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626 results on '"A, Ashton"'

1. Four-factor prothrombin complex concentrate is not inferior to andexanet alfa for the reversal or oral factor Xa inhibitors: An Eastern Association for the Surgery of Trauma multicenter study.

Author

Estroff, Jordan M., Devlin, Joseph, Hoteit, Lara, Hassoune, Adnan, Neal, Matthew D., Brown, Joshua B., Lu, Liling, Kotch, Shannon, Hazelton, Joshua P., Christian, Ashton B., Yeates, Eric O., Nahmias, Jeffry, Jacobson, Lewis E., Williams, Jamie, Schuster, Kevin M., O'Connor, Rick, Semon, Gregory R., Straughn, Angela D., Cullinane, Daniel, and Egodage, Tanya

Published
2024
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3. Association of Plasma Amyloid, P-Tau, GFAP, and NfL With CSF, Clinical, and Cognitive Features in Patients With Dementia With Lewy Bodies.

Author

Bolsewig, Katharina, van Unnik, Annemartijn A. J. M., Blujdea, Elena R., Gonzalez, Maria C., Ashton, Nicholas J., Aarsland, Dag, Zetterberg, Henrik, Padovani, Alessandro, Bonanni, Laura, Mollenhauer, Brit, Schade, Sebastian, Vandenberghe, Rik, Poesen, Koen, Kramberger, Milica G., Paquet, Claire, Bousiges, Olivier, Cretin, Benjamin, Willemse, Eline A. J., Teunissen, Charlotte E., and Lemstra, Afina W.

Published
2024
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5. Long-Term Blood Pressure Reductions Following Catheter-Based Renal Denervation: A Systematic Review and Meta-Analysis.

Author

Sesa-Ashton, Gianni, Nolde, Janis M., Muente, Ida, Carnagarin, Revathy, Macefield, Vaughan G., Dawood, Tye, Lambert, Elisabeth A., Lambert, Gavin W., Walton, Antony, Esler, Murray D., and Schlaich, Markus P.

Abstract

BACKGROUND: Renal denervation is a recognized adjunct therapy for hypertension with clinically significant blood pressure (BP)-lowering effects. Long-term follow-up data are critical to ascertain durability of the effect and safety. Aside from the 36-month follow-up data available from randomized control trials, recent cohort analyses extended follow-up out to 10 years. We sought to analyze study-level data and quantify the ambulatory BP reduction of renal denervation across contemporary randomized sham-controlled trials and available long-term follow-up data up to 10 years from observational studies. METHODS: A systematic review was performed with data from 4 observational studies with follow-up out to 10 years and 2 randomized controlled trials meeting search and inclusion criteria with follow-up data out to 36 months. Study-level data were extracted and compared statistically. RESULTS: In 2 contemporary randomized controlled trials with 36-month follow-up, an average sham-adjusted ambulatory systolic BP reduction of −12.7±4.5 mm Hg from baseline was observed (P =0.05). Likewise, a −14.8±3.4 mm Hg ambulatory systolic BP reduction was found across observational studies with a mean long-term follow-up of 7.7±2.8 years (range, 3.5–9.4 years; P =0.0051). The observed reduction in estimated glomerular filtration rate across the long-term follow-up was in line with the predicted age-related decline. Antihypertensive drug burden was similar at baseline and follow-up. CONCLUSIONS: Renal denervation is associated with a significant and clinically meaningful reduction in ambulatory systolic BP in both contemporary randomized sham-controlled trials up to 36 months and observational cohort studies up to 10 years without adverse consequences on renal function. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Association Between Anesthesiologist Sex and Patients' Postoperative Outcomes: A Population-based Cohort Study.

Author

Jerath, Angela, Satkunasivam, Raj, Kaneshwaran, Kirusanthy, Aminoltejari, Khatereh, Chang, Ashton, MacDonell, D. Su-Yin, Kealey, Alayne, Ladowski, Stephanie, Sarmah, Anita, Flexman, Alana M., Lorello, Gianni R., Nabecker, Sabine, Coburn, Natalie, Conn, Lesley G., Klaassen, Zachary, Ranganathan, Sanjana, Riveros, Carlos, McCartney, Colin J.L., Detsky, Allan S., and Wallis, Christopher J.D.

Abstract

Objective: To examine the association of anesthesiologist sex on postoperative outcomes. Background: Differences in patient postoperative outcomes exist, depending on whether the primary surgeon is male or female, with better outcomes seen among patients treated by female surgeons. Whether the intraoperative anesthesiologist's sex is associated with differential postoperative patient outcomes is unknown. Methods: We performed a population-based, retrospective cohort study among adult patients undergoing one of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between the sex of the intraoperative anesthesiologist and the primary end point of the adverse postoperative outcome, defined as death, readmission, or complication within 30 days after surgery, using generalized estimating equations. Results: Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 311,822 (26.7%) received care from a female anesthesiologist and 853,889 (73.3%) from a male anesthesiologist. Overall, 10.8% of patients experienced one or more adverse postoperative outcomes, of whom 1.1% died. Multivariable adjusted rates of the composite primary end point were higher among patients treated by male anesthesiologists (10.6%) compared with female anesthesiologists (10.4%; adjusted odds ratio 1.02, 95% CI: 1.00–1.05, P =0.048). Conclusions: We demonstrated a significant association between sex of the intraoperative anesthesiologist and patient short-term outcomes after surgery in a large cohort study. This study supports the growing literature of improved patient outcomes among female practitioners. The underlying mechanisms of why outcomes differ between male and female physicians remain elusive and require further in-depth study. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Beyond future directions: what can we do to address the stigma of chronic pain today?

Author

Ashton-James, Claire E.

Subjects
*CHRONIC pain, *ACCEPTANCE & commitment therapy, *CAREER development, *MEDICAL personnel, *MEDICALLY unexplained symptoms, *ATTITUDES toward illness, *SHAME, *PAIN
Abstract

This article explores the issue of stigma surrounding chronic pain and suggests potential strategies to address it. It emphasizes the need for further research on reducing stigma and its impact on individuals with chronic pain. The author highlights existing interdisciplinary research on strategies to reduce stigma and suggests that these strategies can be implemented today. The article emphasizes the importance of education at various levels to increase understanding and reduce stigma associated with chronic pain, but also cautions against unintended stigmatizing consequences. Overall, the article calls for action in addressing chronic pain stigma based on available evidence and research. The document is a list of references cited in a study or article about the associations between stigma, self-compassion, and pain outcomes during treatment for chronic pain. The references cover various topics related to stigma, chronic pain, and healthcare providers' knowledge and attitudes towards pain management, including the impact of pain behaviors on evaluations of warmth and competence, patient perceptions of encounters with interprofessional teams in pain rehabilitation, and the effectiveness of programs for reducing the stigma associated with mental disorders. [Extracted from the article]

Published
2024
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15. Association of Choroid Plexus Volume With Serum Biomarkers, Clinical Features, and Disease Severity in Patients With Frontotemporal Lobar Degeneration Spectrum.

Author

Assogna, Martina, Premi, Enrico, Gazzina, Stefano, Benussi, Alberto, Ashton, Nicholas J., Zetterberg, Henrik, Blennow, Kaj, Gasparotti, Roberto, Padovani, Alessandro, Tadayon, Ehsan, Romanella, Sara, Sprugnoli, Giulia, Pascual-Leone, Alvaro, Di Lorenzo, Francesco, Koch, Giacomo, Borroni, Barbara, and Santarnecchi, Emiliano

Published
2023
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16. Association of CSF GAP-43 With the Rate of Cognitive Decline and Progression to Dementia in Amyloid-Positive Individuals

Author

Öhrfelt, Annika, Benedet, Andréa L., Ashton, Nicholas J., Kvartsberg, Hlin, Vandijck, Manu, Weiner, Michael W., Trojanowski, John Q., Shaw, Leslie M., Zetterberg, Henrik, and Blennow, Kaj

Subjects
Neurology (clinical), Research Article
Abstract

Background and ObjectivesTo test the associations between the presynaptic growth-associated protein 43 (GAP-43), quantified in CSF, and biomarkers of Alzheimer disease (AD) pathophysiology, cross-sectionally and longitudinally.MethodsIn this retrospective study, GAP-43 was measured in participants from the AD Neuroimaging Initiative (ADNI) cohort using an in-house ELISA method, and levels were compared between groups, both cross-sectionally and longitudinally. Linear regression models tested the associations between biomarkers of AD (amyloid beta [Aβ] and tau pathologies, neurodegeneration, and cognition) adjusted by age, sex, and diagnosis. Linear mixed-effect models evaluated how baseline GAP-43 predicts brain hypometabolism, atrophy, and cognitive decline over time. Cox proportional hazard regression models tested how GAP-43 levels and Aβ status, at baseline, increased the risk of progression to AD dementia over time.ResultsThis study included 786 participants from the ADNI cohort, which were further classified in cognitively unimpaired (CU) Aβ-negative (nCU–= 197); CU Aβ-positive (nCU+= 55), mild cognitively impaired (MCI) Aβ-negative (nMCI–= 228), MCI Aβ-positive (nMCI+= 193), and AD dementia Aβ-positive (nAD= 113). CSF GAP-43 levels were increased in Aβ-positive compared with Aβ-negative participants, independent of the cognitive status. In Aβ-positive participants, high baseline GAP-43 levels led to worse brain metabolic decline (p= 0.01), worse brain atrophy (p= 8.8 × 10−27), and worse MMSE scores (p= 0.03) over time, as compared with those with low GAP-43 levels. Similarly, Aβ-positive participants with high baseline GAP-43 had the highest risk to convert to AD dementia (hazard ratio [HR = 8.56, 95% CI 4.94–14.80,p= 1.5 × 10−14]). Despite the significant association with Aβ pathology (η2Aβ PET= 0.09,PAβ PET< 0.001), CSF total tau (tTau) and phosphorylated tau (pTau) had a larger effect size on GAP43 than Aβ PET (η2pTau-181= 0.53,PpTau-181< 0.001; η2tTau= 0.59,PtTau< 0.001).DiscussionHigh baseline levels of CSF GAP-43 are associated with progression in Aβ-positive individuals, with a more aggressive neurodegenerative process, faster rate of cognitive decline, and increased risk of converting to dementia.

Published
2023

20. Potential Utility of Plasma P-Tau and Neurofilament Light Chain as Surrogate Biomarkers for Preventive Clinical Trials.

Author

Ferreira, Pamela C.L., Ferrari-Souza, João Pedro, Tissot, Cécile, Bellaver, Bruna, Leffa, Douglas T., Lussier, Firoza, Povala, Guilherme, Therriault, Joseph, Benedet, Andréa L., Ashton, Nicholas J., Cohen, Ann D., Lopez, Oscar L., Tudorascu, Dana L., Klunk, William E., Soucy, Jean-Paul, Gauthier, Serge, Villemagne, Victor, Zetterberg, Henrik, Blennow, Kaj, and Rosa-Neto, Pedro

Published
2023
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21. Associations of Fully Automated CSF and Novel Plasma Biomarkers With Alzheimer Disease Neuropathology at Autopsy

Author

Grothe, Michel J., Moscoso, Alexis, Ashton, Nicholas J., Karikari, Thomas K., Lantero-Rodriguez, Juan, Snellman, Anniina, Zetterberg, Henrik, Blennow, Kaj, and Schöll, Michael

Subjects
Research Article
Abstract

Objective To study CSF biomarkers of Alzheimer disease (AD) analyzed by fully automated Elecsys immunoassays compared to neuropathologic gold standards and to compare their accuracy to plasma phosphorylated tau (p-tau181) measured with a novel single molecule array method. Methods We studied antemortem Elecsys-derived CSF biomarkers in 45 individuals who underwent standardized postmortem assessments of AD and non-AD neuropathologic changes at autopsy. In a subset of 26 participants, we also analyzed antemortem levels of plasma p-tau181 and neurofilament light (NfL). Reference biomarker values were obtained from 146 amyloid-PET–negative healthy controls (HC). Results All CSF biomarkers clearly distinguished pathology-confirmed AD dementia (n = 27) from HC (area under the curve [AUC] 0.86–1.00). CSF total tau (t-tau), p-tau181, and their ratios with β-amyloid1-42 (Aβ1-42) also accurately distinguished pathology-confirmed AD from non-AD dementia (n = 8; AUC 0.94–0.97). In pathology-specific analyses, intermediate to high Thal amyloid phases were best detected by CSF Aβ1-42 (AUC [95% confidence interval] 0.91 [0.81–1]), while intermediate to high scores for Consortium to Establish a Registry for Alzheimer's Disease neuritic plaques and Braak tau stages were best detected by CSF p-tau181 (AUC 0.89 [0.79–0.99] and 0.88 [0.77–0.99], respectively). Optimal Elecsys biomarker cutoffs were derived at 1,097, 229, and 19 pg/mL for Aβ1-42, t-tau, and p-tau181. In the plasma subsample, both plasma p-tau181 (AUC 0.91 [0.86–0.96]) and NfL (AUC 0.93 [0.87–0.99]) accurately distinguished those with pathology-confirmed AD (n = 14) from HC. However, only p-tau181 distinguished AD from non-AD dementia cases (n = 4; AUC 0.96 [0.88–1.00]) and showed a similar, although weaker, pathologic specificity for neuritic plaques (AUC 0.75 [0.52–0.98]) and Braak stage (AUC 0.71 [0.44–0.98]) as CSF p-tau181. Conclusion Elecsys-derived CSF biomarkers detect AD neuropathologic changes with very high discriminative accuracy in vivo. Preliminary findings support the use of plasma p-tau181 as an easily accessible and scalable biomarker of AD pathology. Classification of Evidence This study provides Class II evidence that fully automated CSF t-tau and p-tau181 measurements discriminate between autopsy-confirmed AD and other dementias.

Published
2021

22. CSF Synaptic Biomarkers in the Preclinical Stage of Alzheimer Disease and Their Association With MRI and PET

Author

Milà-Alomà, Marta, Brinkmalm, Ann, Ashton, Nicholas J., Kvartsberg, Hlin, Shekari, Mahnaz, Operto, Grégory, Salvadó, Gemma, Falcon, Carles, Gispert, Juan Domingo, Vilor-Tejedor, Natalia, Arenaza-Urquijo, Eider M., Grau-Rivera, Oriol, Sala-Vila, Aleix, Sanchez-Benavides, Gonzalo, González-de-Echávarri, José María, Minguillon, Carolina, Fauria, Karine, Niñerola-Baizán, Aida, Perissinotti, Andrés, Kollmorgen, Gwendlyn, Suridjan, Ivonne, Zetterberg, Henrik, Molinuevo, José Luis, Blennow, Kaj, and Suárez-Calvet, Marc

Subjects
Amyloid beta-Peptides, tau Proteins, Middle Aged, Magnetic Resonance Imaging, Cross-Sectional Studies, Alzheimer Disease, Positron-Emission Tomography, Humans, Female, Biomarkers, Research Article
Abstract

Background and Objectives To determine whether CSF synaptic biomarkers are altered in the early preclinical stage of the Alzheimer continuum and associated with Alzheimer disease (AD) risk factors, primary pathology, and neurodegeneration markers. Methods This cross-sectional study was performed in the Alzheimer's and Families (ALFA+) cohort, comprising middle-aged cognitively unimpaired participants. CSF neurogranin and growth-associated protein-43 (GAP-43) were measured with immunoassays, and synaptosomal-associated protein-25 (SNAP-25) and synaptotagmin-1 were measured with immunoprecipitation mass spectrometry. AD CSF biomarkers β-amyloid (Aβ)42/40, phosphorylated tau (p-tau), and total tau and the neurodegeneration biomarker neurofilament light chain (NfL) were also measured. Participants underwent structural MRI and fluorodeoxyglucose and Aβ PET imaging. General linear modeling was used to test the associations between CSF synaptic biomarkers and risk factors, Aβ pathology, tau pathology, and neurodegeneration markers. Results All CSF synaptic biomarkers increased with age. CSF neurogranin was higher in females, while CSF SNAP-25 was higher in APOE ε4 carriers. All CSF synaptic biomarkers increased with higher Aβ load (as measured by CSF Aβ42/40 and Aβ PET Centiloid values), and it is important to note that the synaptic biomarkers were increased even in individuals in the earliest stages of Aβ deposition. Higher CSF synaptic biomarkers were also associated with higher CSF p-tau and NfL. Higher CSF neurogranin and GAP-43 were significantly associated with higher brain metabolism but lower cortical thickness in AD-related brain regions. Discussion CSF synaptic biomarkers increase in the early preclinical stages of the Alzheimer continuum even when a low burden of Aβ pathology is present, and they differ in their association with age, sex, APOE ε4, and markers of neurodegeneration. Trial Registration Information ClinicalTrials.gov Identifier NCT02485730.

Published
2021

23. Catheter-Based Renal Denervation: 9-Year Follow-Up Data on Safety and Blood Pressure Reduction in Patients With Resistant Hypertension.

Author

Sesa-Ashton, Gianni, Nolde, Janis M., Muente, Ida, Carnagarin, Revathy, Lee, Rebecca, Macefield, Vaughan G., Dawood, Tye, Sata, Yusuke, Lambert, Elisabeth A., Lambert, Gavin W., Walton, Antony, Kiuchi, Marcio G., Esler, Murray D., and Schlaich, Markus P.

Abstract

Background: Recent sham-controlled randomized clinical trials have confirmed the safety and efficacy of catheter-based renal denervation (RDN). Long-term safety and efficacy data beyond 3 years are scarce. Here, we report on outcomes after RDN in a cohort of patients with resistant hypertension with an average of ≈9-year follow-up (FU). Methods: We recruited patients with resistant hypertension who were previously enrolled in various RDN trials applying radiofrequency energy for blood pressure (BP) lowering. All participants had baseline assessments before RDN and repeat assessment at long-term FU including medical history, automated office and ambulatory BP measurement, and routine blood and urine tests. We analyzed changes between baseline and long-term FU. Results: A total of 66 participants (mean±SD, 70.0±10.3 years; 76.3% men) completed long-term FU investigations with a mean of 8.8±1.2 years post-procedure. Compared with baseline, ambulatory systolic BP was reduced by −12.1±21.6 (from 145.2 to 133.1) mm Hg (P <0.0001) and diastolic BP by −8.8±12.8 (from 81.2 to 72.7) mm Hg (P <0.0001). Mean heart rate remained unchanged. At long-term FU, participants were on one less antihypertensive medication compared with baseline (P =0.0052). Renal function assessed by estimated glomerular filtration rate fell within the expected age-associated rate of decline from 71.1 to 61.2 mL/min per 1.73 m2. Time above target was reduced significantly from 75.0±25.9% at baseline to 47.3±30.3% at long-term FU (P <0.0001). Conclusions: RDN results in a significant and robust reduction in both office and ambulatory systolic and diastolic BP at ≈9-year FU after catheter-based RDN on less medication and without evidence of adverse consequences on renal function. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Mental Toughness: Yes, Please.

Author

Hathaway, Liz and Shields, Ashton

Abstract

The article presents the discussion on cited as a critical psychological skill and key ingredient in achieving success. Topics include ability for consistently performing towards the upper range of the talent and skill regardless of competitive circumstances; and confidence refering to the self-belief needed to successfully complete tasks being viewed as challenging.

Published
2023
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26. The Use of Different Sepsis Risk Stratification Tools on the Wards and in Emergency Departments Uncovers Different Mortality Risks: Results of the Three Welsh National Multicenter Point-Prevalence Studies

Author

Harry J. A. Unwin, MBBCh, BSc, Maja Kopczynska, MBBCh, BSc, Richard Pugh, FRCA, Laura J. P. Tan, MBBS, BSc, Christian P. Subbe, MD, Gemma Ellis, MSc, Paul Morgan, FRCA, Peter Havalda, MD, Ben Sharif, MBBCh, John Burke, MSc, Tamas Szakmany, MD, PhD, FCCM, on behalf of Welsh Digital Data Collection Platform (WDDCP) Collaborators, Maria Hobrok, Moriah Thomas, Annie Burden, Nadia Youssef, Katherine Carnegie, Helena Colling-Sylvester, Natasha Logier, Meshari Alsaeed, Hannah Williams, Arfa Ayob, Nor Farzana, Sweta Parida, David Lawson, Emily Evans, Laura Jane Davis, Billie Atkins, Llywela Wyn Davies, Lee Sanders-Crook, Steffan Treharne Seal, Alice Cains, Richard Pugh, Katy Crisp, Sarah Venning, Ella Sykes, Stephanie Narine, Georgia Parry, Emily Angela Dillon, Qi Zhuang Siah, Ting Yang, Tyler Jones, Parvathi Thara, Emma Wood, Lara Wirt, Georgina St Pier, Richard Betts, Kyriaki Mitsaki, Mari Tachweed Pierce, Sioned Davies, Yakeen Hafouda, Erin Ifan, Grace Lacey, Francesca Mitchell, John Lynch, Michal Mazur, Lezia D’Souza, Bethan Ponting, Terrance Lau, Ruairidh Kerrigan, Lucy Morgan, Roshan Vindla, Claudia Zeicu, Becky James, Amirah Amin Ariff, Wan Binti Wan Azzlan, Charlotte Collins, Elizabeth Wickens, Alisa Norbee, Aliya Zulkefli, Thomas Haddock, Megan Thomas, Matthew Lee, Miriam Cynan, Nik-Syakirah Nik Azis, Imogen Hay, Catherine Russell, Margriet Vreugdenhil, Mustafa Abdimalik, Joseph Davies, Peter Havalda, Angharad Evans, Kate Robertson, Grace Gitau, Mei-yin Gruber, Thomas Telford, Anas Qarout, Naomi Nandra, Hannah Garrard, James Cutler, Rhiannon Tammy Jones, Amy Prideaux, Timothy Spence, Sarah Hardie, Harriet Seymour, Sam Willis, Matthew Warlow, Shanali Thanthilla, Thomas Downs, Nina Foley, Chad McKeown, Akshita Dandawate, Holleh Shayan-Arani, Ellie Taylor, Oliver Kyriakides, Rachel Price, Ffion Haf Mackey, Emily Haines, Samuel Chun, Nilarnti Vignarajah, Tessa Chamberlain, Dongying Zhao, Nayanatara Nadeesha T Tantirige, Naomi Dennehey, Georgina Evans, John Watts, Ceri Battle, Ryan Jones, Selina Jones, Charlotte James, James O’Hanlon, Isabella Bridges, Bethany Hughes, Leo Polchar, Elise Bisson, Charlotte Mykura, Lara Money, Joshua McKenna, Sarah Kinsman, Demiana Hanna, Emily Baker, Harrison Sprague, Liam Sharma, Tom Pontin, Emma Shore, Tamara Hughes, Sam Nightingale, Philby Baby, Matthew Shield, Alice Cross, Jenna Boss, Olivia Ross, George Ashton, Kimaya Pandit, Daniel Davies, Cameron Garbutt, Charlotte Johnston, Marcus Cox, Chantal Roberts, Alessia Waller, Laura Heekin, Kathy Wang, Rhianna Church, Shrina Patel, Marianne Broderick, Hannah Whillis, Daniel Craig Hathaway, Emel Yildirim, Caitlin Atkins, Elin Walters, Carys Durie, Robert James Hamilton Sinnerton, Benjamin Tanner, Julimar Abreu, Kiran Bashir, Vincent Hamlyn, Amelia Tee, Zoe Ann Hinchcliffe, Rita Otto, Georgie Covell, Megan Stone, Victoria Maidman, Katherine Godfray, Rhidian Caradine, Hannah Beetham, Adanna Nicole Anomneze-Collins, Jeanette Tan, Yasmina Abdelrazik, Azizah Khan, Nabihah Malik, Aidan Clack, Lewis Oliva, Tyler Thomas, Adam George Mounce, Anoopama Ramjeeawon, Ndaba Mtunzi, Duncan Soppitt, Jay Hale, Jack Wellington, Robert Buchanan Ross, Danielle Lis, Rebecca Parsonson, Jude Joseph-Gubra, Ajitha Arunthavarajah, Jessica Nicholas, Aaron Harris, Henry Atkinson, Jessica Webster, Tim Burnett, Josephine Raffan Gowar, Sam DeFriend, Jasmine Whitaker, Elizabeth Beasant, Luis Macchiavello, Danyal Usman, Abdullah Mahdi, Tiffany Ye Tze Shan, Nick Savill, Jennifer Gee, Lizzie Hodges, Ami Desai, Hannah Rossiter, Matthew Taylor, Kevin Pinto, Eleanor Hartley, Oscar Emanuel, Rhiannon Long, Megan Selby, Elilis Wardle, Alexandra Urquhart, Jack Barrington, Matthew Ashman, Elizabeth Adcock, Amelia Dickinson, Rebecca Jordache, Rym Chafai El Alaoui, Sophie Stovold, Sam Vickery, Nia Jones, Alice O’Donnell, Monty Cuthbert, Osa Eghosa, Muhammad Karim, Lowri Williams, Louise Tucker, Tom Downs, Rebecca Walford, Annabelle Hook, Adam Mounce, Emily Eccles, Ross Edwards, Kirtika Ramesh, Charlie Hall, Maria Lazarou, Rhidian Jones, Katy McGillian, Hari Singh Bhachoo, Zoe The, Vithusha Inpahas, Ruchi Desai, Yusuf Cheema, Andrew Hughes, Olivia Cranage, Felicity Bee, Khalid Osman, Humza Khan, Jennifer Pitt, Charlotte Pickwick, Jorge Carter, Fiona Andrew, Naseera Seedat, Roshni Patel, Megan Walker, Alicia Boam, Jessica Randall, Beth Bowyer, Josh Edwards, Natasha Jones, Emma Walker, Ailsa MacNaught, Swagath Balachandran, Abbie Shipley, Jennifer Louise Kent, Samuel Tilley, Bethany Davies, Emma Withers, Krishna Parmar, Lucie Webber, Angelica Sharma, Amy Handley, Alexandra Gordon, Lucy Allen, Rebecca Paddock, Harriet Penney, Lopa Banerjee, Chloe Victoria Vanderpump, Kate Harding, John Burke, Orsolya Minik, Nia Jarrett, Ellie Rowe, Adanna Anomneze-Collins, Harry Griffiths, Sarah Pengelly, Ffion Bennett, Ahmed Bilal, Abdullah El-badawey, Bethan Ellis, Luke Cook, Harriet Elizabeth Valentine Maine, Kiri Armstrong, Hannah Beresford, Timia Raven-Gregg, Tom Liddell-Lowe, Caitlin Ong, Harriet Reed, Frederika Alice St John, Weronika Julia Kozuch, Isabelle Ray, Irukshi Anuprabha Silva, Sin Ting Natalie Cheng, Umme-Laila Ali, Noreena Syed, Luke Murphy, Thomas Grother, Harry Smith, Rachel Watson, Omar Marei, Emma Kirby, Anna Gilfedder, Lydia Maw, Sarah O’Connor, Charlotte Maden, Helena Jones, Hazel Preston, Nur Amirah Binti Maliki, Mark Zimmerman, Jessica Webber, Llewelyn Jones, Rebecca Phillips, Lauren McCarthy, Emily Hubbard, Leo Duffy, Abigail Guerrier Sadler, Tamas Szakmany, Owen Richards, Charles King, Charlotte Killick, Yusuf Chema, Kavita Shergill, Yi Huen, Lillian Lau, Hannah Mustafa Ali, Lucas Wilcock, Molly Timlin, Ayeesha Rela, Daniel Smith, Sarah Ireland, Jennifer Evans, Nayanatara Poobalan, Jessica Pearce, Thivya V Vadiveloo, Zoe Black, Daniel Elis Samuel, Humaira Hussain, Joanna Hawkins, Zeid Atiyah, Rebecca Creamer, Maham Zafar, Ahmad Almazeedi, Hannah Brunnock, Zain Nasser, Mekha Jeyanthi, Poorya Moghbel, Katie Kwan, Isobel Sutherland, Frank Davis, Abigail Rogers, Zhao Xuan Tan, Clare Chantrill, Amal Robertson, Jonathan Foulkes, Rahana Khanam, Jomcy John, Sarah Hannah Meehan, Huria Metezai, Hannah Dawson, Navrhinaa Vadivale, Camilla Lee, Amrit Dhadda, Sian Cleaver, Genna Logue, Joy Inns, Isabel Jones, Robyn Howcroft, Carys Gilbert, Matthew Bradley, Louise Pike, Rachel Keeling, Charldré Banks, Eleanor Cochrane, James McFadyen, Matthew Mo, Emily Ireland, Esme Brittain, Ihssen Laid, Charlotte Green, Adriel Mcforrester, Xuong Michelle Ly, Mariana Nalbanti, Raven Joseph, Jack Tagg, David Purchase, Pan Myat, Ayako Niina, Tyler Joshua Jones, Lowri Hughes Thomas, Natalie Hoyle, Patrick Benc, Ellen Davies, Meng-Chieh Wu, David Fellows, Sam Tilley, Eloise Baxendale, Karishma Khan, Andrew Forrester, Oliver Moore, Hse Juinn Lim, Aimee Owen, Faris Hussain, Nima-banu Allybocus, Maneha Sethi, Harry Waring, Adeel Khan, Claire Smith, Nicholas Doyle, Mohammad Yahya Amjad, Luke Galloway, Paul Morgan, Gemma Ellis, Robert Lundin, Haamed Al Hassan, Bethan Markall, Namratha Kaur, Emmanuel Onyango, Heather Beard, Elliot Field, Ellen Nelson-Rowe, Lizzie Adcock, Amelia Stoddart, Frederika St John, Mathoorika Sivananthan, Rhys Jones, Sung Yeon Kwak, Lily Farakish, Holly Rhys-Ellis, Kate Moss, Tallulah Ray, Tessa David, Talea Roberts, Annie Quy, Aniket Paranjape, Nutchanun Poolworaluk, Mary Keast, Si Liang Yao, Dion Manning, Isobel Irwin, Umair Asim, Emelia Boggon, Ibrahim Alkurd, Genevieve Lawerece, Jade Brown, Emily Murphy, Evie Lambert, Jeremy Guilford, Beth Payne, Mariam Almulaifi, Arwel Poacher, Sashiananthan Ganesananthan, Berenice Cunningham-Walker, Chloe Spooner, Akanksha Kiran, Nabeegh Nadeem, Vidhi Unadkat, Esme Sparey, David Li, Jessica Smith, India Corrin, Amit Kurani, Paul McNulty, Ceri Brown, Wojciech Groblewski, Szilvia Szoke, Amelia Redman, Esther McKeag, Anastasia Donnir, Gaautham Ravishangar, Emanuela Howard, Charlotte Salmon, Sara Tanatova, Jasmine Kew, Megan Eilis Clark, Ellen Hannay, Olesya Godsafe, Christina Houghton, Francesca Lavric, Rachel Mallinson, Chris Littler, Harsha Reddy, Andrew Campbell, Benedict Soo, Rachel Evans, Georgina Donowho, Alexandra Cawthra, Maddison Davies, Matthew Lawrence Ashman, Jamie Scriven, James Vautrey, Shannon Seet, Imogen Britton, Abigail Hodgson, Emma Twohey, Joseph Robbins, Vanessa Yeo Yung Ling, Kimiya Asjadi, Carven Chin Yee Shean, Zoe McCarroll, Oritseweyimi Amatotsero, Hei Man Priscilla Chan, John Ng Cho Hui, Antonia Ashaye, Josephine Acheampong, Ayowade Adeleye, Saber Ahmed, Alexandra Chrysostomou, Harry Unwin, Eshen Ang, Niamh McSwiney, Yin Yin Lim, Zong Xuan Lee, Svetlana Kulikouskaya, Nur Zulkifili, Sheryl Lim, Lim Xin, Adiya Urazbayeva, Nur Haslina Ahmad Hanif, Yau Ke Ying, Alice Coleclough, Eilis Higgins, Naomi Spencer, Tze Gee Ng, Sam Booth, Stephanie Wai Yee Ng, Christian P Subbe, Isabella Patterson, Wen Li Chia, Abdullah Mukit, Hei Yi Vivian Pak, Felicity Lock, Mariana Nalmpanti, Shôn Alun Thomas, Tanisha Burgher, Alfred Wei Zhen Yeo, Siwan Powell Jones, Charlie Miles, Millicent Perry, Holly Burton, Katharine Powell, Luthfun Nessa, Aalaa Fadlalla, Rhian Morgan, Elizabeth Hodges, Amelia Heal, Chloe Scott, Alice Tayler, Thomas Chandy, Abduahad Taufik, James Cochrane, Samuel Willis, Sieh Yen Heng, Alex Cooper, Henrik Graf von der Pahlen, Isabella Talbot, Robin Gwyn Roberts, Jessica Sharma Smith, Aisling Sweeney, Cerian Roberts, Laura Bausor, Chania, Daniah Thomas, Elen Wyn Puw, Ronan A Lyons, and Judith E Hall

Subjects
red flag, medicine.medical_specialty, media_common.quotation_subject, Concordance, Prevalence, Sepsis, sepsis, Sequential Organ Failure Assessment, Excellence, medicine, Risk of mortality, Original Clinical Report, National Institute of Clinical Excellence, media_common, business.industry, RC86-88.9, Medical emergencies. Critical care. Intensive care. First aid, General Medicine, Emergency department, medicine.disease, mortality, Systemic inflammatory response syndrome, systemic inflammatory response syndrome, Emergency medicine, Risk stratification, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, business
Abstract

Supplemental Digital Content is available in the text., OBJECTIVES: To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN: Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING: The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS: We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS: We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS: Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.

Published
2021

27. Understanding the contribution of racially and ethnically discordant interactions to pain disparities: proximal mechanisms and potential solutions.

Author

Ashton-James, Claire E., Anderson, Steven R., and Hirsh, Adam T.

Subjects
*INTERGROUP communication, *ETHNIC differences, *ETHNOPSYCHOLOGY, *CULTURAL pluralism, *PATIENTS' attitudes, *INTERPERSONAL relations, *DISCRIMINATION in medical care
Abstract

Regarding the former, in a recent virtual patient study, Grant et al.[32] found White physicians with higher trait-level intergroup anxiety experienced more state-level discomfort with Black patients, which subsequently affected their pain treatment decisions for these patients. Within pain medicine, robust evidence indicates that Black patients report higher levels of acute and chronic pain than White patients.[[13], [43]] Similarly, the results from more than 40 experimental studies[43] have consistently demonstrated moderate-to-large effects of participant race on experimental pain sensitivity across multiple modalities. In simulated clinical interactions, Black patients paired with racially and ethnically discordant doctors had higher pain and pain-related physiological arousal in response to painful heat stimuli. [Extracted from the article]

Published
2023
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30. Estimating Hidden Population Sizes with Venue-based Sampling

Author

Verdery, Ashton M., Weir, Sharon, Reynolds, Zahra, Mulholland, Grace, and Edwards, Jessie K.

Subjects
Population Density, Sex Workers, Health Policy, Statistics as Topic, HIV Infections, Key populations, Social networks, Venue-based sampling, Drug Users, Sexual and Gender Minorities, Infectious Diseases, Network scale-up methods, Risk Factors, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, HIV/AIDS, Humans, Policy Making, Substance Abuse, Intravenous
Abstract

Supplemental Digital Content is available in the text., Background: Researchers use a variety of population size estimation methods to determine the sizes of key populations at elevated risk of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), an important step in quantifying epidemic impact, advocating for high-risk groups, and planning, implementing, and monitoring prevention, care, and treatment programs. Conventional procedures often use information about sample respondents’ social network contacts to estimate the sizes of key populations of interest. A recent study proposes a generalized network scale-up method that combines two samples—a traditional sample of the general population and a link-tracing sample of the hidden population—and produces more accurate results with fewer assumptions than conventional approaches. Methods: We extended the generalized network scale-up method from link-tracing samples to samples collected with venue-based sampling designs popular in sampling key populations at risk of HIV. Our method obviates the need for a traditional sample of the general population, as long as the size of the venue-attending population is approximately known. We tested the venue-based generalized network scale-up method in a comprehensive simulation evaluation framework. Results: The venue-based generalized network scale-up method provided accurate and efficient estimates of key population sizes, even when few members of the key population were sampled, yielding average biases below ±6% except when false-positive reporting error is high. It relies on limited assumptions and, in our tests, was robust to numerous threats to inference. Conclusions: Key population size estimation is vital to the successful implementation of efforts to combat HIV/AIDS. Venue-based network scale-up approaches offer another tool that researchers and policymakers can apply to these problems.

Published
2019

31. Machine-learning Models Predict 30-Day Mortality, Cardiovascular Complications, and Respiratory Complications After Aseptic Revision Total Joint Arthroplasty.

Author

Abraham, Vivek Mathew, Booth, Greg, Geiger, Phillip, Balazs, George Christian, and Goldman, Ashton

Subjects
FERRANS & Powers Quality of Life Index, TOTAL hip replacement, RESEARCH evaluation, SODIUM, TIME, HYPERNATREMIA, SURGICAL complications, RETROSPECTIVE studies, HYPONATREMIA, RISK assessment, LONGITUDINAL method
Abstract

Background: Aseptic revision THA and TKA are associated with an increased risk of adverse outcomes compared with primary THA and TKA. Understanding the risk profiles for patients undergoing aseptic revision THA or TKA may provide an opportunity to decrease the risk of postsurgical complications. There are risk stratification tools for postoperative complications after aseptic revision TKA or THA; however, current tools only include nonmodifiable risk factors, such as medical comorbidities, and do not include modifiable risk factors.Questions/purposes: (1) Can machine learning predict 30-day mortality and complications for patients undergoing aseptic revision THA or TKA using a cohort from the American College of Surgeons National Surgical Quality Improvement Program database? (2) Which patient variables are the most relevant in predicting complications?Methods: This was a temporally validated, retrospective study analyzing the 2014 to 2019 National Surgical Quality Improvement Program database, as this database captures a large cohort of aseptic revision THA and TKA patients across a broad range of clinical settings and includes preoperative laboratory values. The training data set was 2014 to 2018, and 2019 was the validation data set. Given that predictive models learn expected prevalence of outcomes, this split allows assessment of model performance in contemporary patients. Between 2014 and 2019, a total of 24,682 patients underwent aseptic revision TKA and 17,871 patients underwent aseptic revision THA. Of those, patients with CPT codes corresponding to aseptic revision TKA or THA were considered as potentially eligible. Based on excluding procedures involving unclean wounds, 78% (19,345 of 24,682) of aseptic revision TKA procedures and 82% (14,711 of 17,871) of aseptic revision THA procedures were eligible. Ten percent of patients in each of the training and validation cohorts had missing predictor variables. Most of these missing data were preoperative sodium or hematocrit (8% in both the training and validation cohorts). No patients had missing outcome data. No patients were excluded due to missing data. The mean patient was age 66 ± 12 years, the mean BMI was 32 ± 7 kg/m 2 , and the mean American Society of Anesthesiologists (ASA) Physical Score was 3 (56%). XGBoost was then used to create a scoring tool for 30-day adverse outcomes. XGBoost was chosen because it can handle missing data, it is nonlinear, it can assess nuanced relationships between variables, it incorporates techniques to reduce model complexity, and it has a demonstrated record of producing highly accurate machine-learning models. Performance metrics included discrimination and calibration. Discrimination was assessed by c-statistics, which describe the area under the receiver operating characteristic curve. This quantifies how well a predictive model discriminates between patients who have the outcome of interest versus those who do not. Relevant ranges for c-statistics include good (0.70 to 0.79), excellent (0.80 to 0.89), and outstanding (> 0.90). We estimated 95% confidence intervals (CIs) for c-statistics by 500-sample bootstrapping. Calibration curves quantify reliability of model predictions. Reliable models produce prediction probabilities for outcomes that are similar to observed probabilities of those outcomes, so a well-calibrated model should demonstrate a calibration curve that does not deviate substantially from a line of slope 1 and intercept 0. Calibration curves were generated on the 2019 validation data. Shapley Additive Explanations (SHAP) visualizations were used to investigate feature importance to gain insight into how models made predictions. The models were built into an online calculator for ongoing testing and validation. The risk calculator, which is freely available ( http://nb-group.org/rev2/ ), allows a user to input patient data to calculate postoperative risk of 30-day mortality, cardiac, and respiratory complications after aseptic revision TKA or THA. A post hoc analysis was performed to assess whether using data from 2020 would improve calibration on 2019 data.Results: The model accurately predicted mortality, cardiac complications, and respiratory complications after aseptic revision THA or TKA, with c-statistics of 0.88 (95% CI 0.83 to 0.93), 0.80 (95% CI 0.75 to 0.84), and 0.78 (95% CI 0.74 to 0.82), respectively, on internal validation and 0.87 (95% CI 0.77 to 0.96), 0.70 (95% CI 0.61 to 0.78), and 0.82 (95% CI 0.75 to 0.88), respectively, on temporal validation. Calibration curves demonstrated slight over-confidence in predictions (most predicted probabilities were higher than observed probabilities). Post hoc analysis of 2020 data did not yield improved calibration on the 2019 validation set. Important risk factors for all models included increased age and higher ASA, BMI, hematocrit level, and sodium level. Hematocrit and ASA were in the top three most important features for all models. The factor with the strongest association for mortality and cardiac complication models was age, and for the respiratory model, chronic obstructive pulmonary disease. Risk related to sodium followed a U-shaped curve. Preoperative hyponatremia and hypernatremia predicted an increased risk of mortality and respiratory complications, with a nadir of 138 mmol/L; hyponatremia was more strongly associated with mortality than hypernatremia. A hematocrit level less than 36% predicted an increased risk of all three adverse outcomes. A BMI less than 24 kg/m 2 -and especially less than 20 kg/m 2 -predicted an increased risk of all three adverse outcomes, with little to no effect for higher BMI.Conclusion: This temporally validated model predicted 30-day mortality, cardiac complications, and respiratory complications after aseptic revision THA or TKA with c-statistics ranging from 0.78 to 0.88. This freely available risk calculator can be used preoperatively by surgeons to educate patients on their individual postoperative risk of these specific adverse outcomes. Unanswered questions that remain include whether altering the studied preoperative patient variables, such as sodium or hematocrit, would affect postoperative risk of adverse outcomes; however, a prospective cohort study is needed to answer this question.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Published
2022
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33. Tips on Raising Reliable Local Perforator Flaps

Author

Ashton, MW and Ashton, MW

Abstract

From early on in the development of plastic surgery, it was quickly realized that utilizing locally adjacent tissue, or "matching like with like," yielded superior aesthetic reconstructions to those in which the tissue was derived from a distant location. In many cases, the use of a local perforator flap is a simpler procedure with less patient morbidity and a quicker recovery from surgery. The difficulty with local perforator flaps has been locating the supplying perforators, ensuring that the flap has a robust and reliable blood supply, and that sufficient tissue is able to be transferred. The recent reappraisal of our understanding of the blood supply of the integument has allowed, for the first time, the capacity to accurately and inexpensively, without the need for "high tech equipment," locate perforators, as they emerge from the deep fascia into the overlying integument, and through a better understanding of the interconnecting anastomotic vessels between perforators reliably predict how much tissue can be safely raised on a single perforator, before surgery. Further, through the use of strategic "delay," it is possible to manipulate the interconnecting vessels between the selected perforator and its surrounding neighbors to design a flap of tissue of any dimension, composed of whatever tissue we require, and safely transfer that tissue locally, or if required, distantly, as a free flap. This article will highlight these advances, explain their relevance in raising reliable local perforator flaps, and will, where possible, call attention to any pearls and pitfalls, and how to avoid complications.

Published
2021

34. Effect of Race on Prediction of Brain Amyloidosis by Plasma Aβ42/Aβ40, Phosphorylated Tau, and Neurofilament Light.

Author

Schindler, Suzanne E., Karikari, Thomas K., Ashton, Nicholas J., Henson, Rachel L., Yarasheski, Kevin E., West, Tim, Meyer, Mathew R., Kirmess, Kristopher M., Li, Yan, Saef, Benjamin, Moulder, Krista L., Bradford, David, Fagan, Anne M., Gordon, Brian A., Benzinger, Tammie L.S., Balls-Berry, Joyce, Bateman, Randall J., Xiong, Chengjie, Zetterberg, Henrik, and Blennow, Kaj

Published
2022
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35. Lessons Learned: A Case of Intimate Partner Violence During the COVID-19 Pandemic.

Author

Glover, Hilary Ashton, Hitt, Amanda, and Darby, Wendy

Subjects
*INTIMATE partner violence, *PAIN, *RANGE of motion of joints, *SOCIAL determinants of health, *HOSPITAL emergency services, *SHOULDER injuries, *HUMERAL fractures, *QUARANTINE, *PUBLIC health, *RISK assessment, *STAY-at-home orders, *VICTIMS, *COVID-19 pandemic
Abstract

Intimate partner violence (IPV) has been a major public health threat long before COVID-19. However, the pandemic has removed protective measures from victims, while heightening risk factors associated with IPV. Emergency department providers are often the initial point of contact in the health care system for IPV victims; therefore, knowledge of current screening guidelines and best practices in assessment and management of IPV is essential. The purpose of this case report is to present a missed opportunity involving IPV in an emergency department during the COVID-19 pandemic and to discuss the lessons learned with the aim of educating health care providers on the subtle signs of IPV and current screening guidelines. [ABSTRACT FROM AUTHOR]

Published
2022
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37. A Multidimensional Bioinformatic Platform for the Study of Human Response to Surgery.

Author

Eckhoff, Austin M., Connor, Ashton A., Thacker, Julie K. M., Blazer, Dan G., Moore, Harvey G., Scheri, Randall P., Lagoo-Deenadayalan, Sandhya A., Harpole, David H., Seymour, Keri A., Purves, J. Todd, Ravindra, Kadiyala V., Southerland, Kevin W., Rocke, Daniel J., Gilner, Jennifer B., Parker, Daniel C., Bain, James R., Muehlbauer, Michael J., Ilkayeva, Olga R., Corcoran, David L., and Modliszewski, Jennifer L.

Abstract

Objective: To design and establish a prospective biospecimen repository that integrates multi-omics assays with clinical data to study mechanisms of controlled injury and healing. Background: Elective surgery is an opportunity to understand both the systemic and focal responses accompanying controlled and well-characterized injury to the human body. The overarching goal of this ongoing project is to define stereotypical responses to surgical injury, with the translational purpose of identifying targetable pathways involved in healing and resilience, and variations indicative of aberrant peri-operative outcomes. Methods: Clinical data from the electronic medical record combined with large-scale biological data sets derived from blood, urine, fecal matter, and tissue samples are collected prospectively through the peri-operative period on patients undergoing 14 surgeries chosen to represent a range of injury locations and intensities. Specimens are subjected to genomic, transcriptomic, proteomic, and metabolomic assays to describe their genetic, metabolic, immunologic, and microbiome profiles, providing a multidimensional landscape of the human response to injury. Results: The highly multiplexed data generated includes changes in over 28,000 mRNA transcripts, 100 plasma metabolites, 200 urine metabolites, and 400 proteins over the longitudinal course of surgery and recovery. In our initial pilot dataset, we demonstrate the feasibility of collecting high quality multi-omic data at pre- and postoperative time points and are already seeing evidence of physiologic perturbation between timepoints. Conclusions: This repository allows for longitudinal, state-of-the-art geno-mic, transcriptomic, proteomic, metabolomic, immunologic, and clinical data collection and provides a rich and stable infrastructure on which to fuel further biomedical discovery. [ABSTRACT FROM AUTHOR]

Published
2022
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38. Increasing Perfusion Pressure Does Not Distend Perforators or Anastomoses but Reveals Arteriovenous Shuntings

Author

Gascoigne, AC, Taylor, GI, Corlett, RJ, Briggs, C, Ashton, MW, Gascoigne, AC, Taylor, GI, Corlett, RJ, Briggs, C, and Ashton, MW

Abstract

BACKGROUND: It has been proposed that hyperperfusion of perforators and distension of anastomotic vessels may be a mechanism by which large perforator flaps are perfused. This study investigates whether increasing perfusion pressure of radiographic contrast in cadaveric studies altered the radiographic appearance of vessels, particularly by distending their anastomotic connections. METHODS: From 10 fresh cadavers, bilateral upper limbs above the elbow were removed. Three cadavers were excluded. Seven pairs of limbs were injected with lead oxide solutions via the brachial artery while distally monitoring intravascular pressure in the radial artery using a pressure transducer. One limb was injected slowly (0.5 mL/s) and the other rapidly (1.5 mL/s) to produce low and high perfusion pressures, respectively. Skin and subcutaneous tissue were then removed and radiographed. RESULTS: The filling of perforators and their larger caliber branches appeared unchanged between low- and high-pressure injections, with no significant increase in true anastomoses (P = 0.32) and no association between maximum perfusion pressure and number (P = 0.94) or caliber (P = 0.10). However, high-pressure injections revealed arteriovenous shunting with filling of the tributaries of the major veins. CONCLUSIONS: This study demonstrated that increased perfusion pressure of the cutaneous arteries (1) did not change the caliber of vessels; (2) did not convert choke to true anastomoses; and (3) revealed arteriovenous shunting between major vessels with retrograde filling of venous tributaries as pressure increased. This suggests that it is not possible to distend anastomotic connections between vascular territories by increasing perfusion alone.

Published
2020

39. The social threats of COVID-19 for people with chronic pain

Author

Karos, K, McParland, JL, Bunzli, S, Devan, H, Hirsh, A, Kapos, FP, Keogh, E, Moore, D, Tracy, LM, Ashton-James, CE, Karos, K, McParland, JL, Bunzli, S, Devan, H, Hirsh, A, Kapos, FP, Keogh, E, Moore, D, Tracy, LM, and Ashton-James, CE

Published
2020

41. Beyond pain, distress, and disability: the importance of social outcomes in pain management research and practice.

Author

Ashton-James, Claire E., Anderson, Steven R., Mackey, Sean C., and Darnall, Beth D.

Subjects
*LONELINESS, *PAIN catastrophizing, *PAIN management, *NON-communicable diseases, *CORONARY artery bypass, *CHRONIC pain, *FERRANS & Powers Quality of Life Index, *SOCIAL participation, *PAIN, *DISABILITY evaluation, *PSYCHOLOGICAL tests, *IMPACT of Event Scale, *RESEARCH funding, *PSYCHOLOGICAL stress
Abstract

Marital satisfaction and pain severity mediate the association between negative spouse responses to pain and depressive symptoms in a chronic pain patient sample. More systematic and comprehensive measurement will allow us to evaluate the therapeutic impact of pain management on patients' social outcomes and the contribution of social outcomes to patients' experience of pain, distress, and disability. However, the social outcomes of pain-profoundly influencing both patients' experience of chronic pain and quality of life [22]-are equally important from a clinical perspective and may even be more important therapeutic targets from the patient and their families' perspective. [Extracted from the article]

Published
2022
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43. Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration.

Author

Goldman, Ashton H., Johnson, Daniel D., Griffis, Clare E., Land, Vaughn, and Balazs, George C.

Subjects
*OPIOID epidemic, *MEDICAL prescriptions, *PRESCRIPTION writing, *TREATMENT duration, *PILLS, *THERAPEUTIC use of narcotics, *ANALGESICS
Abstract

Abstract: Prescription opioids remain an important driver of the opioid crisis in the United States. The purpose of this study was to examine recent changes in opioid prescribing patterns in the Military Health System (MHS) which is a nationwide health system service active duty military personnel and civilian beneficiaries. All patients prescribed opioid analgesics by MHS providers and filled at MHS pharmacies between 2014 and 2018 were identified. Prescriptions were converted to oral morphine equivalents (OMEs) and categorized based on prescribing specialty and formulation. Total opioid prescription counts and opioid prescription counts weighted by the annual number of outpatient encounters for each specialty were calculated, as were total OMEs and daily OMEs per prescription. A total of 3,427,308 prescriptions were included. Primary care providers and surgeons wrote 47% and 29% of opioid prescriptions, respectively. Over the study period, there was a 56% decline in annual opioid prescriptions, 25% decline in median total OMEs, and a 57% decline in opioid prescriptions per patient encounter. The proportion of prescriptions written for >90 OMEs per day declined 21%. Declines in opioid prescriptions and quantities were observed in nearly all specialties over the study period. The results of this study suggest a broad-based shift towards less opioid prescribing. [ABSTRACT FROM AUTHOR]

Published
2022
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45. Linagliptin Effects on Heart Failure and Related Outcomes in Individuals With Type 2 Diabetes Mellitus at High Cardiovascular and Renal Risk in CARMELINA

Author

McGuire D, Alexander J, Johansen O, Perkovic V, Rosenstock J, Cooper M, Wanner C, Kahn S, Toto R, Zinman B, Baanstra D, Pfarr E, Schnaidt S, Meinicke T, George J, von Eynatten M, Marx N, Aizenberg D, Fiorella A, Edgardo N, Belen C, Alonso P, Walter M, Maia K, Guillermo S, Leandro B, Constanza R, Alejandra N, Melina C, Ariel I, Rodrigo C, Alvarez C, Jorge M, Gabriel C, German S, Bartolacci I, Bolobanich G, Tale T, Meritano M, Echeverria M, Gerrini S, Alvarez M, Torrijos N, Berli M, Coggiola J, Castaneda G, Rode R, Milessi R, Roude A, Bono J, Caresani J, Arias V, Westberg J, Allende G, Liberman A, Bordonava A, Almagro S, Gerbaudo C, Schiavi L, Budassi N, Cecilia M, Buncuga M, Carlos S, Osvaldo T, Mercedes S, Calella P, Agustina V, Aljandro M, Alberto D, Fiorella M, Cantero M, Cariganano M, Anadon P, Cartasegna L, Gabriela M, Fernanda A, Alberto R, Chacon C, Jazmin F, Colombo H, Coni E, Mattausch S, Thomsenhall K, della Torre M, Morandini M, Berra F, Margarita H, Commendatore V, Tedesco J, Bolzan P, Cuneo C, Narcisa G, Caputi V, Pablo S, Sandra G, Pacora F, Tinari M, Jure H, Parody M, Toranzo A, Frechtel G, Yohena S, Lovecchio S, Muller C, Martin S, Olivera C, Breyaui M, Bianchi G, Garcia C, Luciana V, Florencia F, Ruben G, Gelersztein E, Rey G, Sanchez C, Fornasari L, Di Pierro L, Giacomi G, Miguel S, Laura T, Gonzalo C, Ramon C, Glenny J, Koretzky M, Porto A, Tiberio O, Ellenberg A, Saurral R, Igarzabal C, Vilamajo O, Matkovich J, de Lapertosa S, Villagra M, Cuzziol G, de la Cruz M, Pinchetti R, Mierez M, Lopez C, Gorosito V, Gabito A, Kleiban A, Grosembacher L, Adrian P, Paula R, Javier G, Kraft F, Andres F, Krynski F, Nicolas P, Marcelo F, Alfredo F, de la Fuente R, Natalia C, Luquez H, Recuero Y, Becchetti N, Ruiz M, Costantino M, Vazquez G, Guzman C, Pelatia P, Maffei L, Sassone S, Yantorno M, Prado G, Khron B, Maldonado N, Gustavo L, Veronica V, Marino J, Elizabeth A, Alejandra C, Oscar R, Azize G, Gallardo M, Escudero M, Vargas E, Ramos H, Lucero C, Najenson M, Crocci I, Chiesa A, Nardone L, Dominguez S, Zanini A, Manghi F, Grossman M, Giudice G, Romeo A, Piskorz D, Miguel C, Susana D, Noeli U, Rosa S, Martin V, Soledad A, Virginia M, Lorena G, Prado A, Veronica L, Eduardo H, Adolfo P, Florencia W, Rista L, Scolari C, Rojas N, Bertolio V, Zarandon R, Jair S, Orlando C, Sanabria H, Ignacio D, Viviana C, Marina R, Sarjanovich R, Scaro G, Huerta C, Mana M, Gutierrez M, Dain A, Gavicola R, Sessa H, Sacripanti J, Felman R, Vilarino P, Sicer M, Lagrutta M, Sala J, Casabella T, Cecilia H, Carlos B, Vines G, Javier R, Vico M, Lanchiotti P, Martella C, Torres L, Villarino A, Molina M, Martinez J, Farias C, Bertola S, Rojas M, Guzman P, Nisi J, Martinez D, Barrionuevo M, Vita N, Lopez A, Vottero E, Giuliano M, Paron L, Vogel D, Mele P, Imposti H, Dominguez A, Zaidman C, Fernando G, Beck M, Beltrame P, Chemello D, Junior R, Abreu A, Fernandes V, Saboia J, Rodrigues L, Carvalho M, Gurgel M, Gadelha D, Ramos C, Borba V, Golbert M, Pitthan M, Golbert L, Valentini R, Canani L, Gross J, Valenti A, Sartori C, Dutra O, Azevedo E, Azevedo A, Vaz R, Vaz H, da Costa F, da Costa L, Panarotto D, Lain F, Camazzola F, Dellomea B, Rech R, Pizzato P, Nunes C, Jaeger C, Silveira D, Wagner L, Machado L, Rea R, de Bem A, Alves J, Jonasson T, Malucelli F, Betti R, Lerario A, Lisboa H, Bem J, Tres G, Tavares C, Nardi A, Pozzatto M, Backes L, Reolao J, Scariot E, Ziguer E, Baldissera D, Griz L, Antunes D, Victor F, Freire K, Barros A, Costi B, Sa M, Carneiro A, Felicio J, Felicio K, Penha P, Ferreira J, Melo F, Alves A, Souza A, Costa L, Pinheiro D, Turatti L, Augusto G, Leanca C, Santomauro A, Forti A, Sena R, Marinho A, Facanha C, de Souza K, de Souza A, de Queiroz W, Leite S, Vieira S, Gubert L, Olsen A, Piazzetta G, Fuck A, Ferreira M, Fortes J, Brandao T, Alves F, Radice E, dos Santos J, de Almeida R, Franco D, Saporito W, Eliaschewitz F, de Siqueira K, Bona R, Genestreti P, de Castro D, Visconti G, Sampaio C, Palhares F, Konigsfeld H, Alves E, Feder C, Leao B, Saraiva J, Rodovalho S, Costa M, Pires N, Figueiredo E, Werner G, Garcia J, de Paiva I, Quirino B, Botelho R, da Silva R, Navarro A, Lourenco C, Pereira A, Arantes F, Boner D, Saad J, Falchetto E, Washizu E, Mandil A, Pimenta N, Tofani F, Fonseca T, Teixeira L, Maia L, Lemos M, Mouco O, Nakazone M, Weiand L, Bohn J, Hissa M, Araripe F, Carvalho F, Cancado G, Wang R, Chacra A, Fusaro A, de Mendonca E, Cercato C, Halpern A, Alves B, Braile M, Sestito R, Mustafa E, Ferreira V, Sbardellini B, de Almeida P, Guimaraes F, Piedade M, Bienert I, Braga J, Daher R, Hirakawa T, Terra E, Farias E, Figueiredo M, Lima L, Moraes K, Avelino I, Flato U, Plavnik F, Portes E, Moreira M, Vendramini M, Veloso R, Padilha M, Rodrigues A, Adam R, Santos S, Sayeg N, Guerrero D, Madeira M, Siqueira J, Pinheiro R, Villacorta A, Mellazi A, Braga T, Kaiser S, Paolino B, Lefterov I, Marinchev A, Angelova S, Klyuchkova N, Lybomirova Z, Kerekovski Y, Kuneva T, Penkova D, Levterov G, Videnova E, Georgieva P, Shinkov A, Borissova A, Vlahov J, Dakovska-Dekova L, Lucheva M, Luchev P, Temelkova M, Borisova K, Tsenov S, Andreeva V, Margaritov V, Arasheva G, Lozanov L, Borisov R, Gorcheva D, Henein S, Whatley S, Boutros M, Kalyniuk N, Berlingieri J, Nisker W, Hoag G, Hepburn D, Harvey M, Manjoo P, Yale J, Sherman M, Tsoukas M, Rehman W, Mason M, Santerre M, De Kock J, Barkhuizen F, Rooke C, Gill C, Kooy J, Burgoyne G, de Kock J, Degen G, Hockman L, Invik R, Roberts P, Ward K, Alasaad H, Susan A, Davies V, Gupta N, Milhalidis J, Grossman L, Agawal N, Yared Z, Rwaheed, Nouhad S, Nahla A, Khandwala H, Warwick A, Wadehra D, Manan A, Vecchiarelli J, Aslam N, Ferrao A, St-Maurice F, Collette R, Davey B, Nawaz S, Coutu B, Costi P, Greiss I, Mansour F, Raymond J, St-Phard W, Nadra I, Della Siega A, Barahona L, Klinke P, Contractor H, Fryer M, Chandra N, Conti B, Telzer L, Sorensen S, Lounsbury N, Martin E, Mitchell L, Pelzer E, Nelson S, Jones M, Cox J, Luco G, Trhoughton T, Labonte R, 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Kitamura H, Toriumi Y, Ishiguro H, Naganuma T, Shu S, Suzuki K, Hirota Y, Hayashi T, Hozawa K, Fukui T, Abe Y, Yamauchi K, Maruyama M, Matsumura S, Kozuma R, Nagai Y, Kihara Y, Maeda H, Nakanishi K, Iitsuka T, Hatori M, Shinozaki Y, Akiyama D, Kawabe M, Takei M, Sato A, Kawai Y, Kitajima K, Ide M, Sato N, Morisaki H, Nakashima K, Takayanagi H, Watanabe H, Iwahashi N, Tsujimoto M, Hibuse K, Hata T, Ueno K, Tatsuma H, Wakida Y, Ito T, Mizuno R, Fujita H, Konishi N, Kanehira T, Watanabe R, Miyaoka H, Okada T, Yamamoto M, Okita S, Murakami H, Todo Y, Umeoka F, Hori K, Shiraishi K, Tada F, Shimizu T, Tamai J, Sasaki C, Okuzima Y, Yasuda M, Iwaita Y, Tanaka K, Rha S, Na J, Cho D, Cho Y, Hwang E, Choi T, Won K, Kim H, Kim S, Oh D, Lee J, Choi H, Chung H, Park H, Suh Y, Kim Y, Kim N, Kim K, An J, Kim J, Park K, Kwak S, Kim M, Hwangbo Y, Lee D, Hong A, Kim L, Oh C, Moon S, Jung C, Jin J, Hyun B, Yang Y, Kong S, Yoon K, Yang H, Hong T, Oh J, Park J, Lee H, Choi J, Ahn J, Han S, Park W, Jo S, Suh 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Ocicka-Kozakiewicz A, Jurowiecki J, Stasinska T, Karczewicz-Janowska J, Jaruga J, ZytkiewiczJaruga D, Krupinska E, Pupek-Musialik D, Bogdanski P, Szulinska M, Skrypnik D, Skokowska E, Bojarska-Los M, Giermkowska-Samek M, Pirog M, Wojnowski L, Jelinska A, Gradzka M, Danyluk A, Lysek R, Sliwinska T, Podrazka-Szczepaniak A, Barney M, Tomczyk A, Necki M, Malicka J, Dudzinska M, KiszczakBochynska E, Markiewicz A, Galbas K, Paciorkowski A, Mazur S, Mazur M, Chmielowski A, Swiatek A, Sobocka B, Wis J, Jozefowska M, Kaczmarek M, Timler M, Cieplucha Z, Lazuka L, Lazuka N, Wittek A, Spyra J, Jasiel-Wojculewicz H, Stefanski A, Wierucki L, Hanczuk A, Misiura M, Szmygel K, Kolcowa O, Orlowska-Kunikowska E, Rutkowski M, Ignaszewska-Wyrzykowska A, Popenda G, Maciejewska J, Mostowy A, WojteckaGrabka M, Grazyna M, Wieslaw K, Barbara K, Kramarczuk E, Wojciech C, Jaroslaw H, Ewa B, Karas P, Agnieszka S, Hanna C, Justyna S, Piotr K, Wozniak I, Mateusz W, Katarzyna W, Jacek F, Andrzej J, Cymerman K, Gmytrasiewicz M, Zambrzycki J, Krysiak-Kowaluk H, Klodawska K, Klszczewski Z, Zieleniewski J, Opadczuk P, Urbanska K, Faran-Grabowska K, Szczepanik T, Siegel A, Kleczek A, Kincel K, Nowak D, Slowik-Gomulka L, Watemborska-Matuszyk G, Lampart J, Strozik-Krecichwost A, Dziewit T, Broncel M, Wojcik-Odyniec J, Jakubczyk E, Wierzbicka K, Witowicz A, Jedrych B, Korczyk P, Socik-Pojawa M, Monteiro P, Monteiro S, Mendes P, Soares F, Mendes S, Leite L, Vicente J, Santos M, Ferreira A, Alves P, Rosario F, Garrao A, Duarte L, Rogado C, Duarte R, Laginha T, Matos P, Raposo J, Mariz J, Teixeira J, Capela C, Leitao A, Cardiga R, Alface M, Augusto S, Basto L, Cunha A, Rei D, Dantas J, Verdasca I, Andrade L, Silva A, Suarez M, Dias V, Silva J, Pereira N, Goncalves M, Goncalves A, Silveira A, Sampaio A, Dias A, Diogo M, Vilaca C, Cif A, Calin T, Elena S, Crisan C, Adina S, Ramona S, Anghel V, Simona C, Turcu L, Mihaela V, Cosma D, Cristina H, Marius-Calin H, Negrisanu G, Andreea-Andrada M, Maria-Mihaela V, Camelia T, Oana P, Monia A, Onaca A, Mircea O, Mot A, Stolea V, Elena N, Barbonta D, Cristian B, Oana S, Popescu A, Madalina M, Coman A, Anca C, Constantinescu S, Mircea C, Diaconu-Sotropa M, Ene D, Pintilei E, Mihai G, Delia R, Toarba I, Simona H, Negru D, Flaminzeanu F, Iulian C, Maria-Cristina C, Doros R, Cleo S, Sorin B, Demian L, Mihai S, Raul B, Ioana A, Nicolau A, Cosmin P, Isabela G, Elena C, Ileana T, Valuyskikh E, Miroshnichenko E, Klementyeva N, Zelman O, Chumakova G, Vigel A, Leonova N, Pergaeva Y, Stefanovskaya O, Pushkareva S, Antoshkina L, Zheleznova N, Iveitsman, Barbarash O, Zvereva T, Zhuravleva E, Zavyrylina I, Usoltceva E, Savostyanova Y, Kupriyanova T, Krivoshapova K, Kondyukova N, Inozemceva A, Argunova Y, Tsyba L, Belenky D, Mariich O, Terekhova A, Tsygankova O, Kuznetsova E, Nagibovich G, Ivchenko Y, Dobronravov V, Dobronravov A, Bush M, Trofimenko I, Vishnevsky A, Zikov V, Kositsyn D, Palzman Z, Spiridonova T, Rodina N, Polozhentsev S, Mamedova L, Panov A, Abesadze I, Alugishvili M, Ivashkin V, Drapkina O, Korneeva O, Zyatenkova E, Glinkina I, Poluboyarinova I, Gurova O, Raykhman A, Vertkin A, Rodykova I, Shamaeva K, Petrovskaya T, Uzueva E, Milovanov Y, Milovanova S, Milovanova L, Markina M, Dobrosmyslov I, Markov V, Afanasiev S, Babich E, Belokopytova N, Demyanov S, Maximov A, Maximov I, Rebrova T, Shtatolkina M, Masin A, Demko A, Chuyko O, Pronina A, Charf G, Akatova E, Urlaeva I, Nikolin O, Khovaeva Y, Ermachkova L, Burdina E, Shvalb P, Suchkov I, Pshennikov A, Gryaznov S, Rymar O, Dolinskaya Y, Bahareva Y, Mustafina S, Sherbakova L, Ovsyannikova A, Bolshakova O, Polunicheva E, Dora S, Agafyina A, Yashina A, Vasilieva I, Yakhontova P, Selivanova S, Kargapoltseva O, Shilina N, Bayramova G, Sorokin I, Astamirova K, Kuchuk P, Koniushenko D, Malykh N, Dvorkin M, Krovelets T, Konovalova K, Seeber M, van Niekerk F, Siebert H, Steenkamp W, Wiid S, Noeth M, Siebert R, Breedt J, Bouwer J, Kapp C, Venter T, Rayner B, Trinder Y, Rheeder P, Delport E, Mathijs S, Soma P, van Zyl D, Strydom M, Marais A, Badat A, Hansa S, Fourie D, Walton T, Engelbrecht J, Jansen J, Roos J, du Toit S, Lehloenya K, van Zyl L, van Zyl F, Naude M, Mookadam M, van der Merwe A, Trokis J, Lombard L, Coetzee K, Ismail S, Bruning H, Latiff G, Yasmin O, Pillay T, Mohamed Z, Dawood S, Stapelberg A, Abrahams P, Jurgens J, van Heerden P, Swart E, Botha C, Meeding J, Hemus A, Oosthuysen W, Visagie G, Fourie N, Hutton P, van der Merwe N, Chelin N, Everton T, Duki M, Ghila N, Joshi M, Hira M, Madueno F, Martinez B, Sebastian N, Mercadal L, Isbert S, Gonzalez I, Asencio J, Figueras M, Rivas M, Garcia H, Fusalba A, Geat D, Cambra G, Sastre J, Castro F, Mas A, Portillo C, Serrano I, Hernandez S, Fajardo F, Juan C, Ferrer J, Peralta F, Padin C, Mauricio D, Madorell B, San Miguel F, Pedrol N, Trescoli C, Montanana C, Gonzalo M, Capellan J, Estrella A, Martinez C, Montesinos I, Loscos A, Coronado J, Perez J, Castillo B, Alonso C, Quesada V, Teruel J, Perez S, Lama M, del Rio E, Zlova T, Ponomarenko K, Karpenko O, Bezuglova S, Mitskevych L, Kizim S, Nevolina I, Katerenchuk V, Liudmyla B, Ivan K, Rudyk I, Olena M, Anna I, Ganna B, Topchii I, Semenovykh P, Yulia Y, Mykhalchyshyn G, Kirienko D, Kobiliak N, Bodnar, Mykhalchyshyn, Pertseva N, Olena G, Tomashkevych H, Korpachev V, Prybyla O, Kovalchuk A, Kushnarova N, Zinych O, Tseluyko V, Andriy Z, Olga R, Mankovskyy B, Zherdova N, Lykhoshapko O, Logoida P, Godlevska O, Olena V, Olga C, Gyrina O, Alifer O, Dozhuk K, Pekhenko V, Gorobets N, Korneichuk A, Makarenko E, Martynyuk L, Martynuyk O, Stanislavchuk M, Larysa P, Natalia S, Botsyurko V, Kostitska I, Dzeman O, Ablitsov Y, Ivaseiko S, Konovart O, Sandurska S, Vendzilovych Y, Samoylov O, Iryna C, Rozhkivska L, Ulyanchenko I, Kateryna V, Orlenko V, Ivaskina K, Tronko M, Tronko K, Pashkovska N, Stankova N, Vynnychenko L, Bolotnikova N, Demokhova N, Reshotko D, Popova A, Dr Bogdana, Tetiana S, Svitlana D, Oksana R, Vlasenko M, Litvinova S, Semenyuk I, Fishchuk O, Mostovoy Y, Tkachenko T, Ovcharuk M, Rasputina L, Vakaliuk I, Tymochko N, Drapchak I, Petrovska L, Lai W, Yen H, Voon W, Lin T, Cheng K, Chiu C, Chu C, Hsu P, Chiang C, Li Y, Kuo C, Lin S, Chao T, Yu W, Sung S, Wang K, Lu T, Shih K, Wu C, Chiang F, Hwang J, Tsai C, Juang J, Jeng J, Tang S, Lai C, Cheng C, Hsieh I, Hsieh M, Chen C, Lee C, Pai P, Ko P, Wang T, Chen T, Wu H, Chang S, Chen K, Hsieh L, Chou C, Jiang J, Lee M, Huang J, Chen J, Chiu K, Tsai L, Chen P, Saxena M, Collier D, Vaidya B, Harman S, Ramell M, Davies M, Chatterjee S, Meakin L, Quinn M, Bain S, Mallipedhi A, Min T, Bashir J, Blagden M, Ali J, McCrimmon R, Brennan G, Malcolm E, McDonald D, Pearson E, Illsley G, Darzy K, Winocour P, Hanif W, Cockwell P, Charlton M, Thekkepat S, Howat I, Devers M, Patrick J, Wyatt N, Smith C, Singh B, Nicholas J, Gillani S, Green F, Bell E, Boyle J, MacKin S, Livingstone R, Arif A, Syed M, Hammoud J, Sparks J, Anderson M, Tumey R, Condit J, Reddy M, Abalos-Galito M, Rebecca J, Barker T, Seaton B, Campbell E, Kompanik H, Jayson L, Huffman C, Bialow M, McDonnell G, McCaffrey J, Manis C, DeLuca E, Levins J, Bartlett M, Anorga K, Franco M, Gentry P, Hodge D, Pohil R, Rschultz, Leggett R, Blair L, Gisler J, Niegos F, Osburn M, Parma K, Schendel S, Stines L, Winnie M, Wu P, Canales J, Yu J, Cornett G, Beavins J, Hyde D, Zapinski D, Johnson T, Levinson D, Ahmed A, Kenny B, Kuehl A, Bates C, Jantzi C, Ananthula P, Shafer J, Louthan J, Bays A, Stapleton A, Staton P, Strum D, Taylor P, Smith A, Rapp R, Bao S, Randolph C, MacGillivray B, Schuster R, Harden T, Barnella C, Dunnam T, Whiles R, Bolick C, Brockmyre A, Plucker S, Marshall C, Poteet C, Morin D, Tavel E, Averill N, McFann A, Purcell D, Dixon T, Corey E, Goss J, Drescher R, Irfan M, Naeem M, Egelhof R, Mehta P, Koehler T, Walia J, Fernandez J, Bedel G, Preet R, Bhuchar S, Ahmed F, Onyema D, Benchabbat A, Kohanbash L, Miller P, Lalinde M, Carrithers E, Patterson R, Raube-Miceli A, Martinez A, 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Sherrod T, Krishnaswamy K, Aamir S, Giddaluri P, Guevara S, Kazmi P, Thomas P, Popeil L, Albright D, Pimentel S, Mould E, Cox M, Alderson T, Conrow J, Sandberg J, Raam S, Suresh B, Lafave J, Lorenz T, Johnston J, Fereidouni S, Mahadevan A, West R, Nelson A, Scott K, Ansari S, Khan B, Rastogi A, Saumell F, Gonzalez G, Torres E, Elias R, Hart T, Lozano J, Gudavilla G, Savin V, Khan A, Wiegmann T, Goel A, Gomes M, Fernandez-Gonzalez M, Gustavo F, Ivan C, Chiong R, Llerena S, Jimenez M, Oram D, George D, Lewis J, Kiefer J, Dollman A, Edje L, Pastor F, Kandath D, Lorch D, Graves A, Powell R, Hooker T, Shah S, Gomez N, Miranda F, Rosales J, Bayona I, Gomez Y, Guedes R, Rodriguez Y, Wahlen J, Jonathan W, Spencer H, Michael W, Kumar U, Govindariju K, Ordonez S, Aguirre H, Sulur P, Agarwal N, Peters L, Kaviani B, Fomenko O, Firek A, Loreen W, Ronald F, Olha F, Parrillo J, Janovitz R, Hutchinson R, Delgado E, Ashley A, Robinson S, Barbel-Johnson K, Timothy L, William C, Al-Karadsheh A, Hooper L, 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Colfer H, Kane L, Teklinski A, Gadowski G, Levanovich P, Saba F, Confident L, Hossain S, Steinberg B, Philippe B, Choroenthkongtrakal S, Boccalano F, Anand R, Syam V, Manohar A, Suresh P, Madhusudhan P, Patel P, Cambier P, Klonaris J, Cheng W, Fisher S, Schelle M, Reese L, McLean S, Poock J, Hoens J, Rosie A, Welshons R, Dean J, Kuhlman P, Luke R, Lohrbauer L, Cunningham M, Buday P, Lehmann M, Chrzanowski K, Fletcher A, Hargrove J, Harris F, Debs-Perez G, Maiquez A, Cordoves L, Georgescu M, Tayoun H, Munoz F, Ortiz D, Munoz G, Hamzeh I, Misra A, Zhang L, Forgosh L, Loria K, Roncari C, Hommerding J, Morris G, Lebron C, Blake K, LaVenture K, Lange C, Levinson L, Baungarten T, Edevante S, Shawley S, Moyer H, Elliott K, Iachini K, Rajan R, Davis C, Shattuck A, Simon W, Lakin G, Secrist N, Buth D, Steere D, Talbot K, Singh N, Mascolo R, Sloan S, Kmetzo J, Brown J, Carter L, Lawrence M, Arauz-Pacheco C, Lender D, Kozlow W, Cavanaugh L, Wilson J, Gujja P, Akhter F, Khan M, Mohammed A, Satyavolu S, Dev D, Yalamanchili H, Sumeyye C, Fernandes H, Chaleff F, Jancko M, Trenche S, Kaplan W, Wilcox S, Goisse M, Rua M, Black J, Chapman K, Suh D, Yan L, Song D, Chanara S, Houchin V, McKeinness A, Sotolongo R, Gutierrez K, Miranda-Palma B, Solano M, Jain M, Needell J, Banerjee A, Jarratt M, Hantel S, Lees K, Welty F, Freedman S, Parhofer K, Birkeland K, McGill J, Tijssen J, Clemmensen P, Pehrson S, Grande P, Januzzi J, Wood M, Petrie M, Sairanen T, Tatlisumak T, Soinne L, Kase C, Turan T, Mann J, Agarwal R, Fogarty D, Navaneethan S, Srinivas T, Forsmark C, Frossard J, Gelrud A, Mayerle J, Lee R, Heist R, Sullivan R, Buchbinder E, Chodak G, Edelman M, Thompson V, Coles A, and CARMELINA Investigators

Subjects
cardiovascular disease, type 2 diabetes mellitus, heart failure, chronic kidney diseases
Abstract

Background: Individuals with type 2 diabetes mellitus are at increased risk for heart failure (HF), particularly those with coexisting atherosclerotic cardiovascular disease and/or kidney disease. Some but not all dipeptidyl peptidase-4 inhibitors have been associated with increased HF risk. We performed secondary analyses of HF and related outcomes with the dipeptidyl peptidase-4 inhibitor linagliptin versus placebo in CARMELINA (The Cardiovascular and Renal Microvascular Outcome Study With Linagliptin), a cardiovascular outcomes trial that enrolled participants with type 2 diabetes mellitus and atherosclerotic cardiovascular disease and/or kidney disease. Methods: Participants in 27 countries with type 2 diabetes mellitus and concomitant atherosclerotic cardiovascular disease and/or kidney disease were randomized 1:1 to receive once daily oral linagliptin 5 mg or placebo, on top of standard of care. All hospitalization for HF (hHF), cardiovascular outcomes, and deaths were prospectively captured and centrally adjudicated. In prespecified and post hoc analyses of HF and related events, Cox proportional hazards models adjusting for region and baseline history of HF were used. Recurrent hHF events were analyzed using a negative binomial model. In a subset of participants with left ventricular ejection fraction captured within the year before randomization, HF-related outcomes were assessed in subgroups stratified by left ventricular ejection fraction > or 50%. Results: CARMELINA enrolled 6979 participants (mean age, 65.9 years; estimated glomerular filtration rate, mL/min per 1.73m(2); hemoglobin A1c, 8.0%; 62.9% men; diabetes mellitus duration, 14.8 years), including 1873 (26.8%) with a history of HF at baseline. Median follow-up was 2.2 years. Linagliptin versus placebo did not affect the incidence of hHF (209/3494 [6.0%] versus 226/3485 [6.5%], respectively; hazard ratio [HR], 0.90; 95% CI, 0.74-1.08), the composite of cardiovascular death/hHF (HR, 0.94; 95% CI, 0.82-1.08), or risk for recurrent hHF events (326 versus 359 events, respectively; rate ratio, 0.94; 95% CI, 0.75-1.20). There was no heterogeneity of linagliptin effects on hHF by history of HF at baseline, baseline estimated glomerular filtration rate or urine albumin-creatinine ratio, or prerandomization left ventricular ejection fraction. Conclusions: In a large, international cardiovascular outcome trial in participants with type 2 diabetes mellitus and concomitant atherosclerotic cardiovascular disease and/or kidney disease, linagliptin did not affect the risk of hHF or other selected HF-related outcomes, including among participants with and without a history of HF, across the spectrum of kidney disease, and independent of previous left ventricular ejection fraction. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01897532.

Published
2019

46. Breast Implant Selection: Consensus Recommendations Using a Modified Delphi Method

Author

Magnusson, MR, Connell, T, Miroshnik, M, Layt, C, Ashton, M, Deva, AK, Farrow, H, Januszkiewicz, J, Magnusson, MR, Connell, T, Miroshnik, M, Layt, C, Ashton, M, Deva, AK, Farrow, H, and Januszkiewicz, J

Abstract

BACKGROUND: Geographical differences in breast implant selection approaches exist, and clinical data to guide the process are limited. Developing knowledge of implant-related risk factors further complicates the process. This analysis aimed to establish expert consensus on considerations for breast implant selection in Australia and New Zealand based on practice patterns in those countries. METHODS: A modified Delphi method was used to gain consensus from experts in breast augmentation surgery in Australia and New Zealand. Panelists anonymously completed an initial questionnaire on current considerations in implant selection, discussed a summary of their responses in a live meeting, and completed a final consensus survey based on their live recommendations. RESULTS: Seven panelists completed the final consensus survey. Consensus recommendations included ensuring consideration of proper surgical technique (pocket formation, positioning of implant) and patient tissue and anatomical characteristics, weighing relative expected results of various surface textures, sizes, and degrees of cohesivity, and careful contemplation of the migration risk. CONCLUSIONS: This modified Delphi exercise provided consensus recommendations on the key factors involved in implant selection from the perspective of plastic surgeons with practices in Australia and New Zealand. A primary recommendation was that the choice of implant for each patient should be individualized to patient tissue and anatomical characteristics.

Published
2019

47. Comparison of In Vivo Tissue Temperature Profile and Lesion Geometry for Radiofrequency Ablation With High Power-Short Duration and Moderate Power-Moderate Duration: Effects of Thermal Latency and Contact Force on Lesion Formation.

Author

Hiroshi Nakagawa, Atsushi Ikeda, Sharma, Tushar, Govari, Assaf, Ashton, John, Maffre, Jennifer, Lifshitz, Alexander, Fuimaono, Kristine, Katsuaki Yokoyama, Wittkampf, Fred H. M., Jackman, Warren M., Nakagawa, Hiroshi, Ikeda, Atsushi, and Yokoyama, Katsuaki

Subjects
ATRIAL fibrillation diagnosis, BIOLOGICAL models, RESEARCH, MYOCARDIUM, BODY temperature, ANIMAL experimentation, RESEARCH methodology, ATRIAL fibrillation, EVALUATION research, COMPARATIVE studies, HEART atrium, DOGS
Abstract

[Figure: see text]. [ABSTRACT FROM AUTHOR]

Published
2021
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50. Variation in the Anatomy of the Normal Human Optic Chiasm: An MRI Study.

Author

Bosler, Nicholas S. I., Ashton, David, Neely, Andrew J., and Lueck, Christian J.

Abstract

Background: Compression of the optic chiasm typically leads to bitemporal hemianopia. This implies that decussating nasal fibers are selectively affected, but the precise mechanism is unclear. Stress on nasal fibers has been investigated using finite element modeling but requires accurate anatomical data to generate a meaningful output. The precise shape of the chiasm is unclear: A recent photomicrographic study suggested that nasal fibers decussate paracentrally and run parallel to each other in the central arm of an "H." This study aimed to determine the population variation in chiasmal shape to inform future models. Methods: Sequential MRI scans of 68 healthy individuals were selected. 2D images of each chiasm were created and analyzed to determine the angle of elevation of the chiasm, the width of the chiasm, and the offset between the points of intersection of lines drawn down the centers of the optic nerves and contralateral optic tracts. Results: The mean width of the chiasm was 12.0 ± 1.5 mm (SD), and the mean offset was 4.7 ± 1.4 mm generating a mean offset:width ratio of 0.38 ± 0.09. No chiasm had an offset of zero. The mean incident angle of optic nerves was 56 ± 7°, and for optic tracts, it was 51 ± 7°. Conclusions: The human optic chiasm is "H" shaped, not "X" shaped. The findings are consistent with nasal fibers decussating an average of 2.4 mm lateral to the midline before travelling in parallel across the midline. This information will inform future models of chiasmal compression. [ABSTRACT FROM AUTHOR]

Published
2021
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