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1. Initiatives for promoting educator wellbeing: a Delphi study

Author

Patrick P, Reupert A, Berger E, Morris Z, Diamond Z, Hammer M, Hine R, and Fathers C

Subjects
Educator wellbeing, wellbeing initiatives, Delphi technique, Collegial relationships, Leadership, Intervention design, Psychology, BF1-990
Abstract

Abstract Background Growing demands on educators have resulted in increased levels of burnout and stress and decreasing wellbeing. This study aimed to establish expert consensus on the key characteristics required in prospective educator wellbeing initiatives. Methods The Delphi approach is a process of forecasting that is based on the aggregated opinion of panel members (or experts) within a field of study. Using a Delphi approach, academic and practitioner expertise were sought over a two-rounds, with 17 and 14 participants in each round respectively. The study aimed to identify how systemic factors (e.g., leadership) could be utilised to promote educator wellbeing. The study also sought expert consensus on enablers and barriers for engagement in educator wellbeing initiatives. Results Findings highlighted the importance of fostering positive relationships with colleagues, communities and families, and the active role of wellbeing teams to promote wellbeing initiatives. The need for leaders to address their own wellbeing and build trust within teams was also identified. Panel members identified the need for prospective funding to prioritise wellbeing initiatives. There was also a preference for ongoing initiatives rather than stand-alone wellbeing events that conveyed the ongoing importance of managing one’s wellbeing. Conclusions This paper presents practical recommendations that can be used to inform the development and evaluation of future initiatives and policy. Applying the consensus derived from this study is likely to make wellbeing initiatives more viable and facilitate uptake amongst educators.

Published
2024
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2. Initial Results of a Phase II Trial of Hypofractionated Radiation Therapy for Inoperable Soft Tissue Sarcoma

Author

Eckelmann, B.J., primary, Blitzer, G.C., additional, Smilowitz, J.B., additional, Trask, D., additional, Weiss, M., additional, Weber, S., additional, Abbott, D., additional, Varley, P., additional, Neuman, H., additional, Maloney, J.D., additional, Hinshaw, J.L., additional, Morris, B.A., additional, Merfeld, E., additional, Howard, S.P., additional, Bradley, K.A., additional, Baschnagel, A.M., additional, Bassetti, M.F., additional, Hennessey, D.W., additional, and Morris, Z., additional

Published
2023
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3. Genomics of perivascular space burden unravels early mechanisms of cerebral small vessel disease.

Author

Duperron, M-G, Knol, MJ, Le Grand, Q, Evans, TE, Mishra, A, Tsuchida, A, Roshchupkin, G, Konuma, T, Trégouët, D-A, Romero, JR, Frenzel, S, Luciano, M, Hofer, E, Bourgey, M, Dueker, ND, Delgado, P, Hilal, S, Tankard, RM, Dubost, F, Shin, J, Saba, Y, Armstrong, NJ, Bordes, C, Bastin, ME, Beiser, A, Brodaty, H, Bülow, R, Carrera, C, Chen, C, Cheng, C-Y, Deary, IJ, Gampawar, PG, Himali, JJ, Jiang, J, Kawaguchi, T, Li, S, Macalli, M, Marquis, P, Morris, Z, Muñoz Maniega, S, Miyamoto, S, Okawa, M, Paradise, M, Parva, P, Rundek, T, Sargurupremraj, M, Schilling, S, Setoh, K, Soukarieh, O, Tabara, Y, Teumer, A, Thalamuthu, A, Trollor, JN, Valdés Hernández, MC, Vernooij, MW, Völker, U, Wittfeld, K, Wong, TY, Wright, MJ, Zhang, J, Zhao, W, Zhu, Y-C, Schmidt, H, Sachdev, PS, Wen, W, Yoshida, K, Joutel, A, Satizabal, CL, Sacco, RL, Bourque, G, CHARGE consortium, Lathrop, M, Paus, T, Fernandez-Cadenas, I, Yang, Q, Mazoyer, B, Boutinaud, P, Okada, Y, Grabe, HJ, Mather, KA, Schmidt, R, Joliot, M, Ikram, MA, Matsuda, F, Tzourio, C, Wardlaw, JM, Seshadri, S, Adams, HHH, Debette, S, Duperron, M-G, Knol, MJ, Le Grand, Q, Evans, TE, Mishra, A, Tsuchida, A, Roshchupkin, G, Konuma, T, Trégouët, D-A, Romero, JR, Frenzel, S, Luciano, M, Hofer, E, Bourgey, M, Dueker, ND, Delgado, P, Hilal, S, Tankard, RM, Dubost, F, Shin, J, Saba, Y, Armstrong, NJ, Bordes, C, Bastin, ME, Beiser, A, Brodaty, H, Bülow, R, Carrera, C, Chen, C, Cheng, C-Y, Deary, IJ, Gampawar, PG, Himali, JJ, Jiang, J, Kawaguchi, T, Li, S, Macalli, M, Marquis, P, Morris, Z, Muñoz Maniega, S, Miyamoto, S, Okawa, M, Paradise, M, Parva, P, Rundek, T, Sargurupremraj, M, Schilling, S, Setoh, K, Soukarieh, O, Tabara, Y, Teumer, A, Thalamuthu, A, Trollor, JN, Valdés Hernández, MC, Vernooij, MW, Völker, U, Wittfeld, K, Wong, TY, Wright, MJ, Zhang, J, Zhao, W, Zhu, Y-C, Schmidt, H, Sachdev, PS, Wen, W, Yoshida, K, Joutel, A, Satizabal, CL, Sacco, RL, Bourque, G, CHARGE consortium, Lathrop, M, Paus, T, Fernandez-Cadenas, I, Yang, Q, Mazoyer, B, Boutinaud, P, Okada, Y, Grabe, HJ, Mather, KA, Schmidt, R, Joliot, M, Ikram, MA, Matsuda, F, Tzourio, C, Wardlaw, JM, Seshadri, S, Adams, HHH, and Debette, S

Abstract

Perivascular space (PVS) burden is an emerging, poorly understood, magnetic resonance imaging marker of cerebral small vessel disease, a leading cause of stroke and dementia. Genome-wide association studies in up to 40,095 participants (18 population-based cohorts, 66.3 ± 8.6 yr, 96.9% European ancestry) revealed 24 genome-wide significant PVS risk loci, mainly in the white matter. These were associated with white matter PVS already in young adults (N = 1,748; 22.1 ± 2.3 yr) and were enriched in early-onset leukodystrophy genes and genes expressed in fetal brain endothelial cells, suggesting early-life mechanisms. In total, 53% of white matter PVS risk loci showed nominally significant associations (27% after multiple-testing correction) in a Japanese population-based cohort (N = 2,862; 68.3 ± 5.3 yr). Mendelian randomization supported causal associations of high blood pressure with basal ganglia and hippocampal PVS, and of basal ganglia PVS and hippocampal PVS with stroke, accounting for blood pressure. Our findings provide insight into the biology of PVS and cerebral small vessel disease, pointing to pathways involving extracellular matrix, membrane transport and developmental processes, and the potential for genetically informed prioritization of drug targets.

Published
2023

8. Integrated Child and Family Hub models for detecting and responding to family adversity: protocol for a mixed-methods evaluation in two sites

Author

Hall, T, Goldfeld, S, Loftus, H, Honisett, S, Liu, H, De Souza, D, Bailey, C, Reupert, A, Yap, MBH, Eapen, V, Haslam, R, Sanci, L, Fisher, J, Eastwood, J, Mukumbang, FC, Loveday, S, Jones, R, Constable, L, Forell, S, Morris, Z, Montgomery, A, Pringle, G, Dalziel, K, Hiscock, H, Hall, T, Goldfeld, S, Loftus, H, Honisett, S, Liu, H, De Souza, D, Bailey, C, Reupert, A, Yap, MBH, Eapen, V, Haslam, R, Sanci, L, Fisher, J, Eastwood, J, Mukumbang, FC, Loveday, S, Jones, R, Constable, L, Forell, S, Morris, Z, Montgomery, A, Pringle, G, Dalziel, K, and Hiscock, H

Abstract

INTRODUCTION: Integrated community healthcare Hubs may offer a 'one stop shop' for service users with complex health and social needs, and more efficiently use service resources. Various policy imperatives exist to implement Hub models of care, however, there is a dearth of research specifically evaluating Hubs targeted at families experiencing adversity. To contribute to building this evidence, we propose to co-design, test and evaluate integrated Hub models of care in two Australian community health services in low socioeconomic areas that serve families experiencing adversity: Wyndham Vale in Victoria and Marrickville in New South Wales. METHODS AND ANALYSIS: This multisite convergent mixed-methods study will run over three phases to (1) develop the initial Hub programme theory through formative research; (2) test and, then, (3) refine the Hub theory using empirical data. Phase 1 involves co-design of each Hub with caregivers, community members and practitioners. Phase 2 uses caregiver and Hub practitioner surveys at baseline, and 6 and 12 months after Hub implementation, and in-depth interviews at 12 months. Two stakeholder groups will be recruited: caregivers (n=100-200 per site) and Hub practitioners (n=20-30 per site). The intervention is a co-located Hub providing health, social, legal and community services with no comparator. The primary outcomes are caregiver-reported: (i) identification of, (ii) interventions received and/or (iii) referrals received for adversity from Hub practitioners. The study also assesses child, caregiver, practitioner and system outcomes including mental health, parenting, quality of life, care experience and service linkages. Primary and secondary outcomes will be assessed by examining change in proportions/means from baseline to 6 months, from 6 to 12 months and from baseline to 12 months. Service linkages will be analysed using social network analysis. Costs of Hub implementation and a health economics analysis of unmet need wil

Published
2022

11. Association of common genetic variants with brain microbleeds

Author

Knol, M.J., Lu, D.W., Traylor, M., Adams, H.H.H., Romero, J.R.J., Smith, A.V., Fornage, M., Hofer, E., Liu, J.F., Hostettler, I.C., Luciano, M., Trompet, S., Giese, A.K., Hilal, S., Akker, E.B. van den, Vojinovic, D., Li, S., Sigurdsson, S., Lee, S.J. van der, Jack, C.R., Wilson, D., Yilmaz, P., Satizabal, C.L., Liewald, D.C.M., Grond, J. van der, Chen, C., Saba, Y., Lugt, A. van der, Bastin, M.E., Windham, B.G., Cheng, C.Y., Pirpamer, L., Kantarci, K., Himali, J.J., Yang, Q., Morris, Z., Beiser, A.S., Tozer, D.J., Vernooij, M.W., Amin, N., Beekman, M., Koh, J.Y., Stott, D.J., Houlden, H., Schmidt, R., Gottesman, R.F., MacKinnon, A.D., DeCarli, C., Gudnason, V., Deary, I.J., Duijn, C.M. van, Slagboom, P.E., Wong, T.Y., Rost, N.S., Jukema, J.W., Mosley, T.H., Werring, D.J., Schmidt, H., Wardlaw, J.M., Ikram, M.A., Seshadri, S., Launer, L.J., Markus, H.S., Neurology, Amsterdam Neuroscience - Neurodegeneration, Epidemiology, Neurosciences, Clinical Genetics, and Radiology & Nuclear Medicine

Subjects
0301 basic medicine, medicine.medical_specialty, education.field_of_study, business.industry, Population, Genome-wide association study, Single-nucleotide polymorphism, Odds ratio, Gastroenterology, Hyperintensity, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Internal medicine, Genetic predisposition, medicine, Neurology (clinical), Allele, business, education, 030217 neurology & neurosurgery, Genetic association
Abstract

ObjectiveTo identify common genetic variants associated with the presence of brain microbleeds (BMBs).MethodsWe performed genome-wide association studies in 11 population-based cohort studies and 3 case–control or case-only stroke cohorts. Genotypes were imputed to the Haplotype Reference Consortium or 1000 Genomes reference panel. BMBs were rated on susceptibility-weighted or T2*-weighted gradient echo MRI sequences, and further classified as lobar or mixed (including strictly deep and infratentorial, possibly with lobar BMB). In a subset, we assessed the effects of APOE ε2 and ε4 alleles on BMB counts. We also related previously identified cerebral small vessel disease variants to BMBs.ResultsBMBs were detected in 3,556 of the 25,862 participants, of which 2,179 were strictly lobar and 1,293 mixed. One locus in the APOE region reached genome-wide significance for its association with BMB (lead single nucleotide polymorphism rs769449; odds ratio [OR]any BMB [95% confidence interval (CI)] 1.33 [1.21–1.45]; p = 2.5 × 10−10). APOE ε4 alleles were associated with strictly lobar (OR [95% CI] 1.34 [1.19–1.50]; p = 1.0 × 10−6) but not with mixed BMB counts (OR [95% CI] 1.04 [0.86–1.25]; p = 0.68). APOE ε2 alleles did not show associations with BMB counts. Variants previously related to deep intracerebral hemorrhage and lacunar stroke, and a risk score of cerebral white matter hyperintensity variants, were associated with BMB.ConclusionsGenetic variants in the APOE region are associated with the presence of BMB, most likely due to the APOE ε4 allele count related to a higher number of strictly lobar BMBs. Genetic predisposition to small vessel disease confers risk of BMB, indicating genetic overlap with other cerebral small vessel disease markers.

Published
2020

12. Association of common genetic variants with brain microbleeds: A genome-wide association study

Author

Knol, M.J. (Maria J.), Lu, D. (Dongwei), Traylor, M. (Matthew), Adams, H.H.H. (Hieab), Romero, J.R.J. (José Rafael J), Smith, A.V. (Albert), Fornage, M. (Myriam), Hofer, E. (Edith), Liu, J. (Junfeng), Hostettler, I.C. (Isabel C.), Luciano, M. (Michelle), Trompet, S. (Stella), Giese, A.-K. (Anne-Katrin), Hilal, S. (Saima), Akker, E.B. (Erik) van den, Vojinović, D. (Dina), Li, S. (Shuo), Sigurdsson, S. (Stefan), Lee, S.J. (Sven) van der, Jack Jr., C.R. (Clifford), Wilson, D. (Duncan), Yilmaz, P. (Pinar), Satizabal, C.L. (Claudia), Liewald, D.C.M. (David C M), van der Grond, J. (Jeroen), Chen, C. (Christopher), Saba, Y. (Yasaman), Lugt, A. (Aad) van der, Bastin, M.E. (Mark), Windham, B.G. (Gwen), Cheng, C.Y. (Ching Yu), Pirpamer, L. (Lukas), Kantarci, K. (Kejal), Himali, J.J. (Jayandra), Yang, Q. (Qiong), Morris, Z. (Zoe), Beiser, A. (Alexa), Tozer, D.J. (Daniel J.), Vernooij, M.W. (Meike), Amin, N. (Najaf), Beekman, M. (Marian), Koh, J.Y. (Jia Yu), Stott, D.J. (David. J.), Houlden, H. (Henry), Schmidt, R. (Reinhold), Gottesman, R.F. (Rebecca), MacKinnon, A.D. (Andrew D.), DeCarli, C. (Charles), Gudnason, V. (Vilmundur), Deary, I.J. (Ian), Duijn, C.M. (Cornelia) van, Slagboom, P.E. (Eline), Wong, T.Y. (Tien Yin), Rost, N.S. (Natalia), Jukema, J.W. (Jan Wouter), Mosley, T.H. (Thomas H.), Werring, D.J. (David), Schmidt, H. (Helena), Wardlaw, J.M. (J.), Ikram, M.A. (Arfan), Seshadri, S. (Sudha), Launer, L.J. (Lenore), Markus, H.S. (Hugh), Knol, M.J. (Maria J.), Lu, D. (Dongwei), Traylor, M. (Matthew), Adams, H.H.H. (Hieab), Romero, J.R.J. (José Rafael J), Smith, A.V. (Albert), Fornage, M. (Myriam), Hofer, E. (Edith), Liu, J. (Junfeng), Hostettler, I.C. (Isabel C.), Luciano, M. (Michelle), Trompet, S. (Stella), Giese, A.-K. (Anne-Katrin), Hilal, S. (Saima), Akker, E.B. (Erik) van den, Vojinović, D. (Dina), Li, S. (Shuo), Sigurdsson, S. (Stefan), Lee, S.J. (Sven) van der, Jack Jr., C.R. (Clifford), Wilson, D. (Duncan), Yilmaz, P. (Pinar), Satizabal, C.L. (Claudia), Liewald, D.C.M. (David C M), van der Grond, J. (Jeroen), Chen, C. (Christopher), Saba, Y. (Yasaman), Lugt, A. (Aad) van der, Bastin, M.E. (Mark), Windham, B.G. (Gwen), Cheng, C.Y. (Ching Yu), Pirpamer, L. (Lukas), Kantarci, K. (Kejal), Himali, J.J. (Jayandra), Yang, Q. (Qiong), Morris, Z. (Zoe), Beiser, A. (Alexa), Tozer, D.J. (Daniel J.), Vernooij, M.W. (Meike), Amin, N. (Najaf), Beekman, M. (Marian), Koh, J.Y. (Jia Yu), Stott, D.J. (David. J.), Houlden, H. (Henry), Schmidt, R. (Reinhold), Gottesman, R.F. (Rebecca), MacKinnon, A.D. (Andrew D.), DeCarli, C. (Charles), Gudnason, V. (Vilmundur), Deary, I.J. (Ian), Duijn, C.M. (Cornelia) van, Slagboom, P.E. (Eline), Wong, T.Y. (Tien Yin), Rost, N.S. (Natalia), Jukema, J.W. (Jan Wouter), Mosley, T.H. (Thomas H.), Werring, D.J. (David), Schmidt, H. (Helena), Wardlaw, J.M. (J.), Ikram, M.A. (Arfan), Seshadri, S. (Sudha), Launer, L.J. (Lenore), and Markus, H.S. (Hugh)

Abstract

OBJECTIVE: To identify common genetic variants associated with the presence of brain microbleeds (BMBs). METHODS: We performed genom

Published
2020
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13. Common genetic variation indicates separate causes for periventricular and deep white matter hyperintensities

Author

Armstrong, N.J., Mather, K.A., Sargurupremraj, M., Knol, M.J., Malik, R., Satizabal, C.L., Yanek, L.R., Wen, W., Gudnason, V.G., Dueker, N.D., Elliott, L.T., Hofer, E., Bis, J., Jahanshad, N., Li, S., Logue, M.A., Luciano, M., Scholz, M., Smith, A.V., Trompet, S., Vojinovic, D., Xia, R., Alfaro-Almagro, F., Ames, D., Amin, N., Amouyel, P., Beiser, A.S., Brodaty, H., Deary, I.J., Fennema-Notestine, C., Gampawar, P.G., Gottesman, R., Griffanti, L., Jack, C.R., Jenkinson, M., Jiang, J., Kral, B.G., Kwok, J.B., Lampe, L., Liewald, D.C.M., Maillard, P., Marchini, J., Bastin, M.E., Mazoyer, B., Pirpamer, L., Romero, J.R., Roshchupkin, G.V., Schofield, P.R., Schroeter, M.L., Stott, D.J., Thalamuthu, A., Trollor, J., Tzourio, C., Van der Grond, J., Vernooij, M.W., Witte, V.A., Wright, M.J., Yang, Q., Morris, Z., Siggurdsson, S., Psaty, B.M., Villringer, A., Schmidt, H., Håberg, A.K., van Duijn, C.M., Jukema, J.W., Dichgans, M., Sacco, R.L., Wright, C.B., Kremen, W.S., Becker, L.C., Thompson, P.M., Mosley, T.H., Wardlaw, J.M., Ikram, M.A., Adams, H.H.H., Seshadri, S., Sachdev, P.S., Smith, S.M., Launer, L., Longstreth, W.T., DeCarli, C., Schmidt, R., Fornage, M., Debette, S., Nyquist, P.A., Armstrong, N.J., Mather, K.A., Sargurupremraj, M., Knol, M.J., Malik, R., Satizabal, C.L., Yanek, L.R., Wen, W., Gudnason, V.G., Dueker, N.D., Elliott, L.T., Hofer, E., Bis, J., Jahanshad, N., Li, S., Logue, M.A., Luciano, M., Scholz, M., Smith, A.V., Trompet, S., Vojinovic, D., Xia, R., Alfaro-Almagro, F., Ames, D., Amin, N., Amouyel, P., Beiser, A.S., Brodaty, H., Deary, I.J., Fennema-Notestine, C., Gampawar, P.G., Gottesman, R., Griffanti, L., Jack, C.R., Jenkinson, M., Jiang, J., Kral, B.G., Kwok, J.B., Lampe, L., Liewald, D.C.M., Maillard, P., Marchini, J., Bastin, M.E., Mazoyer, B., Pirpamer, L., Romero, J.R., Roshchupkin, G.V., Schofield, P.R., Schroeter, M.L., Stott, D.J., Thalamuthu, A., Trollor, J., Tzourio, C., Van der Grond, J., Vernooij, M.W., Witte, V.A., Wright, M.J., Yang, Q., Morris, Z., Siggurdsson, S., Psaty, B.M., Villringer, A., Schmidt, H., Håberg, A.K., van Duijn, C.M., Jukema, J.W., Dichgans, M., Sacco, R.L., Wright, C.B., Kremen, W.S., Becker, L.C., Thompson, P.M., Mosley, T.H., Wardlaw, J.M., Ikram, M.A., Adams, H.H.H., Seshadri, S., Sachdev, P.S., Smith, S.M., Launer, L., Longstreth, W.T., DeCarli, C., Schmidt, R., Fornage, M., Debette, S., and Nyquist, P.A.

Abstract

Background and Purpose: Periventricular white matter hyperintensities (WMH; PVWMH) and deep WMH (DWMH) are regional classifications of WMH and reflect proposed differences in cause. In the first study, to date, we undertook genome-wide association analyses of DWMH and PVWMH to show that these phenotypes have different genetic underpinnings. Methods: Participants were aged 45 years and older, free of stroke and dementia. We conducted genome-wide association analyses of PVWMH and DWMH in 26,654 participants from CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology), ENIGMA (Enhancing Neuro-Imaging Genetics Through Meta-Analysis), and the UKB (UK Biobank). Regional correlations were investigated using the genome-wide association analyses -pairwise method. Cross-trait genetic correlations between PVWMH, DWMH, stroke, and dementia were estimated using LDSC. Results: In the discovery and replication analysis, for PVWMH only, we found associations on chromosomes 2 (NBEAL), 10q23.1 (TSPAN14/FAM231A), and 10q24.33 (SH3PXD2A). In the much larger combined meta-analysis of all cohorts, we identified ten significant regions for PVWMH: chromosomes 2 (3 regions), 6, 7, 10 (2 regions), 13, 16, and 17q23.1. New loci of interest include 7q36.1 (NOS3) and 16q24.2. In both the discovery/replication and combined analysis, we found genome-wide significant associations for the 17q25.1 locus for both DWMH and PVWMH. Using gene-based association analysis, 19 genes across all regions were identified for PVWMH only, including the new genes: CALCRL (2q32.1), KLHL24 (3q27.1), VCAN (5q27.1), and POLR2F (22q13.1). Thirteen genes in the 17q25.1 locus were significant for both phenotypes. More extensive genetic correlations were observed for PVWMH with small vessel ischemic stroke. There were no associations with dementia for either phenotype. Conclusions: Our study confirms these phenotypes have distinct and also shared genetic architectures. Genetic analyses indicated PVWMH was mo

Published
2020

14. Association of common genetic variants with brain microbleeds: A genome-wide association study

Author

Knol, Maria, Lu, Difei, Traylor, M, Adams, Hieab, Romero, JR, Smith, AV, Fornage, M, Hofer, E, Liu, Jun, Hostettler, IC, Luciano, M, Trompet, S, Giese, A K, Hilal, S, van den Akker, EB, Vojinovic, Dina, Li, S, Sigurdsson, S, van der Lee, Sven, Jack, CR, Wilson, D, Yilmaz, Pinar, Satizabal, CL, Liewald, DCM, van der Grond, J, Chen, C, Saba, Y, van der Lugt, Aad, Bastin, ME, Windham, BG, Cheng, CY (Ching-Yu), Pirpamer, L, Kantarci, K, Himali, JJ, Yang, Q, Morris, Z, Beiser, AS, Tozer, DJ, Vernooij, Meike, Amin, Najaf, Beekman, M, Koh, JY, Stott, DJM, Houlden, H, Schmidt, R, Gottesman, RF, MacKinnon, AD, DeCarli, C, Gudnason, V, Deary, IJ, Duijn, Cornelia, Slagboom, PE, Wong, TY, Rost, NS, Jukema, JW, Mosley, TH, Jr, Werring, DJ, Schmidt, H, Wardlaw, JM, Ikram, Arfan, Seshadri, S, Launer, LJ, Markus, HS, Knol, Maria, Lu, Difei, Traylor, M, Adams, Hieab, Romero, JR, Smith, AV, Fornage, M, Hofer, E, Liu, Jun, Hostettler, IC, Luciano, M, Trompet, S, Giese, A K, Hilal, S, van den Akker, EB, Vojinovic, Dina, Li, S, Sigurdsson, S, van der Lee, Sven, Jack, CR, Wilson, D, Yilmaz, Pinar, Satizabal, CL, Liewald, DCM, van der Grond, J, Chen, C, Saba, Y, van der Lugt, Aad, Bastin, ME, Windham, BG, Cheng, CY (Ching-Yu), Pirpamer, L, Kantarci, K, Himali, JJ, Yang, Q, Morris, Z, Beiser, AS, Tozer, DJ, Vernooij, Meike, Amin, Najaf, Beekman, M, Koh, JY, Stott, DJM, Houlden, H, Schmidt, R, Gottesman, RF, MacKinnon, AD, DeCarli, C, Gudnason, V, Deary, IJ, Duijn, Cornelia, Slagboom, PE, Wong, TY, Rost, NS, Jukema, JW, Mosley, TH, Jr, Werring, DJ, Schmidt, H, Wardlaw, JM, Ikram, Arfan, Seshadri, S, Launer, LJ, and Markus, HS

Published
2020

19. Effect of IV alteplase on the ischemic brain lesion at 24-48 hours after ischemic stroke

Author

Mair, G, Von Kummer, R, Morris, Z, Von Heijne, A, Bradey, N, Cala, L, Peeters, Anna, Farrall, A J, Adami, A, Potter, G, Sandercock, P A G, Lindley, R I, Wardlaw, J M, Mair, G, Von Kummer, R, Morris, Z, Von Heijne, A, Bradey, N, Cala, L, Peeters, Anna, Farrall, A J, Adami, A, Potter, G, Sandercock, P A G, Lindley, R I, and Wardlaw, J M

Abstract

Objective To determine whether alteplase alters the development of ischemic lesions on brain imaging after stroke. Methods The Third International Stroke Trial (IST-3) was a randomized controlled trial of IV alteplase for ischemic stroke. We assessed CT or brain MRI at baseline (pretreatment) and 24 to 48 hours posttreatment for acute lesion visibility, extent, and swelling, masked to all other data. We analyzed associations between treatment allocation, change in brain tissue appearances between baseline and follow-up imaging, and 6-month functional outcome in IST-3. We performed a meta-analysis of randomized trials of alteplase vs control with pre- and post-randomization imaging. Results Of 3,035 patients recruited in IST-3, 2,916 had baseline and follow-up brain imaging. Progression in either lesion extent or swelling independently predicted poorer 6-month outcome (adjusted odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.88-0.96, p < 0.001; OR = 0.73, 95% CI 0.66-0.79, p < 0.001, respectively). Patients allocated alteplase were less likely than controls to develop increased lesion visibility at follow-up (OR = 0.77, 95% CI 0.67-0.89, p < 0.001), but there was no evidence that alteplase reduced progression of lesion extent or swelling. In meta-analysis of 6 trials including IST-3 (n = 4,757), allocation to alteplase was associated with a reduction in ischemic lesion extent on follow-up imaging (OR = 0.85, 95% CI 0.76-0.95, p = 0.004). Conclusion Alteplase was associated with reduced short-term progression in lesion visibility. In meta-analysis, alteplase reduced lesion extent. These findings may indicate that alteplase improves functional outcome by reducing tissue damage. Classification of evidence This study provides Class II evidence that IV alteplase impedes the progression of ischemic brain lesions on imaging after stroke.

Published
2018

20. Metric to quantify white matter damage on brain magnetic resonance images

Author

Valdés Hernández, M.D.C., Chappell, F.M., Muñoz Maniega, S., Dickie, D.A., Royle, N.A., Morris, Z., Anblagan, D., Sakka, E., Armitage, P.A., Bastin, M.E., Deary, I.J., and Wardlaw, J.M.

Subjects
mental disorders, behavioral disciplines and activities
Abstract

PURPOSE: Quantitative assessment of white matter hyperintensities (WMH) on structural Magnetic Resonance Imaging (MRI) is challenging. It is important to harmonise results from different software tools considering not only the volume but also the signal intensity. Here we propose and evaluate a metric of white matter (WM) damage that addresses this need. METHODS: We obtained WMH and normal-appearing white matter (NAWM) volumes from brain structural MRI from community dwelling older individuals and stroke patients enrolled in three different studies, using two automatic methods followed by manual editing by two to four observers blind to each other. We calculated the average intensity values on brain structural fluid-attenuation inversion recovery (FLAIR) MRI for the NAWM and WMH. The white matter damage metric is calculated as the proportion of WMH in brain tissue weighted by the relative image contrast of the WMH-to-NAWM. The new metric was evaluated using tissue microstructure parameters and visual ratings of small vessel disease burden and WMH: Fazekas score for WMH burden and Prins scale for WMH change. RESULTS: The correlation between the WM damage metric and the visual rating scores (Spearman ρ > =0.74, p =0.72, p

Published
2017

21. Bioreactor for mammalian cell culture

Author

Prokop, Ales, Rosenberg, Morris Z., Fiechter, A., editor, Aiba, S., editor, Bungay, H. R., editor, Cooney, Ch. L., editor, Demain, A. L., editor, Fukui, S., editor, Kieslich, K., editor, Klibanov, A. M., editor, Lafferty, R. M., editor, Primrose, S. B., editor, Rehm, H. J., editor, Rogers, P. L., editor, Sahm, H., editor, Schügerl, K., editor, Suzuki, S., editor, Tsao, G. T., editor, Venkat, K., editor, and Winnacker, E. -L., editor

Published
1989
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24. Effect of alteplase on the CT hyperdense artery sign and outcome after ischemic stroke

Author

Mair, G, Von Kummer, R, Morris, Z, Von Heijne, A, Bradey, N, Cala, L, Peeters, Anna, Farrall, A J, Adami, A, Potter, G, Cohen, G, Sandercock, P A G, Lindley, R I, Wardlaw, J M, Mair, G, Von Kummer, R, Morris, Z, Von Heijne, A, Bradey, N, Cala, L, Peeters, Anna, Farrall, A J, Adami, A, Potter, G, Cohen, G, Sandercock, P A G, Lindley, R I, and Wardlaw, J M

Abstract

Objective: To investigate whether the location and extent of the CT hyperdense artery sign (HAS) at presentation affects response to IV alteplase in the randomized controlled Third International Stroke Trial (IST-3). Methods: All prerandomization and follow-up (24-48 hours) CT brain scans in IST-3 were assessed for HAS presence, location, and extent by masked raters. We assessed whether HAS grew, persisted, shrank, or disappeared at follow-up, the association with 6-month functional outcome, and effect of alteplase. IST-3 is registered (ISRCTN25765518). Results: HAS presence (vs absence) independently predicted poor 6-month outcome (increased Oxford Handicap Scale [OHS]) on adjusted ordinal regression analysis (odds ratio [OR] 0.66, p < 0.001). Outcome was worse in patients with more (vs less) extensive HAS (OR 0.61, p 0.027) but not in proximal (vs distal) HAS (p 0.420). Increasing age was associated with more HAS growth at follow-up (OR 1.01, p 0.013). Treatment with alteplase increased HAS shrinkage/disappearance at follow-up (OR 0.77, p 0.006). There was no significant difference in HAS shrinkage with alteplase in proximal (vs distal) or more (vs less) extensive HAS (p 0.516 and p 0.580, respectively). There was no interaction between presence vs absence of HAS and benefit of alteplase on 6-month OHS (p 0.167). Conclusions: IV alteplase promotes measurable reduction in HAS regardless of HAS location or extent. Alteplase increased independence at 6 months in patients with and without HAS. Classification of evidence: This study provides Class I evidence that for patients within 6 hours of ischemic stroke with a CT hyperdense artery sign, IV alteplase reduced intra-arterial hyperdense thrombus.

Published
2016

25. Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third international stroke trial (IST-3): Secondary analysis of a randomised controlled trial

Author

Wardlaw, JM, Sandercock, P, Cohen, G, Farrall, A, Lindley, RI, von Kummer, R, von Heijne, A, Bradey, N, Peeters, Anna, Cala, L, Adami, A, Morris, Z, Potter, G, Murray, G, Whiteley, W, Perry, D, Sakka, E, Wardlaw, JM, Sandercock, P, Cohen, G, Farrall, A, Lindley, RI, von Kummer, R, von Heijne, A, Bradey, N, Peeters, Anna, Cala, L, Adami, A, Morris, Z, Potter, G, Murray, G, Whiteley, W, Perry, D, and Sakka, E

Published
2015

26. Influence of intracerebral hemorrhage location on incidence, characteristics, and outcome

Author

Samarasekera, N., Fonville, A., Lerpiniere, C., Farrall, A.J., Wardlaw, J.M., White, P.M., Smith, C., Al-Shahi Salman, R., Addison, A., Ahmad, K., Alhadad, S., Andrews, P., Bisset, E., Bodkin, P., Bouhaidar, R., Brennan, P., Campbell, B., Chandran, S., Cook, H., Davenport, R., Dennis, M., Derry, C., Dodds, K., Doubal, F., Duncan, S., Elder, A., Fitzpatrick, M., Foley, P., Fouyas, I., Ghosh, S., Gibson, R., Gordon, C., Grant, R., Hewett, R., Hughes, F., Hughes, M., Hunt, D., Hunter, N., Ironside, J., Liaquat, I., Josephson, C., Kamat, A., Kealley, S., Keir, S., Kerr, G., Kerrigan, S., Keston, P., King, M., Knight, R., Macdonald, E., Mackay, G., Macleod, D., Macleod, M., Maguire, C., Makin, S., Mathews, A., Maxwell, F., McClellan, S., Millar, T., Morris, Z., Morse, T., Mumford, C., Murray, K., Myles, L., Nimmo, G., Ng, Y., Pal, S., Rannikmae, K., Rhodes, J., Ross, J., Russell, T., Sandercock, P., Sellar, R., Shanmuganathan, M., Shekhar, H., Simms, H., Sittampalam, M., Soleiman, H., Spiers, H., Statham, P., Stavrinos, N., Stone, J., Stuart, J., Sudlow, C., Summers, D., Taylor, P., Torgersen, A., van Dijke, M., Walker, R., Weller, B., Whiteley, W., Whittle, I., Will, R., Young, W., Anderson, J., Broadbent, S., Butler, L., Caesar, D., Cantley, P., Carter, J., Clegg, G., Coull, A., Crosswaite, A., Dear, J., Dummer, S., Duncan, F., Elder-Gracie, T., Enright, K., Fitzgerald, T., Fothergill, J., Frier, B., Grant, D., Gray, A., Hart, S., Henderson, R., Jaap, A., Leigh-Smith, S., Jones, M., Masson, M., McCallum, L., McKechnie, M., McKillop, G., Mead, G., Morley, W., Morrow, B., Morrow, F., Murchison, J., Murphy, R., Ng, J., Ogundipe, O., Patel, D., Pollock, A., Reed, M., Roberts, G., Selvarajah, J., Smith, R., Stirling, C., Turner, N., Wilson, M., Yordanov, S., Bell, N., Chambers, S., Dewar, S., Farquhar, D., Harmouche, A., Jacob, A., Jackson, K., Knox, A., McCafferty, J., Moultrie, S., Munang, L., Noble, D., Ramsay, S., Spence, L., Threlfall, B., Williams, A., Wilson, J., Fitzgerald, A., Jamieson, A., Lange, P., McIntosh, A., Morrison, L., Todd, I., Samarasekera, N., Fonville, A., Lerpiniere, C., Farrall, A.J., Wardlaw, J.M., White, P.M., Smith, C., Al-Shahi Salman, R., Addison, A., Ahmad, K., Alhadad, S., Andrews, P., Bisset, E., Bodkin, P., Bouhaidar, R., Brennan, P., Campbell, B., Chandran, S., Cook, H., Davenport, R., Dennis, M., Derry, C., Dodds, K., Doubal, F., Duncan, S., Elder, A., Fitzpatrick, M., Foley, P., Fouyas, I., Ghosh, S., Gibson, R., Gordon, C., Grant, R., Hewett, R., Hughes, F., Hughes, M., Hunt, D., Hunter, N., Ironside, J., Liaquat, I., Josephson, C., Kamat, A., Kealley, S., Keir, S., Kerr, G., Kerrigan, S., Keston, P., King, M., Knight, R., Macdonald, E., Mackay, G., Macleod, D., Macleod, M., Maguire, C., Makin, S., Mathews, A., Maxwell, F., McClellan, S., Millar, T., Morris, Z., Morse, T., Mumford, C., Murray, K., Myles, L., Nimmo, G., Ng, Y., Pal, S., Rannikmae, K., Rhodes, J., Ross, J., Russell, T., Sandercock, P., Sellar, R., Shanmuganathan, M., Shekhar, H., Simms, H., Sittampalam, M., Soleiman, H., Spiers, H., Statham, P., Stavrinos, N., Stone, J., Stuart, J., Sudlow, C., Summers, D., Taylor, P., Torgersen, A., van Dijke, M., Walker, R., Weller, B., Whiteley, W., Whittle, I., Will, R., Young, W., Anderson, J., Broadbent, S., Butler, L., Caesar, D., Cantley, P., Carter, J., Clegg, G., Coull, A., Crosswaite, A., Dear, J., Dummer, S., Duncan, F., Elder-Gracie, T., Enright, K., Fitzgerald, T., Fothergill, J., Frier, B., Grant, D., Gray, A., Hart, S., Henderson, R., Jaap, A., Leigh-Smith, S., Jones, M., Masson, M., McCallum, L., McKechnie, M., McKillop, G., Mead, G., Morley, W., Morrow, B., Morrow, F., Murchison, J., Murphy, R., Ng, J., Ogundipe, O., Patel, D., Pollock, A., Reed, M., Roberts, G., Selvarajah, J., Smith, R., Stirling, C., Turner, N., Wilson, M., Yordanov, S., Bell, N., Chambers, S., Dewar, S., Farquhar, D., Harmouche, A., Jacob, A., Jackson, K., Knox, A., McCafferty, J., Moultrie, S., Munang, L., Noble, D., Ramsay, S., Spence, L., Threlfall, B., Williams, A., Wilson, J., Fitzgerald, A., Jamieson, A., Lange, P., McIntosh, A., Morrison, L., and Todd, I.

Abstract

Background and Purpose— The characteristics of intracerebral hemorrhage (ICH) may vary by ICH location because of differences in the distribution of underlying cerebral small vessel diseases. Therefore, we investigated the incidence, characteristics, and outcome of lobar and nonlobar ICH. Methods— In a population-based, prospective inception cohort study of ICH, we used multiple overlapping sources of case ascertainment and follow-up to identify and validate ICH diagnoses in 2010 to 2011 in an adult population of 695 335. Results— There were 128 participants with first-ever primary ICH. The overall incidence of lobar ICH was similar to nonlobar ICH (9.8 [95% confidence interval, 7.7–12.4] versus 8.6 [95% confidence interval, 6.7–11.1] per 100 000 adults/y). At baseline, adults with lobar ICH were more likely to have preceding dementia (21% versus 5%; P=0.01), lower Glasgow Coma Scale scores (median, 13 versus 14; P=0.03), larger ICHs (median, 38 versus 11 mL; P<0.001), subarachnoid extension (57% versus 5%; P<0.001), and subdural extension (15% versus 3%; P=0.02) than those with nonlobar ICH. One-year case fatality was lower after lobar ICH than after nonlobar ICH (adjusted odds ratio for death at 1 year: lobar versus nonlobar ICH 0.21; 95% confidence interval, 0.07–0.63; P=0.006, after adjustment for known predictors of outcome). There were 4 recurrent ICHs, which occurred exclusively in survivors of lobar ICH (annual risk of recurrent ICH after lobar ICH, 11.8%; 95% confidence interval, 4.6%–28.5% versus 0% after nonlobar ICH; log-rank P=0.04). Conclusions— The baseline characteristics and outcome of lobar ICH differ from other locations.

Published
2015

27. Effect of fluid shear forces on plant cell suspensions

Author

Pradyumna K. Namdev, Eric H. Dunlop, and Morris Z. Rosenberg

Subjects
Lysis, Chemistry, Applied Mathematics, General Chemical Engineering, Shear force, Laminar flow, Fluid mechanics, General Chemistry, Chemostat, Mechanics, Industrial and Manufacturing Engineering, Flow conditions, Shear stress, Bioreactor
Abstract

The sensitivity of plant cell culture to fluid forces, or fluid-mechanical sensitivity, in a stirred bioreactor is evaluated by shearing the cells in viscometers for short duration under a range of laminar and turbulent conditions. This short-term evaluation is compared with the experiments in a stirred bioreactor under chemostat mode at various agitation speeds. Fluid-mechanical sensitivity was quantified by measuring various biological parameters including regrowth ability, membrane integrity, mitochondrial activity, aggregate size and lysis. A critical hydrodynamic variable was derived based on a model whereby the biological activity of cells after a given period in a defined shearing environment was a cumulative effect of the total work done by fluid forces on the cells. This hydrodynamic variable, calculated as total energy dissipation on cells per unit volume, was used as a common basis to quantify the agitation-based shear forces under laminar and turbulent flow conditions. Fluid-mechanical sensitivity data for plant cell suspensions under different flow conditions was successfully correlated with this hydrodynamic variable. This correlation established a hierarchy of response, ranging from a subtle biological inhibitory effect on regrowth ability or sublytic effect, to the gross physical effect of aggregate breakup and lysis. Inhibition of growth rather than lysis was found to dictate the performance of plant cell culture in the bioreactor.

Published
1994

28. Influence of Cultivation Conditions on Glycosylation Pattern-a Fed-Batch and Continuous Culture Study

Author

Rebecca L. Dabora, Morris Z. Rosenberg, and Natascha A. Schill

Subjects
Glycosylation, Golgi apparatus, Fusion protein, Sialic acid, law.invention, carbohydrates (lipids), symbols.namesake, chemistry.chemical_compound, chemistry, Biochemistry, law, Cell culture, symbols, Recombinant DNA, lipids (amino acids, peptides, and proteins), Glycoside hydrolase, Intracellular
Abstract

This project focused on the relationship between cultivation conditions and glycosylation pattern of a recombinant fusion protein produced by a CHO derived cell line. During the investigation it was found that the glycosylation pattern changed during fed-batch cultivation: sialic acid content and antennary complexity increased with cultivation time although ammonium concentration and most likely glycosidase activities — two factors which reportedly can decrease sialic acid concentration-increased simultaneously. Continuous cultures were performed to identify which environmental and kinetic variables impact the glycosylation process. A change in glycosylation pattern was only found when the specific productivity during a continuous culture was increased transiently by an increase in ferric citrate concentration. This indicated that it is a kinetic variable which influences the glycosylation of the studied fusion protein. Further experiments focused on the glycosylation of intracellular fusion protein and support the hypothesis that specific productivity, or rather the residence time of the protein in the Golgi apparatus, is crucial to the extent of glycosylation. Notably, concentration, molecular weight, and sialic acid content of the fusion protein increased with cultivation time, suggesting that a prolonged residence time in the Golgi apparatus leads to more complete glycosylation.

Published
2006

32. A role for clinical audit and peer review in the identification of continuing professional development needs for general dental practitioners: a discussion.

Author

Bullock, A., Butterfield, S., Belfield, C., Morris, Z., Ribbins, P., Frame, J., Bullock, A D, Belfield, C R, Morris, Z S, Ribbins, P M, and Frame, J W

Subjects
DENTISTS, PROFESSIONAL peer review, MEDICAL audit, CONTINUING education
Abstract

The purpose of this paper is to discuss how the role of peer review and clinical audit may be used in the identification of the continuing professional development (CPD) needs of general dental practitioners (GDPs). Clinical audit and peer review are intrinsically valuable in terms of the continued professional development of GDPs. Collaborative clinical audit, in particular, can provide a framework for short course input and there are particular benefits to this combination of activities which might usefully be more widely encouraged. If open to analysis in a way which retains individual anonymity, peer review and clinical audit resumes, these could be used to inform the provision of CPD and, linked to the knowledge of audit facilitators, short courses might more closely match the CPD needs of local dentists. [ABSTRACT FROM AUTHOR]

Published
2000
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34. CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) intracranial bleeding study: the effect of tranexamic acid in traumatic brain injury, a nested randomised, placebo-controlled trial.

Author

Perel, P, primary, Al-Shahi Salman, R, additional, Kawahara, T, additional, Morris, Z, additional, Prieto-Merino, D, additional, Roberts, I, additional, Sandercock, P, additional, Shakur, H, additional, and Wardlaw, J, additional

Published
2012
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42. A systematic review of the utility of 1.5 versus 3 Tesla magnetic resonance brain imaging in clinical practice and research.

Author

Wardlaw JM, Brindle W, Casado AM, Shuler K, Henderson M, Thomas B, Macfarlane J, Muñoz Maniega S, Lymer K, Morris Z, Pernet C, Nailon W, Ahearn T, Mumuni AN, Mugruza C, McLean J, Chakirova G, Tao YT, Simpson J, and Stanfield AC

Abstract

Objective: MRI at 3 T is said to be more accurate than 1.5 T MR, but costs and other practical differences mean that it is unclear which to use.Methods: We systematically reviewed studies comparing diagnostic accuracy at 3 T with 1.5 T. We searched MEDLINE, EMBASE and other sources from 1 January 2000 to 22 October 2010 for studies comparing diagnostic accuracy at 1.5 and 3 T in human neuroimaging. We extracted data on methodology, quality criteria, technical factors, subjects, signal-to-noise, diagnostic accuracy and errors according to QUADAS and STARD criteria.Results: Amongst 150 studies (4,500 subjects), most were tiny, compared old 1.5 T with new 3 T technology, and only 22 (15 %) described diagnostic accuracy. The 3 T images were often described as "crisper", but we found little evidence of improved diagnosis. Improvements were limited to research applications [functional MRI (fMRI), spectroscopy, automated lesion detection]. Theoretical doubling of the signal-to-noise ratio was not confirmed, mostly being 25 %. Artefacts were worse and acquisitions took slightly longer at 3 T.Conclusion: Objective evidence to guide MRI purchasing decisions and routine diagnostic use is lacking. Rigorous evaluation accuracy and practicalities of diagnostic imaging technologies should be the routine, as for pharmacological interventions, to improve effectiveness of healthcare.Key Points: • Higher field strength MRI may improve image quality and diagnostic accuracy. • There are few direct comparisons of 1.5 and 3 T MRI. • Theoretical doubling of the signal-to-noise ratio in practice was only 25 %. • Objective evidence of improved routine clinical diagnosis is lacking. • Other aspects of technology improved images more than field strength. [ABSTRACT FROM AUTHOR]

Published
2012
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43. Bioreactor for mammalian cell culture.

Author

Fiechter, A., Aiba, S., Bungay, H. R., Cooney, Ch. L., Demain, A. L., Fukui, S., Kieslich, K., Klibanov, A. M., Lafferty, R. M., Primrose, S. B., Rehm, H. J., Rogers, P. L., Sahm, H., Schügerl, K., Suzuki, S., Tsao, G. T., Venkat, K., Winnacker, E. -L., Prokop, Ales, and Rosenberg, Morris Z.

Abstract

Purpose of this article is to review the current status of bioreactor design for mammalian cell culture. Morphological and biochemical features of two major mammalian cell groups, anchoragedependent and independent cells are proposed as a basis for different behavior at their cultivation. Different bioreactor configurations are systematically discussed through enumerating elementary physical phenomena and through stressing their physiological significance. Special considerations are given to those areas which are inherent to mammalian cell bioreactor. [ABSTRACT FROM AUTHOR]

Published
1989
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45. Nasal polyps in children.

Author

Schramm, Victor L., Effron, Morris Z., Schramm, V L Jr, and Effron, M Z

Abstract

The inflammatory nasal polyp is the most common benign or malignant nasal mass seen in children. Nasal polyps in the pediatric population appear to occur as inflammatory responses to bacterial infections. In 33% of the patients with polyps whom we studied, antral choanal polyps were noted, and in 20% of the patients the polyps were unilateral but not antral choanal. In 18% of the patients the polyps were bilateral and in an additional 29% they occurred bilaterally in association with cystic fibrosis. History of an allergy is infrequently associated with nasal polyps; allergies are potentially major contributing factors to nasal polyps only in patients without cystic fibrosis whose nasal polyps are bilateral. Patients with antral choanal polyps are most successfully managed by simultaneous Caldwell-Luc antrostomy and polypectomy. Sixty percent of patients with nasal polyps and cystic fibrosis are adequately managed with a single intranasal polypectomy. Simultaneous sinus surgery and polypectomy should be considered for all patients with recurrent polyps and for all patients with clinical or radiographic evidence of significant sinusitis. Complications, including epistaxis and intranasal synechia, occurred in 3% of the 170 surgical procedures performed. [ABSTRACT FROM AUTHOR]

Published
1980
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47. Diagnosis and Management of Drop Attacks of Vestibular Origin: Tumarkin's Otolithic Crisis

Author

F. Owen Black, Morris Z. Effron, and Denise Shamrock Burns

Subjects
Male, medicine.medical_specialty, Labyrinth Diseases, Audiology, Arterial insufficiency, Diagnosis, Differential, Central Nervous System Diseases, otorhinolaryngologic diseases, medicine, Humans, Endolymphatic hydrops, Meniere Disease, Vestibular system, business.industry, Multiple sclerosis, medicine.disease, Middle fossa, Drop attack, Otorhinolaryngology, Cardiovascular Diseases, Vestibule, Female, Surgery, Vestibule, Labyrinth, sense organs, business, Surgical ablation
Abstract

Erroneous signals of vestibular origin can cause sudden falls without warning. Drop attacks of vestibular origin in our experience most commonly occurred in patients with late or end-stage endolymphatic hydrops (usually idiopathic, ie, Meniere's disease). Eponymically termed Tumarkin's otolithic crisis, drop attacks of vestibular origin must be distinguished from drop attacks due to cardiovascular abnormalities, seizure disorders, vertebral basilar arterial insufficiency (transitory brain stem ischemia), multiple sclerosis, and drug-induced motor control disturbances. The treatment of choice for drop attacks of vestibular origin is either surgical ablation (labyrinthectomy) in the absence of serviceable hearing or middle fossa vestibular nerve section in order to preserve serviceable hearing.

Published
1982

48. Advanced Carcinoma of the Tongue: Management by Total Glossectomy Without Laryngectomy

Author

Eugene N. Myers, Jonas T. Johnson, Hugh D. Curtin, Morris Z. Effron, Quinter C. Beery, and Barbara Sigler

Subjects
Larynx, medicine.medical_specialty, medicine.medical_treatment, Speech Therapy, Quality of life (healthcare), Swallowing, Health care, Methods, medicine, Humans, Rehabilitation, Glossectomy, business.industry, General surgery, Carcinoma, General Medicine, Middle Aged, Deglutition, Tongue Neoplasms, Laryngectomy, medicine.anatomical_structure, Otorhinolaryngology, Physical therapy, Surgery, business, Speech-Language Pathology
Abstract

• A major goal of any surgical program for patients with tumors is to cure their cancer. Patients requiring total glossectomy usually are seen initially with faradvanced disease, often after failure of other treatment modalities. As a result, they may be suffering from constant pain as well as impairment of speech and deglutition. The prognosis is poor, and palliative surgery with good rehabilitation of the speaking and swallowing mechanisms becomes a reasonable, albeit limited, objective. Our series does not have sufficient follow-up to assess cure rates. However, our initial results have been encouraging. Our series does show that properly selected patients can be successfully rehabilitated after total glossectomy without laryngectomy. This successful rehabilitation begins with good patient selection and preoperative preparation. Postoperative rehabilitation requires the interplay of a highly motivated patient and a well-coordinated health care team. The physician, nurse, speech pathologist, dietitian, and social worker all have important roles in ensuring the patient's return to a good quality of life. The surgeon will direct the efforts of the team. To the nurse and the speech pathologist falls much of the bedside job of instructing and motivating the patient. Because such effective rehabilitation has been demonstrated by the success of our patients, we advocate preserving the larynx whenever possible in the patient who must undergo total glossectomy. ( Arch Otolaryngol 1981;107:694-697)

Published
1981

49. Plant Cell Bioreactors: Present Status and Future Trends

Author

Morris Z. Rosenberg and Fikret Kargi

Subjects
Materials science, technology, industry, and agriculture, Bioreactor, Biochemical engineering, equipment and supplies, Suspension (vehicle), Plant cell, complex mixtures, Selection (genetic algorithm), Biotechnology
Abstract

Various reactor configurations for suspension, immobilized and surface culture of plant cells are presented. Relative advantages and disadvantages of various reactor configurations and selection criteria for different applications are discussed.

Published
1987

50. Microbiology of chronic and recurrent otitis media with effusion in young infants

Author

Richard H. Michaels, Charles D. Bluestone, John F. Stanievich, Morris Z. Effron, Dale D. Rohn, and Jose A. Lima

Subjects
Male, Pediatrics, medicine.medical_specialty, Haemophilus Infections, Tympanic Membrane, medicine.medical_treatment, medicine.disease_cause, Pneumococcal Infections, Haemophilus influenzae, Myringotomy, Recurrence, Streptococcus pneumoniae, otorhinolaryngologic diseases, medicine, Humans, Tympanostomy tube, Bacteria, business.industry, Infant, General Medicine, Bacteria Present, Antimicrobial, Anti-Bacterial Agents, Surgery, Cleft Palate, Otitis Media, medicine.anatomical_structure, Otorhinolaryngology, Effusion, Chronic Disease, Pediatrics, Perinatology and Child Health, Middle ear, Female, Intubation, business
Abstract

Chronic otitis media with effusion (OME) has been assumed to be sterile, since several reports in the literature have described unsuccessful attempts to culture bacteria from it. However, several recent studies have confirmed an earlier report that there is a significant frequency of bacteria in the middle ears of children with chronic and/or recurrent OME. Similar studies in young infants with chronic and/or recurrent OME have not been previously reported. In this study, cultures were obtained at the time of myringotomy and tympanostomy tube insertion from 50 infants aged 1–12 months who had chronic and/or recurrent OME. From the 80 ears of 40 infants without cleft palate, 32% had bacteria isolated from their middle ears; 22% had Streptococcus pneumoniae or Haemophilus influenzae. In 21 of these ears, no effusion was apparent at myringotomy, but in 28% bacteria were isolated from middle ear washings. From the 20 ears of 10 infants with an unrepaired cleft palate, 55% had bacteria present in their middle ear aspirates; 50% had S. pneumoniae or H. influenzae. Even though the significance of bacteria in chronic OME in children, and now in young infants, is unclear at present, a therapeutic trial with an antimicrobial agent prior to surgical intervention would appear to be reasonable until such therapy is tested in a randomized, clinical trial.

Published
1981

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