda Pharmaceuticals Inc., Washington, DC
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18
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Brooks J, Gibson M, Kite K, Czeisler E, Fisher M, Xiao C, Polymeropoulos C, Polymeropoulos M. 1161 Tasimelteon Shows Persistence Of Efficacy In Improving Sleep Disturbances In Patients With Smith-Magenis Syndrome (SMS) In Open-Label Extension Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Smith-Magenis Syndrome (SMS) is a rare (1/15,000 - 25,000 births) neurodevelopmental disorder resulting from an interstitial deletion of chromosome 17p11.2, or from a point mutation in the RAI1 gene. Severe sleep disorder is almost universal in patients with SMS and poses a significant challenge to patients and their families. Tasimelteon improved sleep symptoms in a randomized, double-blind, two-period, crossover study; and here we show that this effect persists for up to four years in an open-label extension. To our knowledge, this is the largest interventional study of SMS patients to date.
Methods
Following the 4-week crossover study, all eligible participants had the option to enroll in an open-label extension. 31/39 (79.4%) of all individuals who participated in the efficacy study have continued on tasimelteon treatment. Participants in the open-label extension provided daily diary sleep quality (DDSQ), and daily diary total sleep time (DDTST) measures via parental post sleep questionnaire and characterized behavior using the Aberrant Behavior Checklist (ABC).
Results
In the open-label extension, tasimelteon continued to show improvement in the primary endpoints of 50% worst sleep quality (mean = 0.7, SD = 0.94) and 50% worst total nighttime sleep duration (mean = 53.3, SD = 59.01) when compared to baseline. Tasimelteon also improved overall sleep quality (mean=0.7, SD=0.83) and overall total nighttime sleep duration (mean = 51.9, SD=53.03). ABC scores also improved with tasimelteon (mean= -16.3, SD = 15.82).
Conclusion
Tasimelteon continues to demonstrate persistence in efficacy (longest approximately 4 years) with similar magnitudes observed in the 4-week crossover study for sleep quality and total sleep time. Interestingly, daytime behavior also demonstrates long-term improvement in patients with SMS treated with tasimelteon. These results further confirm tasimelteon as a novel therapy for the treatment of sleep disorders in patients with SMS and may provide benefit for behavioral symptoms.
Support
This work was supported by Vanda Pharmaceuticals Inc.
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Affiliation(s)
- J Brooks
- Vanda Pharmaceuticals Inc., Washington, DC
| | - M Gibson
- Vanda Pharmaceuticals Inc., Washington, DC
| | - K Kite
- Vanda Pharmaceuticals Inc., Washington, DC
| | - E Czeisler
- Vanda Pharmaceuticals Inc., Washington, DC
| | - M Fisher
- Vanda Pharmaceuticals Inc., Washington, DC
| | - C Xiao
- Vanda Pharmaceuticals Inc., Washington, DC
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19
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Gibson M, Pinheiro D, Romero E, Ebong I, Cadeiras M. Induction Therapy in Patients with Prolonged Ischemic Times May Be Protective for Early Graft Failure. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.670] [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: 11/29/2022] Open
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20
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Affiliation(s)
- M Gibson
- South Eastern Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C L Rogers
- South Eastern Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - D F Murrell
- South Eastern Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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21
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Gibson M, Theocharous C, Tran K, Murrell DF, Daniel BS. Mycobacterium chelonae infection mimicking Demodex folliculitis. Clin Exp Dermatol 2019; 45:469-470. [PMID: 31675449 DOI: 10.1111/ced.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Affiliation(s)
- M Gibson
- South Eastern Sydney Local Health District, Kogarah, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C Theocharous
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,New South Wales Health Pathology, Sydney, NSW, Australia
| | - K Tran
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,New South Wales Health Pathology, Sydney, NSW, Australia
| | - D F Murrell
- South Eastern Sydney Local Health District, Kogarah, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - B S Daniel
- South Eastern Sydney Local Health District, Kogarah, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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22
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Ariagno S, Holzner S, Gibson M, Jones S, Amsler T, Duff K. P252 A DEVICE FOR FACILITATED SUBCUTANEOUS IMMUNOGLOBULIN USING PATIENT-CENTRIC DESIGN AND MODULAR INNOVATION PRINCIPLES. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Bottomley MJ, Gibson M, Alchi B. PR3 vasculitis presenting with symptomatic splenic and renal infarction: a case report and literature review. BMC Nephrol 2019; 20:84. [PMID: 30841860 PMCID: PMC6404344 DOI: 10.1186/s12882-019-1266-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/25/2019] [Indexed: 11/21/2022] Open
Abstract
Background ANCA-associated vasculitis is a life-threatening, systemic autoimmune disease. There is an increased risk of organ infarction but in many cases this is asymptomatic. We described here the first reported case of PR3 vasculitis presenting with symptomatic bilateral renal wedge infarction. Case presentation A 19-year old Caucasian woman with no past medical history presented on a number of occasions over a number of weeks with progressively more severe back pain, fevers and arthralgia. On the final presentation she was noted to have developed splinter haemorrhages and her blood tests revealed impaired renal function along with elevated inflammatory markers. She was subsequently found to have high titres of serum PR3 antibodies and focal necrotising glomerulonephritis on renal biopsy, consistent with a diagnosis of PR3 ANCA-associated vasculitis. Cross-sectional imaging revealed multiple wedge infarcts of her spleen and both kidneys, confirmed on contrast-enhanced ultrasound. Large vessel, cardiac and thrombophilic causes of thromboembolism were excluded. She was treated with high-dose corticosteroids and CD20 monoclonal antibodies (rituximab) and at time of writing, 4 months after initial presentation, has entered clinical remission. Conclusions Here we describe the first reported case of PR3 vasculitis presenting with symptomatic renal wedge infarction. In patients with vasculitis who present with flank or back pain, infarction of abdominal organs should be considered in the differential. Both splenic and renal infarctions are likely underdiagnosed in the setting of ANCA-associated vasculitis but may have clinical impact in contributing to infection risk and the degree or renal recovery, respectively.
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Affiliation(s)
- M J Bottomley
- Department of Renal Medicine, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK.
| | - M Gibson
- Department of Radiology, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - B Alchi
- Department of Renal Medicine, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
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24
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Lawrence KE, Gibson M, Hickson RE, Gedye K, Hoogenboom A, Fermin L, Draganova I, Pomroy WE. Experimental infection of Friesian bulls with Theileria orientalis (Ikeda) and effects on the haematocrit, live weight, rectal temperature and activity. Vet Parasitol Reg Stud Reports 2018; 14:85-93. [PMID: 31014744 DOI: 10.1016/j.vprsr.2018.09.004] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022]
Abstract
Since 2012, New Zealand has suffered from an epidemic of infectious bovine anaemia associated with T. orientalis (Ikeda), an obligate intracellular protozoan parasite of cattle. Despite widespread agreement that T. orientalis (Ikeda) infection has impacted beef and dairy farming in New Zealand there is very little quantitative data to support this conclusion. A randomised controlled experimental study of the effect of T. orientalis (Ikeda) infection on the live weight, haematocrit (HCT), temperature and activity of 2-year-old Friesian bulls was conducted at a Massey University Research farm, Palmerston North. Ten out of seventeen 2-year-old Friesian bulls were injected intravenously with 30 mL whole blood from 2 clinical cases of Theileria-associated bovine anaemia and then followed over a period of 20 weeks. The bulls were blood sampled, had rectal temperature recorded and weighed 3 times weekly for 13 weeks and then once weekly thereafter until the end of the trial. Infection intensity was monitored using qPCR. All 10 inoculated bulls were successfully infected with T. orientalis (Ikeda). The results showed that the live weight response to infection was varied and the bulls could be divided into two groups based on this response. Four infected bulls showed a significant weight reduction of 41.5 kg (p < 0.0001), a financial loss of around NZ$112 per bull, compared with the other 6 bulls in the infected group, which were not different to the 7 uninfected controls. The live weight of the 4 poor growing bulls was significantly lower than the other 6 infected bulls from Day 71 post infection (p < 0.05). All ten infected bulls showed a similar decrease in HCT, with the lowest HCT reached around Day 60 to 80 post-infection, however the four infected bulls that grew poorly did have a significantly elevated HCT for the first 1 to 3 weeks post infection (p < 0.05). The 4 infected bulls which grew poorly also had a significantly higher infection intensity than the other infected bulls from Day 27 to Day 60 post-infection (p < 0.05). There was no pyrexia recorded in the infected group or control groups, instead there was a tendency for the infected group to have a lower rectal temperature from Day 5 to 70 post infection. The infected bulls walked on average 239 steps per day less than the control bulls, although this difference was not significant (p = 0.35). Overall the study clearly showed, by controlling infection date and infectious dose, that a proportion of cattle infected with T. orientalis (Ikeda) have significantly decreased live weight gains.
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Affiliation(s)
- K E Lawrence
- School of Veterinary Science, Massey University, Palmerston North, New Zealand.
| | - M Gibson
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - R E Hickson
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - K Gedye
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - A Hoogenboom
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - L Fermin
- AgResearch, Hamilton, New Zealand
| | - I Draganova
- School of Agriculture and Environment, Massey University, Palmerston North, New Zealand
| | - W E Pomroy
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Tompane T, Carney J, Wu WW, Nguyen-Ta K, Dewing C, Provencher M, McDonald L, Gibson M, LeClere L. Glenoid Bone Reaction to All-Soft Suture Anchors Used for Shoulder Labral Repairs. J Bone Joint Surg Am 2018; 100:1223-1229. [PMID: 30020128 DOI: 10.2106/jbjs.17.01169] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND All-soft suture anchors (ASSAs) are commonly used for shoulder labral repair and capsulorrhaphy in patients with shoulder instability. While these anchors may have some specific advantages over other types of suture anchors, little is known about the prevalence and time-dependence of bone cyst formation and tunnel expansion after implantation of ASSAs. The aim of this study was to quantify the proportions of cyst formation and tunnel expansion around ASSAs and to characterize and test for differences in abnormalities observed at different postoperative time points. METHODS Thirty patients who were treated with arthroscopic shoulder stabilization surgery with ASSAs (1.4 mm; JuggerKnot, Biomet) underwent a computed tomography (CT) scan of the operatively treated shoulder at 1 month (10 patients), 6 months (10 patients), or 12 months (10 patients) postoperatively. Demographic and operative data were collected, and CT scans were evaluated for cyst formation, tunnel expansion, and tunnel volume measured in cubic millimeters. Statistical analyses were performed to detect differences in these outcomes among the follow-up groups. All shoulders were stable at all time points of the study, and there were no incidents of recurrent instability during the study period. RESULTS Ninety-one suture anchors were evaluated in 30 patients. Tunnel expansion was identified in the large majority of patients in the 6-month and 12-month follow-up groups, with a significant increase in these proportions compared with the 1-month follow-up group (p = 0.002). Mean tunnel volumes also significantly increased over the study period (p < 0.001). The presence of cyst formation was negligible in all 3 follow-up cohorts. CONCLUSIONS This study demonstrated low rates of cyst formation but a significantly increased tunnel volume 6 and 12 months after shoulder labral surgery with ASSAs. There was no association with the initial tunnel location. Additional well-controlled studies with longer follow-up are needed to identify potential associations among tunnel expansion, intraoperative technique, and clinical outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- T Tompane
- Naval Medical Center San Diego, San Diego, California
| | - J Carney
- Naval Medical Center San Diego, San Diego, California
| | - W W Wu
- Naval Medical Center San Diego, San Diego, California
| | - K Nguyen-Ta
- University of California, San Diego, San Diego, California
| | - C Dewing
- Naval Medical Center San Diego, San Diego, California
| | | | - L McDonald
- Naval Medical Center San Diego, San Diego, California
| | - M Gibson
- Naval Medical Center San Diego, San Diego, California
| | - L LeClere
- United States Naval Academy, Annapolis, Maryland
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Affiliation(s)
- R Pursell
- Department of Surgery, Royal Berkshire Hospital, Reading RG1 5AN, UK
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Appleby-Thomas GJ, Fitzmaurice B, Hameed A, Painter J, Gibson M, Wood DC, Hazael R, Hazell PJ. On differences in the equation-of-state for a selection of seven representative mammalian tissue analogue materials. J Mech Behav Biomed Mater 2017; 77:586-593. [PMID: 29096124 DOI: 10.1016/j.jmbbm.2017.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/03/2017] [Accepted: 10/08/2017] [Indexed: 11/25/2022]
Abstract
Tissue analogues employed for ballistic purposes are often monolithic in nature, e.g. ballistic gelatin and soap, etc. However, such constructs are not representative of real-world biological systems. Further, ethical considerations limit the ability to test with real-world tissues. This means that availability and understanding of accurate tissue simulants is of key importance. Here, the shock response of a wide range of ballistic simulants (ranging from dermal (protective/bulk) through to skeletal simulant materials) determined via plate-impact experiments are discussed, with a particular focus on the classification of the behaviour of differing simulants into groups that exhibit a similar response under high strain-rate loading. Resultant Hugoniot equation-of-state data (Us-up; P-v) provides appropriate feedstock materials data for future hydrocode simulations of ballistic impact events.
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Affiliation(s)
- G J Appleby-Thomas
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK.
| | - B Fitzmaurice
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - A Hameed
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - J Painter
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - M Gibson
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - D C Wood
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - R Hazael
- Centre for Defence Engineering, Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon SN6 8LA, UK
| | - P J Hazell
- School of Engineering and Information Technology, The University of New South Wales, Canberra, ACT 2600, Australia
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Chemaly M, Gibson M, Watterson S, Bjourson T, McGilligan V, Peace A. P6229TACE gene expression and soluble receptors TNFRI and TNFRII levels identifies very high risk cardiovascular patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6229] [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: 11/12/2022] Open
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Sorrentino S, Snyder C, Baber U, Sartori S, Cohen D, Cono A, Gibson M, Krucoff M, Moliterno D, Chieffo A, Kini A, Witzenbichler B, Steng F, Pocock S, Mehran R. P511Incidence and patterns of dual antiplatelet therapy cessation among patients with peripheral arterial disease after percutaneous coronary intervention: insights the PARIS registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p511] [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: 11/12/2022] Open
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30
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Awan M, Lavertu P, Zender C, Rezaee R, Fowler N, Gibson M, Wasman J, Faulhaber P, Machtay M, Yao M. Posttreatment Positron Emission Tomography/Computed Tomography and p16 Status for Neck Management in Locally Advanced Head and Neck Cancer After Definitive Chemoradiation. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The goal of this study was to evaluate the coronary vasoconstrictive effects of high doses of eletriptan compared with a standard dose of sumatriptan. Patients with no clinically significant coronary artery disease were randomized to receive high-dose intravenous eletriptan ( n = 24) vs a standard dose of sumatriptan ( n = 18; 6 mg subcutaneously) vs placebo ( n = 18). Serial angiograms were obtained. The primary non-inferiority analysis found equivalence between the mean maximum change in left anterior descending coronary artery diameter for eletriptan, -22% [95% confidence interval (CI) -26, -19], and sumatriptan, -19% (95% CI -22, -16). The change due to placebo was -16% (95% CI -20, -12). No individual cases of clinically significant vasoconstriction were observed. The results confirm that eletriptan has a broad cardiovascular safety margin, with plasma concentrations comparable to three to five times the Cmax of an oral 80-mg dose associated with modest vasoconstriction equivalent to standard therapeutic doses of sumatriptan.
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Affiliation(s)
- J A Goldstein
- William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Gibson M, Sliwinski F, Silva J, Adler E. RV Longitudinal Strain Predicts RV Failure and Other Adverse Events Post LVAD Implantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Bali G, Gibson M, Lavertu P, Baydoun A, Zender C, Rezaee R, Fowler N, Machtay M, Yao M. Taxane-based Chemoradiation for Laryngeal Preservation in Locally Advanced Laryngeal Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1376] [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: 11/17/2022]
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35
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Campbell M, Thomson H, Gibson M. Qualitative systematic review of the health and wellbeing of lone parents in welfare to work. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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36
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Gibson M. Early thoughts on g. Occup Med (Lond) 2015; 65:189. [DOI: 10.1093/occmed/kqu089] [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: 11/12/2022] Open
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38
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Gibson M. I learned (a bit) about aviation medicine from that. Occup Med (Lond) 2014; 64:545. [DOI: 10.1093/occmed/kqu085] [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: 11/13/2022] Open
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39
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Gibson M, Banas K, Lutje V, McKee MJ, Martin S, Thomson H, Bambra CL, Fenton C, Bond L. The effects of welfare to work interventions on the health and well-being of lone parents and their children – a systematic review of randomised controlled trials. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku161.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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40
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Lyon M, Sturgis L, Kutlar A, Gibson M, Lottenberg R, Gibson R. 181 Admission Rates for an Observation Unit Clinical Pathway for the Treatment of Uncomplicated Sickle Cell Disease Vasoocclusive Crisis. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.207] [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: 10/24/2022]
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41
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Gibson M. Health and safety legislation. Occup Med (Lond) 2014; 64:441. [DOI: 10.1093/occmed/kqu084] [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: 11/12/2022] Open
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42
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Gibson M, Banas K, Lutje V, McKee MJ, Martin S, Thomson H, Bambra CL, Fenton C, Bond L. OP96 Welfare to work interventions and their effects on health and well-being of lone parents and their children – a systematic review of randomised controlled trials. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.98] [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: 11/03/2022]
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43
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MacNeill M, Kearney J, Wallace L, Gibson M, Héroux ME, Kuchta J, Guernsey JR, Wheeler AJ. Quantifying the contribution of ambient and indoor-generated fine particles to indoor air in residential environments. Indoor Air 2014; 24:362-75. [PMID: 24313879 DOI: 10.1111/ina.12084] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/02/2013] [Indexed: 05/04/2023]
Abstract
UNLABELLED Indoor fine particles (FPs) are a combination of ambient particles that have infiltrated indoors, and particles that have been generated indoors from activities such as cooking. The objective of this paper was to estimate the infiltration factor (Finf ) and the ambient/non-ambient components of indoor FPs. To do this, continuous measurements were collected indoors and outdoors for seven consecutive days in 50 non-smoking homes in Halifax, Nova Scotia in both summer and winter using DustTrak (TSI Inc) photometers. Additionally, indoor and outdoor gravimetric measurements were made for each 24-h period in each home, using Harvard impactors (HI). A computerized algorithm was developed to remove (censor) peaks due to indoor sources. The censored indoor/outdoor ratio was then used to estimate daily Finfs and to determine the ambient and non-ambient components of total indoor concentrations. Finf estimates in Halifax (daily summer median = 0.80; daily winter median = 0.55) were higher than have been reported in other parts of Canada. In both winter and summer, the majority of FP was of ambient origin (daily winter median = 59%; daily summer median = 84%). Predictors of the non-ambient component included various cooking variables, combustion sources, relative humidity, and factors influencing ventilation. This work highlights the fact that regional factors can influence the contribution of ambient particles to indoor residential concentrations. PRACTICAL IMPLICATIONS Ambient and non-ambient particles have different risk management approaches, composition, and likely toxicity. Therefore, a better understanding of their contribution to the indoor environment is important to manage the health risks associated with fine particles (FPs) effectively. As well, a better understanding of the factors Finf can help improve exposure assessment and contribute to reduced exposure misclassification in epidemiologic studies.
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Affiliation(s)
- M MacNeill
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
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Yao M, Woods C, Savvides P, Lavertu P, Rezaee R, Zender C, Fu P, Gibson M, Wasman J, Machtay M. Update of a Phase 2 Study of Definitive Radiation Therapy With Concurrent Docetaxel and Erlotinib in Locally Advanced Squamous Cell Carcinoma of the Head and Neck (LA-SCCHN). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2013.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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Zender C, Tang D, Gibson M, Fu P, Yao M, Rezaee R, Lavertu P. Prognostic Factors in Patients Undergoing Salvage Surgery of the Pharynx and Larynx. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2013.11.139] [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: 11/24/2022]
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46
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Bailey S, Howman A, Wheatley K, Wherton D, Boota N, Pizer B, Fisher D, Kearns P, Picton S, Saran F, Gibson M, Glaser A, Connolly D, Hargrave D. Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy--results of a United Kingdom phase II trial (CNS 2007 04). Eur J Cancer 2013; 49:3856-62. [PMID: 24011536 PMCID: PMC3853623 DOI: 10.1016/j.ejca.2013.08.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/30/2013] [Accepted: 08/08/2013] [Indexed: 12/03/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis with no chemotherapy regimen so far resulting in any significant improvement over standard radiotherapy. In this trial, a prolonged regimen (21/28d) of temozolomide was studied with the aim of overcoming O(6)-methylguanine methyltransferase (MGMT) mediated resistance. Forty-three patients with a defined clinico-radiological diagnosis of DIPG received radiotherapy and concomitant temozolomide (75 mg/m(2)) after which up to 12 courses of 21d of adjuvant temozolomide (75-100mg/m(2)) were given 4 weekly. The trial used a 2-stage design and passed interim analysis. At diagnosis median age was 8 years (2-20 years), 81% had cranial nerve abnormalities, 76% ataxia and 57% long tract signs. Median Karnofsky/Lansky score was 80 (10-100). Patients received a median of three courses of adjuvant temozolomide, five received all 12 courses and seven did not start adjuvant treatment. Three patients were withdrawn from study treatment due to haematological toxicity and 10 had a dose reduction. No other significant toxicity related to temozolomide was noted. Overall survival (OS) (95% confidence interval (CI)) was 56% (40%, 69%) at 9 months, 35% (21%, 49%) at 1 year and 17% (7%, 30%) at 2 years. Median survival was 9.5 months (range 7.5-11.4 months). There were five 2-year survivors with a median age of 13.6 years at diagnosis. This trial demonstrated no survival benefit of the addition of dose dense temozolomide, to standard radiotherapy in children with classical DIPG. However, a subgroup of adolescent DIPG patients did have a prolonged survival, which needs further exploration.
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Affiliation(s)
- S. Bailey
- Great North Childrens Hospital, Newcastle upon Tyne, United Kingdom
| | - A. Howman
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - K. Wheatley
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - D. Wherton
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - N. Boota
- Nottingham Clinical Trials Unit, Nottingham, United Kingdom
| | - B. Pizer
- Alder Hey Childrens Hospital, Liverpool, United Kingdom
| | - D. Fisher
- Addenbroookes Hopsital, Cambridge, United Kingdom
| | - P. Kearns
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - S. Picton
- Leeds General Infirmary, Leeds, United Kingdom
| | - F. Saran
- Royal Marsden Hospital, Surrey, London, United Kingdom
| | - M. Gibson
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - A. Glaser
- Leeds General Infirmary, Leeds, United Kingdom
| | | | - D. Hargrave
- Great Ormond Street Hospital For Sick Children, London, United Kingdom
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47
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Affiliation(s)
- M. Gibson
- Kansas State University, Manhattan, KS, U.S.A
| | - S. Alavi
- Kansas State University, Manhattan, KS, U.S.A
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Gibson M, Sharif MO, Smith A, Saini P, Brunton PA. A practice-based randomised controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity. J Dent 2013; 41:668-74. [PMID: 23791771 DOI: 10.1016/j.jdent.2013.06.003] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of three different interventions (non-desensitising toothpaste, desensitising toothpaste and professionally applied dentine bonding agent) in reducing dentinal hypersensitivity over a 2-week, 3-month and 6-month-period in a dental practice setting. METHODS This was a randomised controlled, single-blind; parallel-group trial conducted in general dental practice by a single general dental practitioner. Seventy-five subjects were randomly allocated to three groups; non-desensitising toothpaste (NDT), desensitising toothpaste (DT) and professionally applied desensitising agent (DA). Dentinal hypersensitivity was measured using a Visual Analogue Scale (VAS) to record the response from a standardised short blast of air from a triple syringe. Dentinal hypersensitivity was recorded at baseline, two weeks, three months and six months for all groups. RESULTS Dentinal hypersensitivity reduced significantly (p<0.0001) in both groups DT and DA, in addition the reduction in sensitivity was sustained and continued to improve over a 6-month-period. The greatest reduction in dentinal hypersensitivity was recorded in group DA. CONCLUSIONS The results from this study suggest that application of dentine bonding agents, to teeth diagnosed with dentine hypersensitivity provides the greatest improvement in dentine hypersensitivity at 2 weeks and 6 months. This reduction in dentine hypersensitivity is greater than that achieved by the desensitising toothpaste tested and a non-desensitising toothpaste.
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Affiliation(s)
- M Gibson
- Poulton Dental Practice, Poulton Road, Wallasey, Wirral CH44 9DQ, United Kingdom
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Zaghloul M, Ahmed S, Eldebaway E, Mousa A, Amin A, Elkhateeb N, Sabry M, Ogiwara H, Morota N, Sufit A, Donson A, Birks D, Patel P, Foreman N, Handler M, Massimino M, Biassoni V, Gandola L, Schiavello E, Pecori E, Potepan P, Bach F, Janssens GO, Jansen MH, Lauwers SJ, Nowak PJ, Oldenburger FR, Bouffet E, Saran F, van Ulzen KK, van Lindert EJ, Schieving JH, Boterberg T, Kaspers GJ, Span PN, Kaanders JH, Gidding CE, Hargrave D, Bailey S, Howman A, Pizer B, Harris D, Jones D, Kearns P, Picton S, Saran F, Wheatley K, Gibson M, Glaser A, Connolly D, Hargrave D, Kawamura A, Nagashima T, Yamamoto K, Sakata J, Lober R, Freret M, Fisher P, Edwards M, Yeom K, Monje M, Jansen M, Aliaga ES, Van Der Hoeven E, Van Vuurden D, Heymans M, Gidding C, De Bont E, Reddingius R, Peeters-Scholte C, van Meeteren AS, Gooskens R, Granzen B, Paardekoper G, Janssens G, Noske D, Barkhof F, Vandertop WP, Kaspers G, Saratsis A, Yadavilli S, Nazarian J, Monje M, Freret M, Mitra S, Mallick S, Kim J, Beachy P, Nobre L, Vasconcelos F, Lima F, Mattos D, Kuiven N, Lima G, Silveira J, Sevilha M, Lima MA, Ferman S, Leblond P, Lansiaux A, Rialland X, Gentet JC, Geoerger B, Frappaz D, Aerts I, Bernier-Chastagner V, Shah R, Zaky W, Grimm J, Bluml S, Wong K, Dhall G, Caretti V, Schellen P, Lagerweij T, Bugiani M, Navis A, Wesseling P, Vandertop WP, Noske DP, Kaspers G, Wurdinger T, Lee H, Ziegler D, Schroeder K, Huang E, Berlow N, Patel R, Becher O, Taylor I, Mao XG, Hutt M, Weingart M, Kahlert U, Maciacyk J, Nikkhah G, Eberhart C, Raabe E, Barton K, Misuraca K, Misuraca K, Becher O, Zhou Z, Rotman L, Ho S, Souweidane M, Hutt M, Lim KJ, Warren K, Chang H, Eberhart C, Raabe E, Lightner D, Haque S, Souweidane M, Khakoo Y, Dunkel I, Gilheeney S, Kramer K, Lyden D, Wolden S, Greenfield J, De Braganca K, Ting-Rong H, Muh-Li L, Kai-Ping C, Tai-Tong W, Hsin-Hung C, Kebudi R, Cakir FB, Agaoglu FY, Gorgun O, Dizdar Y, Ayan I, Darendeliler E, Zapotocky M, Churackova M, Malinova B, Kodet R, Kyncl M, Tichy M, Stary J, Sumerauer D, Minturn J, Shu HK, Fisher M, Patti R, Janss A, Allen J, Phillips P, Belasco J, Taylor K, Baudis M, von Beuren A, Fouladi M, Jones C. DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG). Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
50
|
Gibson M. The Neurosciences and the Practice of Aviation Medicine. Occup Med (Lond) 2012. [DOI: 10.1093/occmed/kqs013] [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: 11/14/2022] Open
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