Author: "Plunkett A" / Topic: medicine - Searchworks@Jio Institute Digital Library Search Results

1,464 results on '"Plunkett A"'

1. Understanding faculty perspectives on health equity curriculum implementation in graduate medical education: a qualitative study

Author: Krys E. Foster, Dhruvi Shah, Quinn Plunkett, and Randa Sifri
Subjects: Graduate medical education, Health care disparities, Health equity, Faculty curricular barriers, Residency faculty perspectives, Special aspects of education, LC8-6691, Medicine
Abstract: Abstract Background Despite increased awareness of persistent healthcare disparities, integrating health equity education into medical residency curricula needs urgent expansion. The Accreditation Council for Graduate Medical Education (ACGME) mandates addressing healthcare disparities and social determinants of health, but implementation remains insufficient due to pervasive barriers. Objective To explore residency faculty perspectives at one institution surrounding implementing a health equity curriculum within their programs. Methods Between November 2022 and April 2023, qualitative interviews and focus groups were conducted with residency faculty participants (n = 13) from a large academic medical institution. Participants were recruited via an internal email list directory of program directors. Semi-structured sessions explored faculty perspectives on health equity curriculum implementation. Data analysis utilized template analysis and thematic coding. Results Faculty perceived barriers included limited time for teaching health equity, challenges in prioritizing health equity content within the curriculum, lack of formal training and expertise, discomfort in leading discussions, and institutional barriers such as resource allocation and lack of buy-in. Conclusions Findings underscored the need for institutionally supported faculty development and protected learning time for health equity education. Despite participant recruitment and representation limitations, the study provides valuable insights for addressing curricular challenges. This study highlights critical areas for improving health equity curriculum implementation in graduate medical education. Addressing these faculty barriers can enhance resident competency in identifying and addressing healthcare disparities. Trial registration The study received approval from the Thomas Jefferson Institutional Review Board (IRB #22E.762).
Published: 2024
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2. What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? An exploration of antimicrobial stewardship excellence through thematic analysis of appreciative inquiry interviews with healthcare staff

Author: Adrian Plunkett, Alison Jones, and Emma Roche
Subjects: Medicine
Abstract: Objectives Antimicrobial resistance (AMR) is a major global health problem. Efforts to mitigate AMR prioritise antimicrobial stewardship (AMS) interventions. These interventions typically focus on deficiencies in practice and providing negative or normative feedback. This approach may miss opportunities to learn from success. We aimed to identify factors that enable success in AMS practices in the paediatric intensive care unit (PICU) by analysing the data obtained from interviews with staff members who had achieved success in AMS.Design Qualitative study design using thematic analysis of appreciative inquiry interviews with healthcare staff.Setting 31-bedded PICU in the UK between January 2017 and January 2018.Participants 71 staff who had achieved success in AMS in the PICU.Results Six themes were identified: (1) cultural factors including psychological safety, leadership and positive attitude are important enablers for delivering good clinical care; (2) ergonomic design of the physical environment and ready availability of tools and resources are key elements to support good practice and decision-making; (3) expertise and support from members of the multidisciplinary team contribute to good care delivery; (4) clarity of verbal and written communication is important for sharing mental models and aims of care within the clinical team; (5) a range of intrinsic factors influences the performance of individual HCPs, including organisation skill, fear of failure, response to positive reinforcement and empathetic considerations towards peers; (6) good clinical care is underpinned by a sound domain knowledge, which can be acquired through training, mentorship and experience.Conclusion The insights gained in this study originate from frontline staff who were interviewed about successful work-as-done. This strengths-based approach is an understudied area of healthcare, and therefore offers authentic intelligence which may be leveraged to effect tangible improvement changes. The methodology is not limited to AMS and could be applied to a wide range of healthcare settings.
Published: 2024
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3. 'The children of the Sun and Moon are the gardens'-How people, plants, and a living Sun shape life on Tanna, Vanuatu.

Author: Michael J Balick, Dominik M Ramík, Nadine Ramík, Iahwa Kausas Nemisa Kumas, Gregory M Plunkett, Neal Kelso, Presley Dovo, and K David Harrison
Subjects: Medicine, Science
Abstract: Based on original ethnographic and ethnobotanical research, we share how in the cosmology of Tanna, an island in Vanuatu's southernmost province of Tafea, the Sun is viewed as a living, interactive being. Our initial interviews explored knowledge and beliefs concerning individual plant species, then subsequent follow-up interviews further explored topics that emerged therefrom. The results of these interviews are a series of oral narratives of the mytho-historical past involving the Sun, and the description of contemporary practices which are influenced by the Sun. In traditional narratives, the Sun is both a creative and destructive force which is sometimes viewed as an active, personified character, and in other circumstances appears as an instrument created and utilized by greater powers. People from Tanna recount-and we adopt as a hypothesis-that the Sun's physical manifestation and role in the world has changed since the earliest days of its mythological creation, and that it remains an active player in Tanna's biocultural landscape within practices including time-reckoning, agriculture, and architecture. Through its relationships with humans and non-humans alike, the Sun ultimately shapes the cultural practices and even the landscape of Tanna. The nature of these relationships is changing as linguistic and cultural practices shift alongside people's relationship with the land, but the Sun remains a critical factor in lives and livelihoods of Tanna today.
Published: 2024
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4. Enhancing restoration success of rare plants in an arid-tropical climate through water-saving technologies: a case study of Scalesia affinis ssp. brachyloba in the Galapagos Islands

Author: Esme Plunkett, Luka Negoita, Christian Sevilla, Nicolás Velasco, and Patricia Jaramillo Díaz
Subjects: Ecological restoration, Galapagos, Scalesia affinis, Groasis Waterboxx, Endemic, Plants, Medicine, Biology (General), QH301-705.5
Abstract: Arid tropical archipelagos, such as the Galapagos Islands, host a high concentration of endemic plant species, many of which require restoration intervention to recover from past environmental degradation. Water-saving technologies (WSTs) have potential for hastening restoration by providing plants with additional water during the early stages of growth. However, it remains unclear whether such technologies provide an advantage for plant species of arid-tropical regions. This study examined the effect of the water-saving technology Groasis Waterboxx® (Groasis) on the rare endemic plant species Scalesia affinis ssp. brachyloba during early stages of restoration. Survival was monitored for 374 individuals planted across six sites on Santa Cruz Island, Galapagos (326 with technology and 48 as controls). Kaplan-Meier survival analysis showed that the use of Groasis reduced mortality during the first two years of the seedling survival. A mixed-effect logistic regression that modelled plant survival as a function of total precipitation, maximum temperature, and WST treatment (Groasis and no-technology control) found that despite low overall survival rates, plants grown with Groasis exhibited a three-fold higher predicted survival by the end of the 3.7 year duration of the study. Finally, through a resampling method, we demonstrate that the effect of the WST treatment is not dependent on the unbalanced design typical of a restoration project framework. We conclude that water-saving technologies such as the Groasis Waterboxx® can enhance survival of rare plant species such as S. affinis ssp. brachyloba in restoration programs in arid-tropical regions.
Published: 2023
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5. Researching COVID to enhance recovery (RECOVER) pregnancy study: Rationale, objectives and design.

Author: Torri D Metz, Rebecca G Clifton, Richard Gallagher, Rachel S Gross, Leora I Horwitz, Vanessa L Jacoby, Susanne P Martin-Herz, Myriam Peralta-Carcelen, Harrison T Reeder, Carmen J Beamon, James Chan, A Ann Chang, Maged M Costantine, Megan L Fitzgerald, Andrea S Foulkes, Kelly S Gibson, Nick Güthe, Mounira Habli, David N Hackney, Matthew K Hoffman, M Camille Hoffman, Brenna L Hughes, Stuart D Katz, Victoria Laleau, Gail Mallett, Hector Mendez-Figueroa, Vanessa Monzon, Anna Palatnik, Kristy T S Palomares, Samuel Parry, Christian M Pettker, Beth A Plunkett, Athena Poppas, Uma M Reddy, Dwight J Rouse, George R Saade, Grecio J Sandoval, Shannon M Schlater, Frank C Sciurba, Hyagriv N Simhan, Daniel W Skupski, Amber Sowles, Tanayott Thaweethai, Gelise L Thomas, John M Thorp, Alan T Tita, Steven J Weiner, Samantha Weigand, Lynn M Yee, Valerie J Flaherman, and RECOVER Initiative
Subjects: Medicine, Science
Abstract: ImportancePregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads.MethodsRECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators.DiscussionRECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero.Clinical trials.gov identifierClinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.
Published: 2023
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6. The TOMM40 ‘523’ polymorphism in disease risk and age of symptom onset in two independent cohorts of Parkinson’s disease

Author: Megan C. Bakeberg, Madison E. Hoes, Anastazja M. Gorecki, Frances Theunissen, Abigail L. Pfaff, Jade E. Kenna, Kai Plunkett, Sulev Kõks, P. Anthony Akkari, Frank L. Mastaglia, and Ryan S. Anderton
Subjects: Medicine, Science
Abstract: Abstract Abnormal mitochondrial function is a key process in the pathogenesis of Parkinson’s disease (PD). The central pore-forming protein TOM40 of the mitochondria is encoded by the translocase of outer mitochondrial membrane 40 homologue gene (TOMM40). The highly variant ‘523’ poly-T repeat is associated with age-related cognitive decline and age of onset in Alzheimer’s disease, but whether it plays a role in modifying the risk or clinical course of PD it yet to be elucidated. The TOMM40 ‘523’ allele length was determined in 634 people with PD and 422 healthy controls from an Australian cohort and the Parkinson’s Progression Markers Initiative (PPMI) cohort, using polymerase chain reaction or whole genome sequencing analysis. Genotype and allele frequencies of TOMM40 ‘523’ and APOE ε did not differ significantly between the cohorts. Analyses revealed TOMM40 ‘523’ allele groups were not associated with disease risk, while considering APOE ε genotype. Regression analyses revealed the TOMM40 S/S genotype was associated with a significantly later age of symptom onset in the PPMI PD cohort, but not after correction for covariates, or in the Australian cohort. Whilst variation in the TOMM40 ‘523’ polymorphism was not associated with PD risk, the possibility that it may be a modifying factor for age of symptom onset warrants further investigation in other PD populations.
Published: 2021
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7. Trainee doctors’ experiences of learning and well-being while working in intensive care during the COVID-19 pandemic: a qualitative study using appreciative inquiry

Author: Carolyn Tarrant, Tomasz Torlinski, James Rudge, Randeep Mullhi, Emma Plunkett, Jennifer Warren, and Christina Stamoulis
Subjects: Medicine
Abstract: Objectives Concern about trainee work-related well-being has been raised in recent years and is the subject of several reviews, reports and research studies. This study aimed to understand the experiences of trainees working in a large intensive care unit during the first surge of the COVID-19 pandemic from an educational and operational perspective in order to highlight what worked and what could be improved.Design A qualitative study using peer-to-peer semistructured interviews, developed using appreciative inquiry methodology, was conducted during July 2020. Responses were analysed using a thematic analysis technique.Setting A large, tertiary intensive care unit in the UK.Participants All trainees in anaesthesia and intensive care working on the intensive care unit during the first surge were invited to participate.Results Forty interviews were conducted and four over-arching themes were identified. These were: feeling safe and supported; physical demands; the emotional burden of caring; and a sense of fulfilment, value and personal development. Positive aspects of the organisational response to the pandemic included communication, personal protective equipment supply, team working and well-being support. Suggestions for improvement focused on rest facilities, rota patterns and hierarchies, creating opportunities for reflection and ensuring continued educational and training opportunities despite operational demands.Conclusions Trainees described opportunities for learning and fulfilment, as well as challenges, in working through a pandemic. Trainees described their needs and how well these were met during the pandemic. Ideas for improvement most frequently related to basic needs including safety and fatigue, but suggestions also related to supporting learning and development. The appreciative inquiry methodology of the project facilitated effective reflection on positive aspects of trainee experiences.
Published: 2021
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8. 3D-printed external cranial protection following decompressive craniectomy after brain injury: A pilot feasibility cohort study

Author: Karen Sui Geok Chua, Rathi Ratha Krishnan, Jia Min Yen, Tegan Kate Plunkett, Yan Ming Soh, Chien Joo Lim, Catherine M. Chia, Jun Cong Looi, Suan Gek Ng, and Jai Rao
Subjects: Medicine, Science
Abstract: Objectives 3D-printed (3DP) customized temporary cranial protection solutions following decompressive craniectomy (DC) are currently not widely practiced. A pilot trial of a 3DP customized head protection prototype device (HPPD) on 10 subjects was conducted during the subacute rehabilitation phase. Materials and methods Subjects > 30 days post-DC with stable cranial flaps and healed wounds were enrolled. HPPD were uniquely designed based on individuals’ CT scan, where the base conformed to the surface of the individual’s skin covering the cranial defect, and the lateral surface three-dimensionally mirrored, the contralateral healthy head. Each HPPD was fabricated using the fused deposition modeling method. These HPPD were then fitted on subjects using a progressive wearing schedule and monitored over 1, 2, 4, 6 and 8 follow-up (FU) weeks. Outcomes during FU included; reported wearing time/day (hours), subjective pain, discomfort, pruritus, dislodgment, cosmesis ratings; and observed wound changes. The primary outcome was safety and tolerability without pain or wound changes within 30 minutes of HPPD fitting. Results In all, 10 enrolled subjects received 12 HPPDs [5/10 male, mean (SD) age 46 (14) years, mean (SD) duration post-DC 110 days (76)] and all subjects tolerated 30 minutes of initial HPPD fitting without wound changes. The mean (SD) HPPD mass was 61.2 g (SD 19.88). During 8 weeks of FU, no HPPD-related skin dehiscence was observed, while 20% (2/10) had transient skin imprints, and 80% (8/10) reported self-limiting pressure and pruritis. Discussion Findings from this exploratory study demonstrated preliminary feasibility and safety for a customized 3DP HPPD for temporary post-DC head protection over 8 weeks of follow-up. Monitoring and regular rest breaks during HPPD wear were important to prevent skin complications. Conclusion This study suggests the potential for wider 3DP technology applications to provide cranial protection for this vulnerable population.
Published: 2021

9. The relationship between procedural volume and patient outcomes for percutaneous coronary interventions: a systematic review and meta-analysis [version 1; peer review: 2 approved]

Author: Kieran A. Walsh, Thomas Plunkett, Kirsty K. O'Brien, Conor Teljeur, Susan M. Smith, Patricia Harrington, and Máirín Ryan
Subjects: Medicine
Abstract: Background: The relationship between procedural volume and outcomes for percutaneous coronary interventions (PCI) is contentious, with previous reviews suggesting an inverse volume-outcome relationship. The aim of this study was to systematically review contemporary evidence to re-examine this relationship. Methods: A systematic review and meta-analysis was undertaken to examine the relationship between PCI procedural volume (both at hospital- and operator-levels) and outcomes in adults. The primary outcome was mortality. The secondary outcomes were complications, healthcare utilisation and process outcomes. Searches were conducted from 1 January 2008 to 28 May 2019. Certainty of the evidence was assessed using ‘Grading of Recommendations, Assessment, Development and Evaluations’ (GRADE). Screening, data extraction, quality appraisal and GRADE assessments were conducted independently by two reviewers. Results: Of 1,154 unique records retrieved, 22 observational studies with 6,432,265 patients were included. No significant association was found between total PCI hospital volume and mortality (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.69-1.03, I2 = 86%). A temporal trend from significant to non-significant pooled effect estimates was observed. The pooled effect estimate for mortality was found to be significantly in favour of high-volume operators for total PCI procedures (OR: 0.77, 95% CI: 0.63-0.94, I2 = 93%), and for high-volume hospitals for primary PCI procedures (OR: 0.77, 95% CI: 0.62-0.94, I2 = 78%). Overall, GRADE certainty of evidence was ‘very low’. There were mixed findings for secondary outcomes. Conclusions: A volume-outcome relationship may exist in certain situations, although this relationship appears to be attenuating with time, and there is ‘very low’ certainty of evidence. While volume might be important, it should not be the only standard used to define an acceptable PCI service and a broader evaluation of quality metrics should be considered that encompass patient experience and clinical outcomes. Systematic review registration: PROSPERO, CRD42019125288
Published: 2021
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10. Characterization of a ripening-related transcription factor FcNAC1 from Fragaria chiloensis fruit

Author: C. Carrasco-Orellana, Y. Stappung, A. Mendez-Yañez, A. C. Allan, R. V. Espley, B. J. Plunkett, M. A. Moya-Leon, and R. Herrera
Subjects: Medicine, Science
Abstract: Abstract Fragaria chiloensis is a strawberry endemic from Chile with attractive white-pink fruit, pleasant aroma and taste. However, this fruit has a limited post-harvest period due to fast softening. Several transcription factors (TFs) are involved in the regulation of fruit ripening, and members of the NAC family have been implicated in cell wall remodeling. FcNAC1 was isolated from F. chiloensis fruit, coding a protein of 332 amino acid residues and displaying a characteristic NAC domain at the N terminus. FcNAC1 protein showed nuclear localization. An increase in transcript level was observed during ripening. A sequence of 1488 bp of FcNAC1 promoter was obtained. In silico analysis identified cis elements able to respond to some hormones and Secondary wall NAC binding elements (SNBE), and responding to auxin and ABA. A structural model of FcNAC1 provided evidence for interaction with DNA sequences containing SNBE, while a dual luciferase assay confirmed the transcriptional activation by FcNAC1 of the promoter of FcPL, a gene involved in cell wall remodeling in F. chiloensis fruit. The results suggest the participation of FcNAC1 during ripening development of strawberry fruit, by regulating pectin metabolism during softening.
Published: 2018
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11. Establishing core outcome domains in pediatric kidney disease: report of the Standardized Outcomes in Nephrology—Children and Adolescents (SONG-KIDS) consensus workshops

Author: Camilla S. Hanson, Jonathan C. Craig, Charlotte Logeman, Aditi Sinha, Allison Dart, Allison A. Eddy, Chandana Guha, Debbie S. Gipson, Detlef Bockenhauer, Hui-Kim Yap, Jaap Groothoff, Michael Zappitelli, Nicholas J.A. Webb, Stephen I. Alexander, Susan L. Furth, Susan Samuel, Alicia Neu, Andrea K. Viecelli, Angela Ju, Ankit Sharma, Eric H. Au, Hailey Desmond, Jenny I. Shen, Karine E. Manera, Karolis Azukaitis, Louese Dunn, Simon A. Carter, Talia Gutman, Yeoungjee Cho, Amanda Walker, Anna Francis, Cheryl Sanchez-Kazi, Joshua Kausman, Meghan Pearl, Nadine Benador, Shobha Sahney, Allison Tong, Abhjit Guha, Adaobi Solarin, Adriana Platona, Alexander Hamilton, Alice Woods-Barnard, Allison Eddy, Alyssa Karathanas, Amanda Baumgart, Amelia Fielding, Amelia LePage, Amelie Bernier-Jean, Amy Kelly, Ana Teixeira, Andrea Viecelli, Andrea Matus, Andrew Narva, Angela Yee-Moon Wang, Anna Fielding, Anthony Meza, Aria Fielding, Armando Teixeira-Pinto, Arvind Bagga, Augustina Jankauskienė, Ayano Kelly, Barbara Gillespie, Benedicte Sautenet, Beth Vogt, Bethany Foster, Bradley Warady, Bradley Dixon, Braden Manns, Brenda Hemmelgarn, Brittney Bscardark, Brooklyn Romeo, Camilla Hanson, Carlos Meza, Carter Brockett, Chanel Prestidge, Charmaine Green, Christy Perkins, Claus Peter Schmitt, Craig Fielding, Craig Settee, Daniel Sumpton, Daniel Meza, Darien Karathanas, David Harris, David Wheeler, David Hooper, Debbie Gipson, Denis Geary, Dieter Haffner, Djalila Mekahli, Dorota Drozdz, Ed Romeo, Elaine Ku, Elaine Urbina, Elena Levtchenko, Elena Balovlenkov, Elisabeth Hodson, Emily Morales, Emma O'Lone, Emma Machuca, Emmah Carlton, Eric Au, Erin Olver, Estefania Morales, Fatima Mirza, Fiona Mackie, Francesca Tentori, Franz Schaefer, Gail Higgins, Georges Deschenes, Georgia Plunkett, Gerilyn Yoder, Germaine Wong, Giselle Morales, Greg Germino, Hayley Perkins, Harrison Mitchell-Smith, Helen Coolican, Hong Xu, Ifeoma Anochie, Il-Soo Ha, Ira Davis, Isaac Liu, Israel Samaniego, Jaime Machuca, James Machuca, Jasmijn Kerklaan, Jeff Brockett, Jenna Norton, Jenny Shen, Jens Goebel, Jia Rao, Jimmy Machuca, Jo Mitchell-Smith, Jo Watson, John Gill, Jonathan Craig, Joseph T. Flynn, Joshua Samuels, Justine Bacchetta, Kaleb Yoder, Karine Manera, Katherine Twombley, Kelly-Ann McMichael, Kenji Ishikura, Kennedy Romeo, Kevin Settee, Kim Linh Van, Lachlan McMichael, Lany Trinh, Larry Greenbaum, Laura Sanchez, Leo Fielding, Lesley Rees, Leslie Lippincott, Levi Mejia-Saldivar, Lidia Saldivar, Lisa Guay-Woodford, Lizett Samaniego, Lorraine Hamiwka, Lorraine Bell, Lucinda Barry, Luke Macauley, Luke Holmes, Madelynn Karathanas, Madison Mitchell-Smith, Mandy Walker, Manuel Benavides, Marcello Tonelli, Maria Ferris, Marina Vivarelli, Mark Wolfenden, Martin Howell, Martin Christian, Martin Schreiber, Marva Moxey-Mims, Mary Leonard, Matthew Karathanas, Melissa Natatmadja, Melissa Brockett, Melvin Bonilla-Felix, Meredith Atkinson, Michel Baum, Michelle Rheault, Mignon McCulloch, Mina Matsuda-Abedini, Mini Michael, Mohammad Khan, Mohammad Salih, Mycah Ann Carlton, Ngairre Plunkett, Nick Webb, Nicki Scholes-Robertson, Nicolas Larkins, Nicole Evangelidis, Nigel Yoder, Norma Meza, Paige Olver, Paiyton Carlton, Patrick Brophy, Peter Tugwell, Pierre Cochat, Rajnish Mehrotra, Raphael Wolfenden, Rasheed Gbadegesin, Raymond Benavides, Rebecca Johnson, Ricardo Morales, Richard McGee, Richard Fish, Robert Gardos, Roberto Pecoits-Filho, Rocio Vargas, Rodolfo Saldivar, Rosanna Coppo, Rukshana Shroff, Rupesh Raina, Sajeda Youssouf, Sally Crowe, Samaya Anumudu, Samuel Chan, Sarah Baldacchino, Scott Wenderfer, Sebastian Wolfenden, Selah Carlton, Shanna Sutton, Shannon Murphy, Sharon Teo, Sheyma Salih, Silas Carlton, Simon Carter, Simone Pearson, Simra Khan, Skyla Wilson, Sonia Sharma, Stephen Alexander, Stephen Marks, Stephen Cornish, Stuart Goldstein, Susan Furth, Susan Mendley, Susan Lippincott, Symone Charles, Terri Mitchell-Smith, Tess Harris, Thorsten Vetter, Tiffany Carlton, Timothy Carlton, Uwe Querfeld, Valeria Saglimbene, Virginia Charles, Wim van Biesen, Wolfgang Winkelmayer, Yenissey Machuca, Yusuf Salih, Yo Han Anh, Zachary Perkins, Zeynab Salih, Paediatric Nephrology, APH - Methodology, APH - Quality of Care, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, and Other Research
Subjects: 0301 basic medicine, Nephrology, medicine.medical_specialty, Consensus, Adolescent, medicine.medical_treatment, 030232 urology & nephrology, patient-centered care, outcomes, Outcome (game theory), 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), children, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, transplant, Renal Insufficiency, Chronic, Child, Dialysis, Depression (differential diagnoses), business.industry, Australia, trials, Reproducibility of Results, medicine.disease, 030104 developmental biology, core outcomes set, Family medicine, dialysis, Consensus Workshops, business, Inclusion (education), chronic kidney disease, Kidney disease
Abstract: Trials in children with chronic kidney disease do not consistently report outcomes that are critically important to patients and caregivers. This can diminish the relevance and reliability of evidence for decision making, limiting the implementation of results into practice and policy. As part of the Standardized Outcomes in Nephrology—Children and Adolescents (SONG-Kids) initiative, we convened 2 consensus workshops in San Diego, California (7 patients, 24 caregivers, 43 health professionals) and Melbourne, Australia (7 patients, 23 caregivers, 49 health professionals). This report summarizes the discussions on the identification and implementation of the SONG-Kids core outcomes set. Four themes were identified; survival and life participation are common high priority goals, capturing the whole child and family, ensuring broad relevance across the patient journey, and requiring feasible and valid measures. Stakeholders supported the inclusion of mortality, infection, life participation, and kidney function as the core outcomes domains for children with chronic kidney disease.
Published: 2020

12. Targeting obstetric providers in interventions for obesity and gestational weight gain: A systematic review.

Author: Michelle A Kominiarek, Linda C O'Dwyer, Melissa A Simon, and Beth A Plunkett
Subjects: Medicine, Science
Abstract: BACKGROUND:Providers need to be comfortable addressing obesity and gestational weight gain so they may give appropriate care; however, health care providers lack guidelines for the most effective educational strategies to assist in providing optimal care. OBJECTIVE:To identify studies that involved the obstetric provider in interventions for either the perinatal management of obesity and/or gestational weight gain in a systematic review. SEARCH STRATEGY:A keyword search of databases was performed up to April 2017. SELECTION CRITERIA:Obstetric providers who participated in an intervention with the aim to change a provider's clinical practice, knowledge, and/or satisfaction with the intervention in relation to the perinatal management of obesity or gestational weight gain were included. Provider intervention could include training or education, changes in systems or organization of care, or resources to support practice. PROSPERO database #42016038921. DATA COLLECTION AND ANALYSIS:Bias was assessed according to the validated Mixed Methods Appraisal Tool. The following variables were synthesized: study location and setting, provider and patient characteristics, intervention features, outcomes and efficacy, and strengths and weakness. MAIN RESULTS:Of the 6,821 abstracts screened, seven studies (4 quantitative, 3 mixed-methods) with a total of 335 providers met the inclusion criteria; two of which focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics. Interventions that incorporated motivational interviewing skills (n = 2), required additional training for the research study and addressed specific knowledge deficits such as nutrition and exercise (n = 3), and interfaced with the electronic medical record (n = 1) demonstrated the greatest impact on provider outcomes. Provider reported satisfaction scores were generally favorable, but none addressed provider-level efficacy in practice change. CONCLUSIONS:Given the limited number of studies, varying range of provider participation, and lack of provider-level efficacy, further evaluation of provider training and involvement in interventions for perinatal obesity or gestational weight gain is indicated to determine best practices for provider and patient outcomes.
Published: 2018
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13. Discordance and concordance on perception of quality care at end of life between older patients, caregivers and clinicians: a scoping review

Author: Magnolia Cardona, Joan Carlini, Emily Plunkett, Danial Bahudin, Zoe A Michaleff, Éidín Ní Shé, and Justin Clark
Subjects: Palliative care, Service delivery framework, Concordance, media_common.quotation_subject, Professional–patient relations, Family conflict, Review, Nursing, Humans, Medicine, Quality (business), Aged, media_common, Terminal Care, Social work, business.industry, Professional–family relations, Death, Caregivers, End-of-life care, Older adults, Quality of health care, Perception, Thematic analysis, business, Inclusion (education)
Abstract: Key summary points Aim The purpose of this review was to synthesise and critically analyse the points of discordance and concordance between consumers and clinicians about quality end-of-life care. Findings Respecting patient autonomy and the role of family is now clearly understood, but the role of healthcare provider and purpose of treatment withdrawal are still a matter of conflict between clinicians and patients or families. Clinician awareness of the possibility of misunderstanding by patients or families is the first step in preventing discordance of views on care quality at the end of life. Message To prevent the conflict between parties, further efforts are needed to investigate ways to better communicate the goals of care, limitations of treatment and uncertainty associated with forecasting time to end of life. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00549-6., Background This scoping review aimed to investigate the presence of discordance or concordance in the perceptions of end-of-life (EOL) care quality between consumers (i.e. patients aged over 60 in their last years of life and/or their informal caregivers) and clinicians, to inform further improvements in end-of-life care service delivery. Methods A scoping review of qualitative and quantitative studies was systematically undertaken by searching for English language publications in MEDLINE database and manual reference search of eligible articles. Thematic analysis was employed to identify and extract common concordance and discordance themes leading to the development of analytical constructs. Articles were eligible for inclusion if they reported on consumers’ (i.e. older patients aged 60 + years in their final years of life and/or their informal caregivers) and clinicians’ (doctors, nurses, social workers, etc.) perspectives on quality of medical, surgical or palliative/supportive care administered to older adults in the last year of life across all healthcare settings. Results Of the 2736 articles screened, 21 articles were included. Four themes identified concordance between consumers’ and clinicians’ perceptions of care quality: holistic patient care; coordinated care that facilitated EOL; the role of family at EOL; and impact of prognostic uncertainty on care planning. Three themes emerged for discordance of perceptions: understanding the patient needs at EOL; capacity of healthcare system/providers to accommodate family needs; and knowledge and communication of active or palliative care at EOL. Conclusions While progress has been made on promoting patient autonomy and respecting the family role in representing patient’s best interest, gaps remain in terms of care coordination, communication of prognosis, public understanding of the meaning of goals of care including de-escalation of management and enactment of advance care directives by clinicians for people with diminished decision capacity. Public understanding of the meaning of “comfort” care and the need to prevent over-treatment are essential for their satisfaction with care and their ability to embrace the concept of a good death. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00549-6.
Published: 2021
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14. Ibrutinib, fludarabine, cyclophosphamide, and obinutuzumab (iFCG) regimen for chronic lymphocytic leukemia (CLL) with mutated IGHV and without TP53 aberrations

Author: Zeev Estrov, Prithviraj Bose, Varsha Gandhi, Jan A. Burger, Xuemei Wang, Naveen Garg, Rashmi Kanagal-Shamanna, Naveen Pemmaraju, Philip A. Thompson, Ana Ayala, Hagop M. Kantarjian, Koji Sasaki, Keyur P. Patel, Tapan M. Kadia, Alessandra Ferrajoli, Susan O'Brien, Elias Jabbour, Gautam Borthakur, Koichi Takahashi, Marina Konopleva, Wanda Lopez, Michael J. Keating, Wei Wang, William G. Wierda, Nitin Jain, Jeffrey L. Jorgensen, William Plunkett, and Sa Wang
Subjects: Adult, Male, 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, Cyclophosphamide, Chronic lymphocytic leukemia, Immunoglobulin Variable Region, Neutropenia, Antibodies, Monoclonal, Humanized, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Piperidines, Obinutuzumab, Chemoimmunotherapy, hemic and lymphatic diseases, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, Biomarkers, Tumor, medicine, Humans, Aged, business.industry, Adenine, Hematology, Middle Aged, Prognosis, medicine.disease, Leukemia, Lymphocytic, Chronic, B-Cell, Fludarabine, Survival Rate, 030104 developmental biology, chemistry, 030220 oncology & carcinogenesis, Ibrutinib, Mutation, Female, Tumor Suppressor Protein p53, Immunoglobulin Heavy Chains, business, IGHV@, Vidarabine, Follow-Up Studies, medicine.drug
Abstract: Chemoimmunotherapy with combined fludarabine, cyclophosphamide and rituximab (FCR) has been an effective treatment for patients with chronic lymphocytic leukemia (CLL). We initiated a phase II trial for previously untreated patients with CLL with mutated IGHV and absence of del(17p)/TP53 mutation. Patients received ibrutinib, fludarabine, cyclophosphamide, and obinutuzumab (iFCG) for three cycles. Patients who achieved complete remission (CR)/CR with incomplete count recvoery (CRi) with marrow undetectable measurable residual disease (U-MRD) received additional nine cycles of ibrutinib with three cycles of obinutuzumab; all others received nine additional cycles of ibrutinib and obinutuzumab. Patients in marrow U-MRD remission after cycle 12 discontinued all treatment, including ibrutinib. Forty-five patients were treated. The median follow-up is 41.3 months. Among the total 45 treated patients, after three cycles, 38% achieved CR/CRi and 87% achieved marrow U-MRD. After cycle 12, the corresponding numbers were 67% and 91%, respectively. Overall, 44/45 (98%) patients achieved marrow U-MRD as best response. No patient had CLL progression. The 3-year progression-free survival (PFS) and overall survival (OS) were 98% and 98%, respectively. Per trial design, all patients who completed cycle 12 discontinued ibrutinib, providing for a time-limited therapy. Grade 3-4 neutropenia and thrombocytopenia occurred in 58% and 40% patients, respectively. The iFCG regimen with only 3 cycles of chemotherapy is an effective, time-limited regimen for patients with CLL with mutated IGHV and without del(17p)/TP53 mutation.
Published: 2021
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15. Physiological response of the retinal pigmented epithelium to 3‐ns pulse laser application, in vitro and in vivo

Author: Marzieh Tahmasebi, Robert J Casson, Malcolm Plunkett, Glyn Chidlow, and John P. M. Wood
Subjects: 0301 basic medicine, Blotting, Western, Vimentin, Lasers, Solid-State, Retinal Pigment Epithelium, Epithelium, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Cyclin D1, Hsp27, In vivo, Heat shock protein, medicine, Animals, Retinal pigment epithelium, biology, business.industry, Retinal, Nestin, eye diseases, Rats, Cell biology, Ophthalmology, 030104 developmental biology, medicine.anatomical_structure, chemistry, 030221 ophthalmology & optometry, biology.protein, sense organs, business
Abstract: Background To treat healthy retinal pigmented epithelium (RPE) with the 3-ns retinal rejuvenation therapy (2RT) laser and to investigate the subsequent wound-healing response of these cells. Methods Primary rat RPE cells were treated with the 2RT laser at a range of energy settings. Treated cells were fixed up to 7 days post-irradiation and assessed for expression of proteins associated with wound-healing. For in vivo treatments, eyes of Dark Agouti rats were exposed to laser and tissues collected up to 7 days post-irradiation. Isolated wholemount RPE preparations were examined for structural and protein expression changes. Results Cultured RPE cells were ablated by 2RT laser in an energy-dependent manner. In all cases, the RPE cell layer repopulated completely within 7 days. Replenishment of RPE cells was associated with expression of the heat shock protein, Hsp27, the intermediate filament proteins, vimentin and nestin, and the cell cycle-associated protein, cyclin D1. Cellular tight junctions were lost in lased regions but re-expressed when cell replenishment was complete. In vivo, 2RT treatment gave rise to both an energy-dependent localised denudation of the RPE and the subsequent repopulation of lesion sites. Cell replenishment was associated with the increased expression of cyclin D1, vimentin and the heat shock proteins Hsp27 and αB-crystallin. Conclusions The 2RT laser was able to target the RPE both in vitro and in vivo, causing debridement of the cells and the consequent stimulation of a wound-healing response leading to layer reformation.
Published: 2021
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16. The Association between Maternal Body Mass Index and the Risk of Perinatal Depression

Author: Annie Dude, Marci Adams, Beth A. Plunkett, David W. Ouyang, Samantha de los Reyes, and Deshala Castille
Subjects: medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Obstetrics and Gynecology, Gestational age, Retrospective cohort study, Overweight, 03 medical and health sciences, 0302 clinical medicine, Edinburgh Postnatal Depression Scale, Pediatrics, Perinatology and Child Health, medicine, Mass index, medicine.symptom, Underweight, business, Body mass index, 030217 neurology & neurosurgery, Perinatal Depression
Abstract: Objective The aim of this study was to evaluate whether the risk of perinatal depression is associated with body mass index (BMI) category. Study Design We performed a retrospective cohort study of women who completed an Edinburgh Postnatal Depression Scale (EPDS) questionnaire during the antepartum period at an integrated health system from January 2003 to May 2018. Risk of perinatal depression was defined as a score of ≥10 on the EPDS or an affirmative response to thoughts of self-harm. Risk of perinatal depression was compared by first trimester BMI category, defined as underweight (BMI: Results Our analysis included 3,420 obese women, 3,839 overweight women, 5,949 normal weight women, and 1,203 underweight women. The overall median gestational age at EPDS administration was 27 weeks (interquartile range: 23–29). Overweight and obese women were more likely to be non-Hispanic Black, Hispanic, multiparous, to have public insurance, prepregnancy diabetes, and chronic hypertension as compared with normal or underweight women (p Conclusion Obesity is associated with an increased risk of perinatal depression as compared with women of normal weight. Key Points
Published: 2021
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17. The development of contour processing abilities in the second year

Author: Kim Plunkett and Samuel H. Forbes
Subjects: Male, medicine.medical_specialty, Visual perception, genetic structures, Color vision, media_common.quotation_subject, Fixation, Ocular, PsycINFO, Audiology, Developmental psychology, Child Development, Discrimination, Psychological, Perception, Developmental and Educational Psychology, medicine, Humans, 0501 psychology and cognitive sciences, Toddler, Life-span and Life-course Studies, Demography, media_common, Contouring, Color Vision, 05 social sciences, Infant, Popularity, Test (assessment), Female, Psychology, 050104 developmental & child psychology
Abstract: Recent years have seen a rise in the popularity of eye-tracking methods to evaluate infant and toddler interpretation of visual stimuli. The application of these methods makes it increasingly important to understand the development of infant sensitivity to the perceptual properties implicated in such methods. In light of recent studies that demonstrate the use of pseudoisochromatic plates in testing infants for color vision, we investigated the perceptual contouring abilities required to pass a color-vision test of this type. A total of 115 (51 female) 16- and 19-month-old U.K.-based participants from the Oxfordshire region participated in this study. The evidence collected in this study indicated their ability to systematically fixate a contoured target, but the speed at which they did so was much slower in the younger age group. These findings suggest that the perceptual contouring abilities implicated in this study are still under development in the second year of life, and as such, the results suggest a lower age limit for color-vision tests displayed in this format. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Published: 2021
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18. Niclosamide’s potential direct targets in ovarian cancer

Author: Kanako Hayashi, Cindy A. Pru, Martin M. Matzuk, James A. MacLean, Kyle N. Plunkett, Sambasiva R. Bheemireddy, Nikola Sekulovski, Zhifeng Yu, and Hiroshi Okuda
Subjects: 0301 basic medicine, Antineoplastic Agents, RNA-binding protein, Biology, Mice, 03 medical and health sciences, 0302 clinical medicine, Affinity chromatography, Cell Line, Tumor, medicine, Animals, Humans, Viability assay, Niclosamide, Ovarian Neoplasms, Gene knockdown, RNA-Binding Proteins, Cancer, Cell Biology, General Medicine, medicine.disease, 030104 developmental biology, Reproductive Medicine, 030220 oncology & carcinogenesis, Cancer research, Female, Signal transduction, Ovarian cancer, Research Article, medicine.drug
Abstract: Recent evidence indicates that niclosamide is an anti-cancer compound that is able to inhibit several signaling pathways. Although niclosamide has previously been identified by high-throughput screening platforms as a potential effective compound against several cancer types, no direct binding interactions with distinct biological molecule(s) has been established. The present study identifies key signal transduction mechanisms altered by niclosamide in ovarian cancer. Using affinity purification with a biotin-modified niclosamide derivative and mass spectrometry analysis, several RNA-binding proteins (RBPs) were identified. We chose the two RBPs, FXR1 and IGF2BP2, for further analysis. A significant correlation exists in which high-expression of FXR1 or IGF2BP2 is associated with reduced survival of ovarian cancer patients. Knockdown of FXR1 or IGF2BP2 in ovarian cancer cells resulted in significantly reduced cell viability, adhesion, and migration. Furthermore, FXR1 or IGF2BP2 deficient ovarian cancer cells exhibited reduced response to most doses of niclosamide showing greater cell viability than those with intact RBPs. These results suggest that FXR1 and IGF2BP2 are direct targets of niclosamide and could have critical activities that drive multiple oncogenic pathways in ovarian cancer.
Published: 2021
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19. Treating Knee Osteoarthritis With Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy: A Systematic Review

Author: W Kelton Vasileff, Michael R. Baria, James Borchers, Alex C. DiBartola, Robert A. Magnussen, Evan Plunkett, and David C. Flanigan
Subjects: 030222 orthopedics, Combination therapy, Platelet-Rich Plasma, business.industry, Physical Therapy, Sports Therapy and Rehabilitation, Articular cartilage, 030229 sport sciences, Osteoarthritis, Osteoarthritis, Knee, Pharmacology, medicine.disease, Injections, Intra-Articular, 03 medical and health sciences, chemistry.chemical_compound, Treatment Outcome, 0302 clinical medicine, chemistry, Platelet-rich plasma, Hyaluronic acid, medicine, Humans, Orthopedics and Sports Medicine, Hyaluronic Acid, business
Abstract: Background: Platelet-rich plasma (PRP) and hyaluronic acid (HA) are injectable treatments for knee osteoarthritis. The focus of previous studies has compared their efficacy against each other as monotherapy. However, a new trend of combining these 2 injections has emerged in an attempt to have a synergistic effect. Purpose: To systematically review the clinical literature examining the combined use of PRP + HA. Design: Systematic review. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed and Embase. The following search terms were used: knee osteoarthritis AND platelet rich plasma AND hyaluronic acid. The review was performed by 2 independent reviewers who applied the inclusion/exclusion criteria and independently extracted data, including methodologic scoring, PRP preparation technique, HA composition, and patient-reported outcomes (PROs). Results: A total of 431 articles were screened, 12 reviewed in full, and 8 included in the final analysis: 2 case series, 3 comparative, and 3 randomized studies. Average follow-up was 9 months. The modified Coleman Methodology Score was 38.13 ± 13.1 (mean ± SD). Combination therapy resulted in improved PROs in all studies. Of the comparative and randomized studies, 2 demonstrated that combination therapy was superior to HA alone. However, when PRP alone was used as the control arm (4 studies), combination therapy was not superior to PRP alone. Conclusion: Combination therapy with PRP + HA improves PROs and is superior to HA alone but is not superior to PRP alone.
Published: 2021
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20. COVID‐19, when fourteen days are not enough—A case series of affected healthcare workers

Author: Zenia Martin, Patrick Plunkett, Mary Paula Colgan, Eilis O’Toole, Caitriona Canning, Catherine Murphy, Martina Hennessy, and Noirin Noonan
Subjects: Medicine (General), Coronavirus disease 2019 (COVID-19), Case Report, Case Reports, 030204 cardiovascular system & hematology, Return to work, 03 medical and health sciences, 0302 clinical medicine, R5-920, Nursing, healthcare worker, COVID‐19, Intervention (counseling), Health care, Medicine, prolonged course, rehabilitation program, business.industry, Healthcare worker, General Medicine, return to work, Work (electrical), 030220 oncology & carcinogenesis, Workforce, business
Abstract: We highlight the need for planning for mass workforce absentees as we prepare for subsequent surges. We suggest a multicomponent intervention including guiding return dates more by symptomatology and fitness for work rather than infectivity status.
Published: 2021

21. A longitudinal evaluation of the impact of the COVID-19 pandemic on patients with pre-existing anxiety disorders

Author: K Hennigan, R Plunkett, Brian Hallahan, M McGovern, S Costello, and Colm McDonald
Subjects: SARS-CoV-2, COVID-19, Anxiety, medicine.disease, Mental health, Anxiety Disorders, obsessive-compulsive disorder, Psychiatry and Mental health, Distress, Quality of life (healthcare), History and Philosophy of Science, Rating scale, Cohort, medicine, Quality of Life, Humans, Social isolation, medicine.symptom, Psychology, Pandemics, Applied Psychology, Anxiety disorder, Clinical psychology, Original Research
Abstract: Objectives:To examine if the COVID-19 pandemic is associated with a differential effect over time in relation to its psychological and social impact on patients with established anxiety disorders.Methods:Semi-structured interviews were conducted with 24 individuals attending the Galway–Roscommon Mental Health Services with an International Classification of Diseases (ICD)-10 diagnosis of an anxiety disorder at two time points (six months apart) to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life.Results:No statistical difference in symptomatology was noted between the two time points in relation to anxiety symptoms as measured by utilising psychometric rating scales (BAI and HARS) or utilising a Likert scale. The greatest impact of COVID-19 at both time points is related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted social isolation, concern for the participants’ future and increased difficulty managing anxiety with ongoing restrictions.Conclusions:No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders. Variability was, however, demonstrated between individuals, with some individuals describing ongoing anxiety, social isolation and concern for their future. Identifying those with ongoing symptoms or distress and providing multidisciplinary support to this cohort is suggested.
Published: 2021

22. Silent brain infarcts and early cognitive outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

Author: Brian T Plunkett, Kei Woldendorp, Ben Indja, Paul G. Bannon, Stuart M. Grieve, and Jonathon P. Fanning
Subjects: Brain Infarction, medicine.medical_specialty, Silent stroke, 030204 cardiovascular system & hematology, Brain Ischemia, Transcatheter Aortic Valve Replacement, 03 medical and health sciences, Cognition, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, Humans, Medicine, Stroke, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Magnetic resonance imaging, Aortic Valve Stenosis, medicine.disease, Diffusion Magnetic Resonance Imaging, Aortic Valve, Meta-analysis, Cardiology, Cardiology and Cardiovascular Medicine, business, Neurocognitive, 030217 neurology & neurosurgery, Kidney disease
Abstract: Background Silent brain infarcts (SBIs) are frequently identified after transcatheter aortic valve implantation (TAVI), when patients are screened with diffusion-weighted magnetic resonance imaging (DW-MRI). Outside the cardiac literature, SBIs have been correlated with progressive cognitive dysfunction; however, their prognostic utility after TAVI remains uncertain. This study’s main goals were to explore (i) the incidence of and potential risk factors for SBI after TAVI; and (ii) the effect of SBI on early post-procedural cognitive dysfunction (PCD). Methods and results A systematic literature review was performed to identify all publications reporting SBI incidence, as detected by DW-MRI after TAVI. Silent brain infarct incidence, baseline characteristics, and the incidence of early PCD were evaluated via meta-analysis and meta-regression models. We identified 39 relevant studies encapsulating 2408 patients. Out of 2171 patients who underwent post-procedural DW-MRI, 1601 were found to have at least one new SBI (pooled effect size 0.76, 95% CI: 0.72–0.81). The incidence of reported stroke with focal neurological deficits was 3%. Meta-regression noted that diabetes, chronic renal disease, 3-Tesla MRI, and pre-dilation were associated with increased SBI risk. The prevalence of early PCD increased during follow-up, from 16% at 10.0 ± 6.3 days to 26% at 6.1 ± 1.7 months and meta-regression suggested an association between the mean number of new SBI and incidence of PCD. The use of cerebral embolic protection devices (CEPDs) appeared to decrease the volume of SBI, but not their overall incidence. Conclusions Silent brain infarcts are common after TAVI; and diabetes, kidney disease, and pre-dilation increase overall SBI risk. While higher numbers of new SBIs appear to adversely affect early neurocognitive outcomes, long-term follow-up studies remain necessary as TAVI expands to low-risk patient populations. The use of CEPD did not result in a significant decrease in the occurrence of SBI.
Published: 2021
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23. Post-Cesarean Opioid Use after Implementation of Enhanced Recovery after Surgery Protocol

Author: David Alspach, Beth A. Plunkett, Mark G. Neerhof, Caitlin MacGregor, Alexandria Choi, Rebecca Blumenthal, and Mary Jo Sperling
Subjects: Adult, Gabapentin, Ibuprofen, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Interquartile range, Humans, Pain Management, Medicine, Acetaminophen, Pain, Postoperative, 030219 obstetrics & reproductive medicine, Cesarean Section, business.industry, Health Plan Implementation, Obstetrics and Gynecology, Perioperative, Length of Stay, Quality Improvement, Analgesics, Opioid, 030220 oncology & carcinogenesis, Anesthesia, Pediatrics, Perinatology and Child Health, Cohort, Morphine, Female, Enhanced Recovery After Surgery, business, Oxycodone, Body mass index, Program Evaluation, medicine.drug
Abstract: OBJECTIVE This study aimed to evaluate whether implementation of an enhanced recovery after surgery (ERAS) protocol is associated with lower maternal opioid use after cesarean delivery (CD). STUDY DESIGN We performed a pre- and postimplementation (PRE and POST, respectively) study of an ERAS protocol for cesarean deliveries. ERAS is a multimodal, multidisciplinary perioperative approach. The four pillars of our protocol include education, pain management, nutrition, and early ambulation. Patients were counseled by their outpatient providers and given an educational booklet. Pain management included gabapentin and acetaminophen immediately prior to spinal anesthesia. Postoperatively patients received scheduled acetaminophen and ibuprofen. Oxycodone was initiated as needed 24 hours after spinal analgesia. Preoperative diet consisted of clear carbohydrate drink consumed 2 hours prior to scheduled operative time with advancement as tolerated immediately postoperation. Women with a body mass index (BMI)
Published: 2020
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24. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: A Pragmatic Effectiveness Trial of a Nonpharmacologic Alternative for the Treatment of Postoperative Pain

Author: Brian M. Ilfeld, Robert J. Hackworth, Alice M Vijjeswarapu, Edward J. Mascha, Anthony Plunkett, Daniel I. Sessler, Steven P Cohen, James C. Eisenach, Alparslan Turan, Scott R. Griffith, Sandeep Dhanjal, Steven R. Hanling, and Harold Gelfand
Subjects: Percutaneous, Clinical Trials and Supportive Activities, Clinical Sciences, Analgesic, Pain, Substance Misuse, Clinical Research, Anesthesiology, medicine, Humans, Peripheral Nerves, Postoperative, Ultrasonography, Interventional, Ultrasonography, Postoperative Pain, Pain, Postoperative, Interventional, Neuromodulation, business.industry, Pain Research, Neurosciences, Chronic pain, Orthopedic Surgical Procedure, Pharmacology and Pharmaceutical Sciences, General Medicine, Postoperative Analgesia, Ambulatory Surgical Procedure, medicine.disease, Neuromodulation (medicine), Anesthesiology and Pain Medicine, Opioid, Anesthesia, Ambulatory, Public Health and Health Services, Transcutaneous Electric Nerve Stimulation, Patient Safety, Neurology (clinical), Chronic Pain, Drug Abuse (NIDA only), business, Percutaneous Peripheral Nerve Stimulation, EDITORIALS, medicine.drug
Abstract: Background Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducer needle followed by the delivery of electric current after needle withdrawal. This modality has been used extensively to treat chronic pain, but only small series have been published involving postoperative pain. The ultimate objective of this study is to determine the postoperative effects of percutaneous PNS following moderately to severely painful ambulatory surgery within a real-world clinical practice setting. The primary hypothesis is that surgical pain and opioid consumption during the initial 7 days after surgery will be reduced by percutaneous PNS compared with usual and customary analgesia (dual primary outcome measures). Design A multicenter pragmatic effectiveness trial. We are randomizing participants having painful orthopedic surgical procedures of the upper and lower extremity to receive 14 days of either 1) electrical stimulation or 2) sham in a double-masked fashion. End points are being assessed at various time points over 12 postoperative months. Summary The postoperative experience will be much improved if percutaneous PNS provides potent analgesia while concurrently decreasing opioid requirements following painful surgery. Because this modality can be administered for up to 60 days at home, it may provide postoperative analgesia that outlasts surgical pain yet has relatively few risks and, unlike opioids, has no systemic side effects or potential for abuse, addiction, and overdose. Percutaneous PNS has the potential to revolutionize postoperative analgesia as it has been practiced for the past century. This study will inform key stakeholders regarding an evidence-based nonpharmacologic approach to the management of postoperative pain.
Published: 2020
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25. Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: A quality improvement project

Author: Janine Cassidy, Al Lew, Sharon McNamara, Rich Plunkett, Elizabeth Andes, Susan Whitmore, Thida Ong, and Freda F. Liu
Subjects: Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Quality management, Adolescent, Cystic Fibrosis, Psychological intervention, Anxiety, Cystic fibrosis, Health administration, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Prevalence, medicine, Humans, Mass Screening, Depression (differential diagnoses), Descriptive statistics, Depression, business.industry, medicine.disease, Quality Improvement, Mental health, 030228 respiratory system, Family medicine, Pediatrics, Perinatology and Child Health, Female, medicine.symptom, business
Abstract: BACKGROUND Guidelines to integrate mental health screening (MHS) into Cystic fibrosis (CF) care has increased adoption across the United States and European CF Centers, however, there has been limited discussion on specific strategies for implementation. OBJECTIVE Share key strategies that led to successful MHS implementation in one pediatric CF center and report implementation and screening outcomes. METHODS Parent partners, mental health experts from the Department of Psychiatry, and the CF clinic team codesigned interventions to support three major stakeholders: (a) patients and families (b) clinic team, and (c) hospital system. The mental health coordinator approached patients (12 and older) to introduce MHS and administered screening and reviewed results using an electronic tablet and digital measurement-feedback system. We used strategies that promoted visibility of screening progress and sharing of data with hospital administration. Descriptive statistics were used to assess prevalence of clinically significant symptoms of anxiety and depression and symptom severity within our sample. RESULTS Over the first 2 years of the project, we exceeded our goal of screening 80% of eligible patients per year (80%-95% screened) and are on a similar trajectory within the first 7 months of year 3. We identified high prevalence of clinically significant symptoms of depression (16%) and anxiety (14%) similar to those found in other chronic illness populations. These data helped us advocate hospital leadership to support the development of new mental health services to address identified needs at our center. CONCLUSION Leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
Published: 2020
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26. Intrathecal Baclofen for Severe Spasticity: Longitudinal Data From the Product Surveillance Registry

Author: Robert J. Plunkett, Robert Spencer, Peter E. Konrad, Sam Eldabe, Todd Weaver, Lisa Molus, Mya C. Schiess, and Katherine Stromberg
Subjects: Adult, Male, Baclofen, medicine.medical_specialty, Longitudinal data, registry, intrathecal baclofen, 03 medical and health sciences, 0302 clinical medicine, Clinical Research, Intervention (counseling), medicine, Humans, Case Series, Prospective Studies, Registries, Spasticity, Child, Adverse effect, Injections, Spinal, risk, Muscle Relaxants, Central, business.industry, spasticity, Infusion Pumps, Implantable, General Medicine, Intrathecal baclofen, Discontinuation, Catheter, Anesthesiology and Pain Medicine, Neurology, Muscle Spasticity, Emergency medicine, Female, Registry data, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Objective To assist in the assessment of intrathecal baclofen (ITB) therapy risks and benefits by providing surgical intervention rate, safety, and elective device replacement rate data. Materials and methods An ongoing prospective, long-term, multicenter Product Surveillance Registry (PSR) (NCT01524276) enrolled consented patients implanted with the SynchroMed II infusion system. Pump and catheter performance data were collected, with patients followed prospectively for events related to the device, procedure, and therapy. Investigators provided event descriptions, patient symptoms, and patient outcomes. Results We analyzed registry data from 1743 patients (77% adult, 46.8% female) treated with ITB for severe spasticity at 53 registry sites between August 2003 and October 2017, for an accumulated 6481 patient-years. Discontinuation from the registry was largely (58.6% of discontinued patients) due to study site closure and patient relocation; exit due to an adverse event was limited to 0.3%. After 10 years, 87.2% of adult and 76.3% of pediatric patients continued with ITB. Overall, 99.1% of pumps reaching end of battery life were replaced at the time of explant. Conclusions ITB therapy for the treatment of severe spasticity requires surgical implantation of a programmable infusion system for chronic drug delivery. If complications arise, many necessitate surgical intervention for correction. For spinal and cerebral spasticity in pediatric and adult patients, discontinuation rates due to an adverse event were low (0.3%), and there was high acceptance (99.1%) of surgical intervention for therapy continuation. Patient/caregiver willingness to accept surgical and other risks for therapy continuation was extremely high.
Published: 2020
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27. Ultrasound-guided Percutaneous Tendon Scraping: A Novel Technique for Treating Patellar Tendinopathy

Author: Robert A. Magnussen, Meghan M. Miller, Evan Plunkett, James Borchers, Timothy L. Miller, and Michael R. Baria
Subjects: Novel technique, medicine.medical_specialty, Percutaneous, medicine.anatomical_structure, business.industry, medicine, Orthopedics and Sports Medicine, Radiology, Patellar tendinopathy, business, Ultrasound guided, Tendon
Published: 2020
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28. Cultural land use and vegetation dynamics in the uplands of northern Portugal from the Middle Ages to the Modern period

Author: Luís Fernando Oliveira Fontes, Gill Plunkett, and Carla Sá Ferreira
Subjects: 010506 paleontology, Land use, Modern history, Paleontology, 15. Life on land, 010502 geochemistry & geophysics, medicine.disease_cause, Vegetation dynamics, 01 natural sciences, Geography, Arts and Humanities (miscellaneous), Pollen, Earth and Planetary Sciences (miscellaneous), medicine, Middle Ages, Physical geography, SDG 15 - Life on Land, 0105 earth and related environmental sciences
Abstract: In Europe, mountain landscapes have evolved in a long‐term relationship with human communities and present‐day landscapes reflect that ancient interaction. The present study aims to reconstruct human activity in twomountain areas in northern Portugal using palynological analysis integrated with the available regional historical,archaeological and palaeo environmental archives. Pollen records from two sedimentary sequences span the Medieval and Modern periods and show that mixed agriculture and livestock grazing were consistently present in both regions throughout these times. Variations in cultural indicators show that the extent of farming fluctuated throughout time, with a general increase in cultivation during the Medieval period but with contractions likely coinciding with times of social disturbance. Historical sources suggest that sociopolitical factors and population pressure were fundamental in the utilisation of upland spaces. This study did not find any convincing evidence to suggest that fire was a fundamental factor in heathland spread. We conclude that long‐term occupation of the uplands was sustained by low‐intensity land use throughout the Medieval to post‐Medieval periods, and that the present landscape has assumed a very different character following depopulation of the mountain areas and a shift towards commercial forestry.© 2020 The Authors. Journal of Quaternary Science Published by John Wiley & Sons Ltd
Published: 2020
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29. Does the All Wales Universal Orthodontic Referral Form enable accurate triage of new NHS orthodontic patients? A service evaluation

Author: Juliet V. Ashley, David J. Plunkett, and Robert Ireland
Subjects: Service (business), Referral, Descriptive statistics, business.industry, Retrospective cohort study, 030206 dentistry, medicine.disease, Triage, 03 medical and health sciences, 0302 clinical medicine, Clinical information, Medicine, 030212 general & internal medicine, Medical emergency, business, General Dentistry
Abstract: Introduction This study was designed to investigate the accuracy of clinical information provided by referring general dental practitioners (GDPs) following the introduction of a standardised referral form across Wales (the All Wales Universal Orthodontic Referral Form [AWUORF]) and to see whether the information given could be reliably used to screen the referrals. Aim To evaluate whether priority cases were being readily identified and whether inappropriate referrals could be minimised, thereby potentially reducing waiting lists. Method A service evaluation involving the retrospective study of 200 consecutive referrals to a specialist practice over a three-month period. A descriptive data analysis was undertaken. Results The GDPs had successfully identified the main complaint in 156 (78%) of the referrals. Of the 44 (22%) clinically inaccurate referrals, there was no impact on the patient in terms of referral pathway in 32 (16%) cases, but in the remaining 12 (6%), 5 (2.5%) cases were prioritised unnecessarily and the remaining 7 (3.5%) would have been seen more quickly had the GDP provided the relevant clinical information. The appropriateness of referral in terms of eligibility of the patient to receive NHS-funded orthodontic treatment was high with only 18 (9%) patients failing to meet the criteria. Conclusion The AWUORF successfully guides the GDP to make appropriate referrals and enables accurate triage in the majority of cases.
Published: 2020
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30. First-in-Human Experience of Transcatheter Mitral Valve Repair With the PASCAL Ace Implant System

Author: Avalon Moonen, Lisa A. Simmons, Martin K.C. Ng, Michael P. Vallely, and Brian T. Plunkett
Subjects: medicine.medical_specialty, business.industry, Pascal (programming language), First in human, Surgery, medicine.anatomical_structure, Mitral valve, cardiovascular system, Medicine, Transcatheter mitral valve repair, cardiovascular diseases, Implant, Cardiology and Cardiovascular Medicine, business, computer, computer.programming_language
Abstract: The PASCAL transcatheter mitral valve repair (TMVr) system (Edwards Lifesciences, Irvine, CA) enables repair of a regurgitant mitral valve through leaflet approximation around an anatomic spacer.1,...
Published: 2021
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31. Early prediction of language and literacy problems: is 18 months too early?

Author: Fiona J. Duff, Kate Nation, Kim Plunkett, and DVM Bishop
Subjects: Late talkers, Specific language impairment, Language, Literacy, Medicine, Biology (General), QH301-705.5
Abstract: There is a lack of stability in language difficulties across early childhood: most late talkers (LTs) resolve their difficulties by pre-school; and a significant number of children who were not LTs subsequently manifest language difficulties. Greater reliability in predicting individual outcomes is needed, which might be achieved by waiting until later in development when language is more stable. At 18 months, productive vocabulary scores on the Oxford Communicative Developmental Inventory were used to classify children as LTs or average talkers (ATs). Thirty matched-pairs of LTs and ATs were followed up at school-age (average age 7 years), when language and literacy outcomes were assessed. For 18 children, intermediate testing at age 4 had classified them as showing typical development (TD) or specific language impairment (SLI). After correcting for multiple comparisons, there were no significant differences between the LTs and ATs on any outcome measure, and the LTs were performing in the average range. However, there were large-sized effects on all outcomes when comparing the TD and SLI groups. LT status on its own is not determinative of language and literacy difficulties. It would therefore not be appropriate to use expressive vocabulary measures alone to screen for language difficulties at 18 months. However, children with language impairment at age 4 are at risk of enduring difficulties.
Published: 2015
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32. Critical care admission following elective surgery was not associated with survival benefit

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Mikhail, Kirov, Denis, Protsenko, Bruce, Biccard, Cesar, Aldecoa, Michelle, Chew, Christoph, Hofer, Martin, Hubner, James, Ditai, Tamas, Szakmany, Lee, Fleisher, Marissa, Ferguson, Michael, Macmahon, Ritchie, Cherian, Helen, Currow, Kathirgamanathan, Kanathiban, David, Gillespie, Edward, Pathmanathan, Katherine, Phillips, Jenifer, Reynolds, Joanne, Rowley, Jeanene, Douglas, Ross, Kerridge, Sameer, Garg, Michael, Bennett, Megha, Jain, David, Alcock, Nico, Terblanche, Rochelle, Cotter, Kate, Leslie, Marcelle, Stewart, Nicolette, Zingerle, Antony, Clyde, Oliver, Hambidge, Adam, Rehak, Sharon, Cotterell, Wilson Binh Quan Huynh, Timothy, Mcculloch, Erez, Ben-Menachem, Thomas, Egan, Jennifer, Cope, Paul, Fellinger, Simone, Haselberger, Caroline, Holaubek, Paul, Lichtenegger, Florian, Scherz, Franz, Hoffer, Veronika, Cakova, Andreas, Eichwalder, Norbert, Fischbach, Reinhold, Klug, Elisabeth, Schneider, Martin, Vesely, Reinhart, Wickenhauser, Karl Gernot Grubmueller, Marion, Leitgeb, 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Despina, Fiorentza, Klara, Frantzeskos, Georgio, Geromarkaki, Elisavet, Kafkalaki, Kalliopi, Kalogridaki, Marina, Karydi, Konstyllia, Kokkini, Sofia, Kougentakis, Georgio, Lefaki, Tatiana, Lilitsis, Emmanouhl, Makatounaki, Aikaterini, Malliotakis, Polychroni, Michelakis, Dimostheni, Neonaki, Maria, Nyktari, Vasileia, Palikyra, Iliana, Papadakis, Eleftherio, Papaioannou, Alexandra, Sfakianakis, Konstantino, Sgouraki, Maria, Souvatzis, Xenia, Spartinou, Anastasia, Stefanidou, Nefeli, Syrogianni, Paulina, Tsagkaraki, Georgia, Arnaoutoglou, Elena, Arnaoutoglou, Christina, Bali, Christina, Bouris, Vasilio, Doumos, Rodamantho, Gkini, Konstantia-Paraskevi, Kapaktsi, Clio, Koulouras, Vasilio, Lena, Arian, Lepida, Dimitra, Michos, Evangelo, Papadopoulos, Dimitrio, Paschopoulos, Mina, Rompou, Vaia Aliki, Siouti, Ioanna, Tsampalas, Stavro, Ververidou, Ourania, Zilis, Georgio, Charlalampidoy, Alexandra, Christodoulidis, Gregory, Flossos, Andrea, Stamoulis, Konstantino, Tsang, Man Shing Caleb, Tsang, Man Shing, Lai, Man Ling, Yip, Chi Pang, Chan, Hey Man Heyman, Law, Bassanio, Li, Wing Sze, Chu, Hiu Man, Koo, Emily Gar Yee, Lam, Chi Cheong Joe, Cheng, Ka Ho, Lam, Tracy, Chu, Susanna, Lam, Wing Yan, Wong, Kin Wai Kevin, Kwok, Dily, Hung, Ching Yue Janice, Chan, Wai Kit Jacky, LamWong, Wing, Chung, Chun Kwong Eric, Ma, Shu Kai, Kaushik, Shuchi, Shah, Bhagyesh, Shah, Dhiren, Shah, Sanjay, Ar, Praburaj, Muthuchellappan, Radhakrishnan, Agarwal, Vandana, Divatia, Jigeeshu, Mishra, Sanghamitra, Nimje, Ganesh, Pande, Swati, Savarkar, Sukhada, Shrivastava, Aditi, Thomas, Martin, Yegnaram, Shashikant, Hidayatullah, Rahmat, Puar, Nasman, Niman, Sumara, Indra, Imai, Hamzah, Zulkarnain, Yuliana, Annika, Abidin, Ucu Nurhadiat, Dursin, Ade Nurkacan, Kurnia, Andri, Susanti, Ade, Handayani, Dini, Aribawa, Mahaalit Alit, Arya, Aryabiantara, Senapathi, Tjokorda Gde Agung, Utara, Utara Hartawan, Wid, Widnyana Made, Wima, Semarawima, Wir, Wiryana Made, Jehosua, Brillyan, Kaunang, Jonathan, 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Maurizio, Gastaldi, Christian, Marchesi, Alessandro, Pascazio, Angelantonio, Pata, Francesco, Pozzi, Emilio, Premoli, Alberto, Tessera, Gaetano, Boschi, Luca, D’Andrea, Rocco, Ghignone, Federico, Poggioli, Gilberto, Sibilio, Andrea, Taffurelli, Mario, Ugolini, Giampaolo, Ab Majid, Mohd Azuan, Ab Rahman, Rusnah, Joseph, Jame, Pathan, Furquan, Shah, Mohammad Hafizshah Sybil, Yap, Huey Ling, Cheah, Seleen, Chin, Im Im, Looi, Ji Keon, Tan, Siew Ching, Visvalingam, Sheshendrasurian, Kwok, Fan Yin, Lee, Chew Kiok, Tan, Tse Siang, Wong, Sze Meng, Abdullah, Noor Hairiza, Liew, Chiat Fong, Luxuman, Lovenia, Mohd Zin, Nor Hafizah, Norddin, Muhamad Faiz, Alias, Raja Liza Raja, Wong, Juan Yong, Yong, Johnny, Bin Mustapha, Mohd Tarmimi, Chan, Weng Ken, Dzulkipli, Norizawati, Kuan, Pei Xuan, Lee, Yew Ching, Alias, Anita, Guok, Eng Ching, Jee, Chiun Chen, Ramon, Brian Rhadamantyne, Weng, Cheng Wong, Abd Ghafar, Fara Nur Idayu, Aziz, Faizal Zuhri, Hussain, Nabilah, Lee, Hooi Sean, Sukawi, Ismawaty, Woon, Yuan Liang, Abd Hadi, Husni Zaeem, Ahmad Azam, Ummi Azmira, Alias, Abdul Hafiz, Kesut, Saiful Aizar, Lee, Jun May, Ooi, Dar Vin, Sulaiman, Hetty Ayuni, Tengku Lih, Tengku Alini, Veerakumaran, Jeyaganesh, Rojas, Eder, Resendiz, Gerardo Esteban Alvarez, Zapata, Darcy Danitza Mari, Aguilar López, Julio Cesar Jesú, Flores, Armando Adolfo Alvarez, Amador, Juan Carlosc Bravo, Avila, Erendira Jocelin Dominguez, Aquino, Laura Patricia González, Rodriguez, Ricardo Lopez, Landa, Mariana Torre, Urias, Emma, Hollmann, Marku, Hulst, Abraham, Kirzner, Osne, Preckel, Benedikt, Koopman-van Gemert, Ankie, Buise, Marc, Tolenaar, Noortje, Weber, Eric, de Fretes, Jennifer, Houweling, Peter, Ormskerk, Patricia, Van Bommel, Jasper, Lance, Marcu, Smit-Fun, Valerie, van Zundert, Tom, Baas, Peter, de Boer, Hans Donald, Sprakel, Joost, Elferink-Vonk, Renske, Noordzij, Peter, van Zeggeren, Laura, Brand, Bastiaan, spanjersberg, Rob, ten Bokkel-Andela, Janneke, Numan, Janneke, van Klei, Wilton, van Zaane, 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Ganter, Donna Louise, McCann, Lloyd, Foley, Julia, Gilmour, Fiona, Lumsden, Rachelle, Moores, Mark, Olliff, Sue, Sardareva, Elitza, Tai, Joyce, Wikner, Matthew, Wong, Christopher, Chaddock, Mark, Czepanski, Carolyn, McKendry, Patrick, Polakovic, Daniel, Polakovich, Daniel, Robert, Axe, Tormo Belda, Margarita, Norton, Tracy, Alherz, Fadhel, Barneto, Lisa, Ramirez, Alberto, Sayeed, Ahmed, Smith, Nicola, Bennett, Cambell, McQuoid, Shane, Jansen, Tracy-Lee, Nico, Zin, Scott, John, Freschini, David, Freschini, Angela, Hopkins, Brian, Manson, Lara, Stoltz, Deon, Bates, Alexander, Davis, Simon, Freeman, Victoria, McGaughran, Lynette, Baskar Sharma, Swarna, Burrows, Tom, Byrne, Kelly, English, Duane, Johnson, Robert, Chai Law, Kiew, Manikkam, Brendon, Naidoo, Shaun, Rumball, Margot, Whittle, Nicola, Franks, Romilla, Gibson-Lapsley, Hannah, Salter, Ryan, Walsh, Dean, Cooper, Richard, Perry, Katherine, Obobolo, Amo, Sule, Umar Musa, Ahmad, Abdurrahman, Atiku, Mamuda, Mohammed, Alhassan Datti, 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Mariethel, Hobrok, Maria, Arawwawala, Dilshan, Fergey, Lauren, Gardiner, Matthew, Gunn, Jacqueline, Johnson, Lyndsay, Lofting, Amanda, Lyle, Amanda, Mc Neela, Fiona, Smolen, Susan, Topliffe, Joanne, Williams, Sarah, Bland, Martin, Kaura, Vika, Lanka, Prasad, Naylor, Chardé, Smith, Neil, Ahmed, Ahmed, Myatt, John, Shenoy, Ravikiran, Soon, Wai Cheong, Tan, Jessica, Karadia, Sunny, Self, Jame, Durant, Emma, Tripathi, Shiva, Bullock, Clare, Campbell, Debbie, Ghosh, Alison, Hughes, Thoma, Zsisku, Lajo, Bengeri, Sheshagiri, Cowton, Amanda, Khalid, Mohammed Shazad, Limb, Jame, McAdam, Colin, Porritt, Mandy, Rafi, M. Amir, Shekar, Priya, Harden, Catherine, Hollands, Heidi, King, Angela, March, Linda, Minto, Gary, Patrick, Abigail, Waugh, Darren, Kumara, Paramesh, Simeson, Karen, Yarwood, Jamie, Browning, Julie, Hatton, Jonathan, Julian, Howe, Mitra, Atideb, Newton, Maria, Pernu, Pawan, Wilson, Alison, Commey, Thelma, Foot, Helen, Glover, Lyn, Gupta, Ajay, Lancaster, Nicola, Levin, Jill, Mackenzie, Felicity, Mestanza, Claire, Nofal, Emma, Pout, Lauren, Varden, Rosanna, Wild, Jonathan, Jones, Stephanie, Moreton, Sarah, Pulletz, Mark, Davies, Charlotte, Martin, Matthew, Thomas, Sian, Burns, Karen, McArthur, Carol, Patel, Panna, Lau, Gary, Rich, Natalie, Davis, Fiona, Lyons, Rachel, Port, Beth, Prout, Rachel, Smith, Christopher, Adelaja, Yemi, Bennett, Victoria, Bidd, Heena, Dumitrescu, Alexandra, Murphy, Jacqui Fox, Keen, Abigail, Mguni, Nhlanhla, Ong, Cheng, Adams, George, Boshier, Pier, Brown, Richard, Butryn, Izabella, Chatterjee, Jayanta, Freethy, Alexander, Lockwood, Geoffrey, Tsakok, Maria, Tsiligiannis, Sophia, Peat, William, Stephenson, Lorraine, Bradburn, Mike, Pick, Sara, Cunha, Pedro, Olagbaiye, Olufemi, Tayeh, Salim, Abernethy, Caroline, Balasubramaniam, Madhu, Bennett, Rachael, Bolton, David, Martinson, Victoria, Naylor, Charde, Bell, Stephanie, Heather, Blaylock, Kushakovsky, Vlad, Alcock, Liam, Alexander, Hazel, Anderson, Colette, Baker, Paul, Brookes, Morag, Cawthorn, Louise, Cirstea, Emanuel, Colling, Kerry, Coulter, Ian, Das, Suparna, Haigh, Kathryn, Hamdan, Alhafidz, Hugill, Keith, Kottam, Lucksy, Lisseter, Emily, Mawdsley, Matthew, McGivern, Julie, Padala, Krishnaveni, Phelps, Victoria, kumar, Vineshykaa Ramesh, Stewart, Kirsten, Towse, Kayley, Tregonning, Julie, Vahedi, Ali, Walker, Alycon, Baines, Duncan, Bilolikar, Anjali, Chande, Shiv, Copley, Edward, Dunk, Nigel, Kulkarni, Raghavendra, Kumar, Pawan, Metodiev, Yavor, Ncomanzi, Dumisani, Raithatha, Bhavesh, Raymode, Parizade, Szafranski, Jan, Twohey, Linda, Watt, Philip, Weatherall, Lucie, Weatherill, J., Whitman, Zoe, Wighton, Elinor, Abayasinghe, Chamika, Chan, Alexander, Darwish, Sharif, Gill, Jame, Glasgow, Emma, Hadfield, Daniel, Harris, Clair, Kochhar, Arun, Mellis, Clare, Pool, Andrew, Riozzi, Paul, Selman, Andrew, Smith, Emma-Jane, Vele, Liana, Gercek, Yuksel, Guy, Kramer, Holden, Dougla, Watson, Nichola, Whysall, Karen, Andreou, Prematie, Hales, Dawn, Thompson, Jonathan, Bowrey, Sarah, McDonald, Shara, Gilmore, Jemma, Hills, Vicky, Kelly, Chan, Kelly, Sinead, Lloyd, Geraint, Abbott, Tom, Gall, Lewi, Torrance, Hew, Vivian, Mark, Berntsen, Emer, Nolan, Tracey, Turner, Angu, Vohra, Akbar, Brown, Andrew, Clark, Richard, Coughlan, Elaine, Daniel, Conway, Patvardhan, Chinmay, Pearson, Rachel, Predeep, Sheba, Saad, Hesham, Shanmugam, Mohanakrishnan, Varley, Simon, Wylie, Katharine, Cooper, Lucy, Makowski, Arystarch, Misztal, Beata, Moldovan, Eliza, Pegg, Claire, Donovan, Andrew, Foot, Jayne, Large, Simon, Claxton, Andrew, Netke, Bhagyashree, Armstrong, Richard, Calderwood, Claire, Kwok, Andy, Mohr, Otto, Oyeniyi, Peter, Patnaik, Lisa, Post, Benjamin, Ali, Sarah, Arshad, Homa, Baker, Gerard, Brenner, Laura, Brincat, Maximilian, Brunswicker, Annemarie, Cox, Hannah, Cozar, Octavian Ionut, Durst, Alexander, Fengas, Lior, Flatt, Jim, Glister, Georgina, Narwani, Vishal, Photi, Evangelo, Rankin, Adeline, Rosbergen, Melissa, Tan, Mark, Beaton, Ceri, Horn, Rachel, Hunt, Jane, Rousseau, Guy, Stancombe, Lucia, Absar, Mohammed, Allsop, Joanne, Drinkwater, Zoe, Hodgkiss, Tracey, Smith, Kirsty, Brown, Jamie, Alexander-Sefre, Farhad, Campey, Lorraine, Dudgeon, Lucy, Hall, Kathryn, Hitchcock, Rachael, James, Lynne, Smith, Kate, Winstone, Ulrika, Ahmad, Norfaizan, Bauchmuller, Kri, Harrison, Jonathan, Jeffery, Holly, Miller, Duncan, Pinder, Angela, Pothuneedi, Sailaja, Rosser, Jonathan, Sanghera, Sumayer, Swift, Diane, Walker, Rachel, Bester, Delia, Cavanagh, Sarah, Cripps, Heather, Daniel, Harvey, Lynch, Julie, Paton, Alison, Pyke, Shirley, Scholefield, John, Whitworth, Helen, Bottrill, Fiona, Ramalingam, Ganesh, Webb, Stephen, Akerman, Nik, Antill, Philip, Bourner, Lynsey, Buckley, Sarah, Castle, Gail, Charles, Rob, Eggleston, Christopher, Foster, Rebecca, Gill, Satwant, Lindley, Kate, Lklouk, Mohamed, Lowery, Tracey, Martin, Oliver, Milne, David, O’Connor, Patrick, Ratcliffe, Andrew, Rose, Alastair, Smith, Annie, Varma, Sandeep, Ward, Jackie, Barcraft-Barnes, Helena, Camsooksai, Julie, Colvin, Carolyn, Reschreiter, Henrik, Tbaily, Lee, Venner, Nicola, Hamilton, Caroline, Kelly, Lewi, Toth-Tarsoly, Piroska, Dodsworth, Kerry, Foord, Denise, Gordon, Paul, Hawes, Elizabeth, Lamb, Nikki, Mouland, Johanna, Nightingale, Jeremy, Rose, Steve, Schrieber, Joe, Al ‘Amri, Khalid, Aladin, Hafiz, Arshad, Mohammed Asif, Barraclough, Jame, Bentley, Conor, Bergin, Colin, Carrera, Ronald, Clarkson, Aisling, Collins, Michelle, Cooper, Lauren, Denham, Samuel, Griffiths, Ewen, Ip, Peter, Jeyanthan, Somasundaram, Joory, Kavita, Kaur, Satwant, Marriott, Paul, Mitchell, Natalie, Nagaiah, Sukumar, Nilsson, Annette, Parekh, Nilesh, Pope, Martin, Seager, Joseph, Serag, Hosam, Tameem, Alifia, Thomas, Anna, Thunder, Joanne, Torrance, Andrew, Vohra, Ravinder, whitehouse, Arlo, Wong, Tony, Blunt, Mark, Wong, Kate, Giles, Julian, Reed, Isabelle, Weller, Debbie, Bell, Gillian, Birch, Julie, Damant, Rose, Maiden, Jane, Mewies, Clare, Prince, Claire, Radford, Jane, Balain, Birender, Banerjee, Robin, Barnett, Andrew, Burston, Ben, Davies, Kirsty, Edwards, Jayne, Evans, Chri, Ford, David, Gallacher, Pete, Hill, Simon, Jaffray, David, Karlakki, Sudheer, Kelly, Cormac, Kennedy, Julia, Kiely, Nigel, Lewthwaite, Simon, Marquis, Chri, Ockendon, Matthew, Phillips, Stephen, Pickard, Simon, Richardson, Jame, Roach, Richard, Smith, Tony, Spencer-Jones, Richard, Steele, Niall, Steen, Julie, Van Liefland, Marck, White, Steve, Faulds, Matthew, Harris, Meredyth, Kelly, Carrie, Nicol, Scott, Pearson, Sally Anne, Chukkambotla, Srikanth, Andrew, Alyson, Attrill, Elizabeth, Campbell, Graham, Datson, Amanda, Fouracres, Anna, Graterol, Juan, Graves, Lynne, Hong, Bosun, Ishimaru, Alexander, Karthikeyan, Arvind, King, Helen, Lawson, Tom, Lee, Gregory, Lyons, Saoirse, Macalister Hall, Andrew, Mathoulin, Sophie, Mcintyre, Eilidh, Mclaughlin, Danny, Mulcahy, Kathleen, Ratcliffe, Anna, Robbins, Jame, Sung, Weilin, Tayo, Adeoluwa, Trembath, Lisa, Venugopal, Suneetha, Walker, Robert, Wigmore, Geoffrey, Boereboom, Catherine, Downes, Charlotte, Humphries, Ryan, Melbourne, Susan, Smith, Coral, Tou, Samson, Ullah, Shafa, Batchelor, Nick, Boxall, Leigh, Broomby, Rupert, Deen, Tariq, Hellewell, Alistair, Helliwell, Laurence, Hutchings, Melanie, Hutchins, David, Keenan, Samantha, Mackie, Donna, Donna, Alison, Smith, France, Stone, Lucy, Thorpe, Kevin, Wassall, Richard, Woodgate, Andrew, Baillie, Shelley, Campbell, Tara, James, Sarah, King, Chri, Marques de Araujo, Daniela, Martin, Daniel, Morkane, Clare, Neely, Julia, Rajendram, Rajkumar, Burton, Megan, James, Kathryn, Keevil, Edward, Minik, Orsolya, Morgan, Jenna, Musgrave, Anna, Rajanna, Harish, Roberts, Tracey, Adamson, Michael, Jumbe, Sandra, Kendall, Jennie, Muthuswamy, Mohan Babu, Anderson, Charlotte, Cruikshanks, Andrew, Wrench, Ian, Zeidan, Lisa, Ardern, Diane, Harris, Benjamin, Hellstrom, Johanna, Martin, Jane, Thomas, Richard, Varsani, Nimu, Wrey Brown, Caroline, Docherty, Philip, Gillies, Michael, McGregor, Euan, Usher, Helen, Craig, Jayne, Smith, Andrew, Ahmad, Tahania, Bodger, Phoebe, Creary, Thai, Fowler, Alexander, Hewson, Ru, Ijuo, Eke, Jones, Timothy, Kantsedikas, Ilya, Lahiri, Sumitra, McLean, Aaron Lawson, Niebrzegowska, Edyta, Phull, Mandeep, Wang, Difei, Wickboldt, Nadine, Baldwin, Jacqueline, Doyle, Donna, Mcmullan, Sean, Oladapo, Michelle, Owen, Thoma, Williams, Alexandra, Daniel, Hull, Gregory, Peter, Husain, Tauqeer, Kirk-Bayley, Justin, Mathers, Edward, Montague, Laura, White, Stuart, Avis, Joanne, Cook, Tim, Dali-Kemmery, Lola, Kerslake, Ian, Lambourne, Victoria, Pearson, Annabel, Boyd, Christine, Callaghan, Mark, Lawson, Cathy, McCrossan, Roopa, Nesbitt, Vanessa, O’connor, Laura, Scott, Julia, Sinclair, Rhona, Farid, Nahla, Morgese, Ciro, Bhatia, Kailash, Karmarkar, Swati, Ahmed, Jamil, Branagan, Graham, Hutton, Monica, Swain, Andrew, Brookes, Jamie, Cornell, Jonathan, Dolan, Rachael, Hulme, Jonathan, Jansen van Vuuren, Amanda, Jowitt, Tom, Kalashetty, Gunasheela, Lloyd, Fran, Patel, Kiran, Sherwood, Nichola, Brown, Lynne, Chandler, Ben, Deighton, Kerry, Emma, Temlett, Haunch, Kirsty, Cheeseman, Michelle, Dent, Kathy, Garg, Sanjeev, Gray, Carol, Hood, Marion, Jones, Dawn, Juj, Joanne, Rao, Roshan, Walker, Tara, Al Anizi, Mashel, Cheah, Clarissa, Cheing, Yushio, Coutinho, Francisco, Gondo, Prisca, Hadebe, Bernard, Onie Hove, Mazvangu, khader, Ahamed, Krishnachetty, Bobby, Rhodes, Karen, Sokhi, Jagdish, Baker, Katie-Anne, Bertram, Wendy, Looseley, Alex, Mouton, Ronelle, Arnold, Glenn, Arya, Shobhit, Balfoussia, Danai, Baxter, Linden, Harris, Jame, Jones, Craig, Knaggs, Alison, Markar, Sheraz, Perera, Anisha, Scott, Alasdair, Shida, Asako, Sirha, Ravneet, Wright, Sally, Frost, Victoria, Gray, Catherine, MacGregor, Mark, Andrews, Emma, Arrandale, Lindsay, Barrett, Stephen, Cifra, Elna, Cooper, Mariese, Dragnea, Drago, Elna, Cifra, Maclean, Jennifer, Meier, Sonja, Milliken, Donald, Munns, Christopher, Ratanshi, Nadir, Salvana, Abegail, Watson, Anthony, Ali, Hani, Campbell, Gill, Critchley, Rebecca, Hicks, Catherine, Liddle, Alison, Pass, Marc, Ritchie, Charlotte, Thomas, Charlotte, Too, Lingxi, Welsh, Sarah, Gill, Talvinder, Johnson, Joanne, Reed, Joanne, Davis, Edward, Papadopoullos, Sam, Attwood, Clare, Biffen, Andrew, Boulton, Kerenza, Gray, Sophie, Hay, David, Mills, Sarah, Montgomery, Jane, Riddell, Rory, Simpson, Jame, Bhardwaj, Neeraj, Paul, Elaine, Uwubamwen, Nosakhare, Alexander, Maini, Arrich, Jame, Arumugam, Swarna, Blackwood, Dougla, Boggiano, Victoria, Brown, Robyn, Lam Chan, Yik, Chatterjee, Devnandan, Chhabra, Ashok, Christian, Rachel, Costelloe, Hannah, Coxwell Matthewman, Madeline, Dalton, Emma, Darko, Julia, Davari, Maria, Dave, Tejal, Deacon, Matthew, Deepak, Shantal, Edmond, Holly, Ellis, Jessica, El-Sayed, Ahmed, Eneje, Philip, English, Rose, Ewe, Renee, Foers, William, Franklin, John, Gallego, Laura, Garrett, Emily, Goldberg, Olivia, Goss, Harry, Greaves, Rosanna, Harris, Rudy, Hennings, Charle, Jones, Eleanor, Kamali, Nelson, Kokkinos, Naomi, Lewis, Cary, Lignos, Leda, Malgapo, Evaleen Victoria, Malik, Rizwana, Milne, Andrew, Mulligan, John-Patrick, Nicklin, Philippa, Palipane, Natasha, Parsons, Thoma, Piper, Rebecca, Prakash, Rohan, Ramesh, Byron, Rasip, Sarah, Reading, Jacob, Rela, Mariam, Reyes, Anna, Robert, Stephen, Rooms, Martin, Shah, Karishma, Simons, Henry, Solanki, Shalil, Spowart, Emma, Stevens, Amy, Thomas, Christopher, Waggett, Helena, Yassaee, Arrash, Kennedy, Anthony, Scott, Sara, Somanath, Sameer, Berg, Andrew, Hernandez, Miguel, Nanda, Rajesh, Tank, Ghanshyambhai, Wilson, Natalie, 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A., Klarin, B., Ögren, K., Barras, J.P., Bührer, T., Despotidis, V., Helmy, N., Holliger, S., Raptis, D.A., Schmid, R., Meyer, A., Jaquet, Y., Kessler, U., Muradbegovic, M., Nahum, S.R., Rotunno, T., Schiltz, B., Voruz, F., Worreth, M., Christoforidis, D., Popeskou, S.G., Furrer, M., Prevost, G.A., Stocker, A., Lang, K., Breitenstein, S., Ganter, M.T., Geisen, M., Soll, C., Korkmaz, M., Lubach, I., Schmitz, M., Meyer Zu Schwabedissen, M., Zingg, U., Hillermann, T., Wildi, S., Pinto, B.B., Walder, B., Hübner, M., Mariotti, G., Slankamenac, K., Namuyuga, M., Kyomugisha, E., Kituuka, O., Wesonga Shikanda, A., Kakembo, N., Otim Tom, C., Webombesa, A., Bua, E., Ssettabi, E.M., Epodoi, J., Kabagenyi, F., Kirya, F., Dempsey, G., Seasman, C., Basit Nawaz Khan, R., Kurasz, C., Macgregor, M., Shawki, B., Hariharan, V., Chau, S., Ellis, K., Butt, G., Chicken, D.W., Christmas, N., Allen, S., Daniel, G.D., Dempster, A., Kemp, J., Matthews, L., Mcglone, P., Tambellini, J., Trodd, D., Freitas, K., Garg, A., Karpate, S., O'Hara, C., Troko, J., Angus, K., Bradley, J., Brennan, E., Brooks, C., Brown, J., Brown, G., Finch, A., Gratrix, K., Hesketh, S., Hill, G., Jeffs, C., Morgan, M., Pemberton, C., Slawson, N., Spickett, H., Swarbrick, G., Van Duyvenvoorde, G., Brennan, A., Briscoe, R., Cooper, S., Lawton, T., Northey, M., Senaratne, R., Stanworth, H., Burrows, L., Cain, H., Craven, R., Davies, K., Jonas, A., Pachucki, M., Walkden, G., Davies, H., Gudaca, M., Hobrok, M., Arawwawala, D., Fergey, L., Gardiner, M., Gunn, J., Johnson, L., Lofting, A., Lyle, A., Mc Neela, F., Smolen, S., Topliffe, J., Williams, S., Bland, M., Kaura, V., Lanka, P., Naylor, C., Ahmed, A., Myatt, J., Shenoy, R., Soon, W.C., Tan, J., Karadia, S., Self, J., Durant, E., Tripathi, S., Bullock, C., Ghosh, A., Hughes, T., Zsisku, L., Bengeri, S., Cowton, A., Khalid, M.S., Limb, J., McAdam, C., Porritt, M., Rafi, M.A., Shekar, P., Harden, C., Hollands, H., King, A., March, L., Minto, G., Patrick, A., Waugh, D., Kumara, P., Simeson, K., Yarwood, J., Browning, J., Hatton, J., Julian, H., Mitra, A., Newton, M., Pernu, P., Wilson, A., Commey, T., Foot, H., Glover, L., Gupta, A., Lancaster, N., Levin, J., Mackenzie, F., Mestanza, C., Nofal, E., Pout, L., Varden, R., Wild, J., Jones, S., Moreton, S., Pulletz, M., Davies, C., Martin, M., Thomas, S., Burns, K., McArthur, C., Patel, P., Lau, G., Rich, N., Davis, F., Lyons, R., Port, B., Prout, R., Smith, C., Adelaja, Y., Bennett, V., Bidd, H., Dumitrescu, A., Murphy, J.F., Keen, A., Mguni, N., Ong, C., Adams, G., Boshier, P., Brown, R., Butryn, I., Chatterjee, J., Freethy, A., Lockwood, G., Tsakok, M., Tsiligiannis, S., Peat, W., Stephenson, L., Bradburn, M., Pick, S., Cunha, P., Olagbaiye, O., Tayeh, S., Abernethy, C., Balasubramaniam, M., Bennett, R., Bolton, D., Martinson, V., Bell, S., Heather, B., Kushakovsky, V., Alcock, L., Alexander, H., Anderson, C., Baker, P., Brookes, M., Cawthorn, L., Cirstea, E., Colling, K., Coulter, I., Das, S., Haigh, K., Hamdan, A., Hugill, K., Kottam, L., Lisseter, E., Mawdsley, M., McGivern, J., Padala, K., Phelps, V., Kumar, V.R., Stewart, K., Towse, K., Tregonning, J., Vahedi, A., Walker, A., Baines, D., Bilolikar, A., Chande, S., Copley, E., Dunk, N., Kulkarni, R., Kumar, P., Metodiev, Y., Ncomanzi, D., Raithatha, B., Raymode, P., Szafranski, J., Twohey, L., Watt, P., Weatherall, L., Whitman, Z., Wighton, E., Abayasinghe, C., Chan, A., Darwish, S., Gill, J., Glasgow, E., Hadfield, D., Harris, C., Kochhar, A., Mellis, C., Pool, A., Riozzi, P., Selman, A., Smith, E.J., Vele, L., Gercek, Y., Guy, K., Holden, D., Watson, N., Whysall, K., Andreou, P., Hales, D., Thompson, J., Bowrey, S., McDonald, S., Gilmore, J., Hills, V., Kelly, C., Kelly, S., Lloyd, G., Abbott, T., Gall, L., Torrance, H., Vivian, M., Berntsen, E., Nolan, T., Turner, A., Vohra, A., Brown, A., Clark, R., Coughlan, E., Daniel, C., Patvardhan, C., Pearson, R., Predeep, S., Saad, H., Shanmugam, M., Varley, S., Wylie, K., Cooper, L., Makowski, A., Misztal, B., Moldovan, E., Pegg, C., Donovan, A., Foot, J., Large, S., Claxton, A., Netke, B., Armstrong, R., Calderwood, C., Kwok, A., Mohr, O., Oyeniyi, P., Patnaik, L., Post, B., Ali, S., Arshad, H., Baker, G., Brenner, L., Brincat, M., Brunswicker, A., Cox, H., Cozar, O.I., Durst, A., Fengas, L., Flatt, J., Glister, G., Narwani, V., Photi, E., Rankin, A., Rosbergen, M., Beaton, C., Horn, R., Hunt, J., Rousseau, G., Stancombe, L., Absar, M., Allsop, J., Drinkwater, Z., Hodgkiss, T., Smith, K., Alexander-Sefre, F., Campey, L., Dudgeon, L., Hall, K., Hitchcock, R., James, L., Winstone, U., Ahmad, N., Bauchmuller, K., Harrison, J., Jeffery, H., Miller, D., Pinder, A., Pothuneedi, S., Rosser, J., Sanghera, S., Swift, D., Walker, R., Bester, D., Cavanagh, S., Cripps, H., Daniel, H., Lynch, J., Pyke, S., Scholefield, J., Whitworth, H., Bottrill, F., Ramalingam, G., Webb, S., Akerman, N., Antill, P., Bourner, L., Buckley, S., Castle, G., Charles, R., Eggleston, C., Foster, R., Gill, S., Lindley, K., Lklouk, M., Lowery, T., Martin, O., Milne, D., O'Connor, P., Ratcliffe, A., Rose, A., Smith, A., Varma, S., Ward, J., Barcraft-Barnes, H., Camsooksai, J., Colvin, C., Reschreiter, H., Tbaily, L., Venner, N., Hamilton, C., Kelly, L., Toth-Tarsoly, P., Dodsworth, K., Foord, D., Gordon, P., Hawes, E., Lamb, N., Mouland, J., Nightingale, J., Rose, S., Schrieber, J., Al 'Amri, K., Aladin, H., Arshad, M.A., Barraclough, J., Bentley, C., Bergin, C., Carrera, R., Clarkson, A., Collins, M., Denham, S., Griffiths, E., Ip, P., Jeyanthan, S., Joory, K., Kaur, S., Marriott, P., Mitchell, N., Nagaiah, S., Nilsson, A., Parekh, N., Pope, M., Seager, J., Serag, H., Tameem, A., Thomas, A., Thunder, J., Torrance, A., Vohra, R., Whitehouse, A., Wong, T., Blunt, M., Wong, K., Giles, J., Reed, I., Weller, D., Bell, G., Birch, J., Damant, R., Maiden, J., Mewies, C., Prince, C., Radford, J., Balain, B., Banerjee, R., Barnett, A., Burston, B., Edwards, J., Evans, C., Ford, D., Gallacher, P., Hill, S., Jaffray, D., Karlakki, S., Kennedy, J., Kiely, N., Lewthwaite, S., Marquis, C., Ockendon, M., Phillips, S., Pickard, S., Richardson, J., Roach, R., Smith, T., Spencer-Jones, R., Steele, N., Steen, J., Van Liefland, M., White, S., Faulds, M., Harris, M., Nicol, S., Pearson, S.A., Chukkambotla, S., Andrew, A., Attrill, E., Campbell, G., Datson, A., Fouracres, A., Graterol, J., Graves, L., Hong, B., Ishimaru, A., Karthikeyan, A., King, H., Lawson, T., Lee, G., Lyons, S., Macalister Hall, A., Mathoulin, S., Mcintyre, E., Mclaughlin, D., Mulcahy, K., Robbins, J., Sung, W., Tayo, A., Trembath, L., Venugopal, S., Wigmore, G., Boereboom, C., Downes, C., Humphries, R., Melbourne, S., Tou, S., Ullah, S., Batchelor, N., Boxall, L., Broomby, R., Deen, T., Hellewell, A., Helliwell, L., Hutchings, M., Hutchins, D., Keenan, S., Mackie, D., Donna, A., Smith, F., Stone, L., Thorpe, K., Wassall, R., Woodgate, A., Baillie, S., Campbell, T., James, S., King, C., Marques de Araujo, D., Martin, D., Morkane, C., Neely, J., Rajendram, R., Burton, M., James, K., Keevil, E., Minik, O., Morgan, J., Musgrave, A., Rajanna, H., Roberts, T., Adamson, M., Jumbe, S., Kendall, J., Muthuswamy, M.B., Cruikshanks, A., Wrench, I., Zeidan, L., Ardern, D., Harris, B., Hellstrom, J., Martin, J., Thomas, R., Varsani, N., Wrey Brown, C., Docherty, P., Gillies, M., McGregor, E., Usher, H., Craig, J., Ahmad, T., Bodger, P., Creary, T., Fowler, A., Ijuo, E., Jones, T., Kantsedikas, I., Lahiri, S., McLean, A.L., Niebrzegowska, E., Phull, M., Wickboldt, N., Baldwin, J., Doyle, D., Mcmullan, S., Oladapo, M., Owen, T., Williams, A., Gregory, P., Husain, T., Kirk-Bayley, J., Mathers, E., Montague, L., Avis, J., Cook, T., Dali-Kemmery, L., Kerslake, I., Lambourne, V., Pearson, A., Boyd, C., Callaghan, M., Lawson, C., McCrossan, R., Nesbitt, V., O'connor, L., Sinclair, R., Farid, N., Morgese, C., Bhatia, K., Karmarkar, S., Ahmed, J., Branagan, G., Hutton, M., Swain, A., Brookes, J., Cornell, J., Dolan, R., Hulme, J., Jansen van Vuuren, A., Jowitt, T., Kalashetty, G., Lloyd, F., Patel, K., Sherwood, N., Brown, L., Chandler, B., Deighton, K., Emma, T., Haunch, K., Cheeseman, M., Dent, K., Gray, C., Hood, M., Jones, D., Juj, J., Rao, R., Walker, T., Al Anizi, M., Cheah, C., Cheing, Y., Coutinho, F., Gondo, P., Hadebe, B., Onie Hove, M., Khader, A., Krishnachetty, B., Rhodes, K., Sokhi, J., Baker, K.A., Bertram, W., Looseley, A., Mouton, R., Arnold, G., Arya, S., Balfoussia, D., Baxter, L., Harris, J., Jones, C., Knaggs, A., Markar, S., Perera, A., Scott, A., Shida, A., Sirha, R., Wright, S., Frost, V., MacGregor, M., Andrews, E., Arrandale, L., Barrett, S., Cifra, E., Cooper, M., Dragnea, D., Elna, C., Maclean, J., Meier, S., Milliken, D., Munns, C., Ratanshi, N., Salvana, A., Watson, A., Ali, H., Critchley, R., Hicks, C., Liddle, A., Pass, M., Ritchie, C., Thomas, C., Too, L., Welsh, S., Gill, T., Johnson, J., Reed, J., Davis, E., Papadopoullos, S., Attwood, C., Biffen, A., Boulton, K., Gray, S., Hay, D., Mills, S., Montgomery, J., Riddell, R., Simpson, J., Bhardwaj, N., Paul, E., Uwubamwen, N., Alexander, M., Arrich, J., Arumugam, S., Blackwood, D., Boggiano, V., Lam Chan, Y., Chatterjee, D., Chhabra, A., Christian, R., Costelloe, H., Coxwell Matthewman, M., Dalton, E., Darko, J., Davari, M., Dave, T., Deacon, M., Deepak, S., Edmond, H., Ellis, J., El-Sayed, A., Eneje, P., English, R., Ewe, R., Foers, W., Franklin, J., Gallego, L., Garrett, E., Goldberg, O., Goss, H., Greaves, R., Harris, R., Hennings, C., Jones, E., Kamali, N., Kokkinos, N., Lewis, C., Lignos, L., Malgapo, E.V., Malik, R., Milne, A., Mulligan, J.P., Nicklin, P., Palipane, N., Parsons, T., Piper, R., Prakash, R., Ramesh, B., Rasip, S., Reading, J., Rela, M., Reyes, A., Robert, S., Rooms, M., Shah, K., Simons, H., Solanki, S., Spowart, E., Stevens, A., Waggett, H., Yassaee, A., Kennedy, A., Scott, S., Somanath, S., Berg, A., Hernandez, M., Nanda, R., Tank, G., Wilson, N., Wilson, D., Al-Soudaine, Y., Baldwin, M., Cornish, J., Davies, Z., Davies, L., Edwards, M., Frewer, N., Gallard, S., Glasbey, J., Harries, R., Hopkins, L., Kim, T., Koompirochana, V., Lawson, S., Lewis, M., Makzal, Z., Scourfield, S., Ahmad, Y., Bates, S., Blackwell, C., Bryant, H., Coulter, S., Cruickshank, R., Daniel, S., Daubeny, T., Golder, K., Hawkins, L., Helen, B., Hinxman, H., Levett, D., Skinner, B., Walsgrove, J., Dickson, J., Constantin, K., Karen, M., O'Brien, P., O'Donohoe, L., Payne, H., Sundayi, S., Walker, E., Brooke, J., Cardy, J., Humphreys, S., Kessack, L., Kubitzek, C., Kumar, S., Cotterill, D., Hodzovic, E., Hosdurga, G., Miles, E., Saunders, G., Campbell, M., Chan, P., Jemmett, K., Raj, A., Naik, A., Ramamoorthy, R., Shah, N., Sylvan, A., Blyth, K., Burtenshaw, A., Freeman, D., Johnson, E., Lo, P., Martin, T., Plunkett, E., Wollaston, J., Allison, J., Carroll, C., Craw, N., Craw, S., Pitt-Kerby, T., Rowland-Axe, R., Spurdle, K., McDonald, A., Simon, D., Sinha, V., Banner-Goodspeed, V., Boone, M., Campbell, K., Lu, F., Scannell, J., Sobol, J., Balajonda, N., Clemmons, K., Conde, C., Funk, B., Hopkins, T., Olaleye, O., Omer, O., Pender, M., Porto, A., Waweru, P., Yeh, E., Bodansky, D., Evans, A., Kleopoulos, S., Maril, R., Mathney, E., Sanchez, A., Tinuoye, E., Bateman, B., Eng, K., Jiang, N., Ladha, K., Needleman, J., Chen, L.L., Lane, R., Robinowitz, D., Ghushe, N., Irshad, M., Patel, S., Takemoto, S., Wallace, A., Mazzeffi, M., Rock, P., Wallace, K., Zhu, X., Chua, P., Mattera, M., Sharar, R., Thilen, S., Treggiari, M., Morgan, A., Sofjan, I., Subramaniam, K., Avidan, M., Maybrier, H., Muench, M., and Wildes, T.
Subjects: Male, HSJ UCI, Critical Care and Intensive Care Medicine, law.invention, Perioperative Care/methods, 0302 clinical medicine, Surgical procedures, 030202 anesthesiology, law, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, statistics and numerical data, Prospective Studies, Postoperative Period, Postoperative care/methods, education.field_of_study, Postoperative care/method, Elective Surgical Procedures/mortality, fluid output, Middle Aged, fluid administration, Intensive care unit, Hospitalization, Length of Stay/statistics & numerical data, operative/mortality, Intensive Care Units/statistics & numerical data, outcome, Female, Elective Surgical Procedure, Human, Adult, medicine.medical_specialty, Logistic Model, Postoperative care/statistics and numerical data, Critical care/utilisation, Population, Intensive Care Unit, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, Humans, Logistic Models, Surgical procedures, operative/mortality, Postoperative care, methods, Perioperative Care, NO, 03 medical and health sciences, Anesthesiology, Intensive care, medicine, Elective surgery, Intensive care medicine, education, business.industry, 030208 emergency & critical care medicine, Perioperative, Length of Stay, Clinical trial, Prospective Studie, septic shock, business
Abstract: PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. CONCLUSIONS: We did not identify any survival benefit from critical care admission following surgery. info:eu-repo/semantics/publishedVersion
Published: 2017
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33. Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

Author: Siobhan MacHale, Elizabeth Barrett, Maurice Clancy, Katherine McEvoy, Anne M. Doherty, Elaine Greene, William Lee, Rosie Plunkett, Eric Kelleher, and Eugene M. Cassidy
Subjects: Psychiatry, hospital psychiatry, business.industry, Cross-sectional study, RC435-571, Specialty, Staffing, Emergency department, medicine.disease, Mental health, Proxy (climate), Psychiatry and Mental health, liaison psychiatry, Work (electrical), consultation-liaison (C-L) psychiatry, Liaison psychiatry, Medicine, Medical emergency, health services research [MeSH], business, Ireland, mental health, Original Research
Abstract: Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.
Published: 2021
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34. Long-term outcomes of adults with acute respiratory failure treated with veno-venous extracorporeal membrane oxygenation

Author: Timothy J Southwood, Emma L. Gray, Paul J. Torzillo, Brian T Plunkett, Paul Forrest, and Richard Totaro
Subjects: Adult, Male, Respiratory Distress Syndrome, business.industry, medicine.medical_treatment, Medical record, Australia, Critical Care and Intensive Care Medicine, Anesthesiology and Pain Medicine, Extracorporeal Membrane Oxygenation, Respiratory failure, Quality of life, Anesthesia, Extracorporeal membrane oxygenation, medicine, Humans, Respiratory system, business, Respiratory Insufficiency, Survival rate, Body mass index, Depression (differential diagnoses), Retrospective Studies
Abstract: Veno-venous extracorporeal membrane oxygenation is increasingly used for severe but potentially reversible acute respiratory failure in adults; however, there are limited data regarding long-term morbidity. At our institution, most patients requiring veno-venous extracorporeal membrane oxygenation have been followed up by a single physician. Our primary aim was to describe the serial long-term morbidity for respiratory, musculoskeletal and psychological functioning. A retrospective audit of inpatient and outpatient medical records was conducted. A total of 125 patients treated with veno-venous extracorporeal membrane oxygenation for primary respiratory failure were included. The patients were young (mean (standard deviation) age 43.7 (4.1) years), obese (mean (standard deviation) body mass index 30.8 (10.4) kg/m2), and mostly were male (59%). Most patients (60%) had no comorbidities. The survival rate to discharge was 70%, with body mass index and the number of comorbidities being independent predictors of survival on multiple logistic regression analysis. Over half (57%) of the Australian survivors had regular outpatient follow-up. They had a median of three reviews (range 1–9) over a median of 11.8 months (range 1.5-79) months. Breathlessness and weakness resolved in most within six months, with lung function abnormalities taking longer to resolve. Over half (60%) returned to employment within six months of discharge. Over a quarter (29%) displayed symptoms of anxiety, depression or post-traumatic stress disorder.
Published: 2021

35. Nucleoside Analogs: Cellular Pharmacology, Mechanisms of Action, and Strategies for Combination Therapy

Author: Varsha Gandhi and William Plunkett
Subjects: Cellular pharmacology, Action (philosophy), Combination therapy, Nucleoside analogue, Chemistry, medicine, Pharmacology, medicine.drug
Published: 2021
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36. Non-diphtheriae Corynebacterium species are associated with decreased risk of pneumococcal colonization during infancy

Author: Andrew P. Steenhoff, Rebecca R Young, Samir S. Shah, Jhoanna N. Aquino, Jillian H. Hurst, Catherine H. Plunkett, Matthew S. Kelly, Tirayaone Leburu, Sweta M. Patel, Mohamed Z. Patel, Sefelani Boiditswe, Coleen K. Cunningham, Marek Smieja, John F. Rawls, Patrick C. Seed, Yahe Yu, Tiny Mazhani, Jayanth Jawahar, Christopher R. Polage, Kristen A. Feemster, and Tonya Arscott-Mills
Subjects: medicine.drug_class, Antibiotics, Corynebacterium, Colonisation resistance, medicine.disease_cause, Microbiology, Article, Pneumococcal Infections, Nasopharynx, Streptococcus pneumoniae, medicine, Humans, Colonization, Microbiome, Child, Ecology, Evolution, Behavior and Systematics, biology, Microbiota, Infant, biology.organism_classification, medicine.disease, Pneumococcal infections, medicine.anatomical_structure, Respiratory tract
Abstract: Streptococcus pneumoniae (pneumococcus) is a leading cause of severe infections among children and adults. Interactions between commensal microbes in the upper respiratory tract and S. pneumoniae are poorly described. In this study, we sought to identify interspecies interactions that modify the risk of S. pneumoniae colonization during infancy and to describe development of the upper respiratory microbiome during infancy in a sub-Saharan African setting. We collected nasopharyngeal swabs monthly (0-6 months of age) or bimonthly (6-12 months of age) from 179 mother-infant dyads in Botswana. We used 16S ribosomal RNA gene sequencing to characterize the nasopharyngeal microbiome and identified S. pneumoniae colonization using a species-specific PCR assay. We detect S. pneumoniae colonization in 144 (80%) infants at a median age of 71 days and identify a strong negative association between the relative abundance of the bacterial genera Corynebacterium within the infant nasopharyngeal microbiome and the risk of S. pneumoniae colonization. Using in vitro cultivation experiments, we demonstrate growth inhibition of S. pneumoniae by secreted factors from strains of several Corynebacterium species isolated from these infants. Finally, we demonstrate that antibiotic exposures and the winter season are associated with a decline in the relative abundance of Corynebacterium within the nasopharyngeal microbiome, while breastfeeding is associated with an increase in the Corynebacterium relative abundance. Our findings provide novel insights into the interspecies interactions that contribute to colonization resistance to S. pneumoniae and suggest that the nasopharyngeal microbiome may be a previously unrecognized mechanism by which environmental factors influence the risk of pneumococcal infections during childhood. Moreover, this work lays the foundation for future studies seeking to use targeted manipulation of the nasopharyngeal microbiome to prevent infections caused by S. pneumoniae.
Published: 2021

37. Baseline Prevalence of Trachoma in Refugee Settlements in Uganda: Results of 11 Population-based Surveys

Author: Elizabeth Plunkett, Sarah Boyd, Ana Bakhtiari, Wangeci Thuo, Martin K Osilo, Patrick Turyaguma, Jeremiah Ngondi, Alfred Mubangizi, Stella Agunyo, Darlson Kusasira, Binta Kahwa, Michael T. French, Gilbert Baayenda, Edridah M. Tukahebwa, Francis Mugume, Aryc Mosher, Anthony W. Solomon, Robert Butcher, Ben Binagwa, Sarah Byakika, Emma M. Harding-Esch, and Kathryn Crowley
Subjects: medicine.medical_specialty, education.field_of_study, Sanitation, Epidemiology, business.industry, Public health, media_common.quotation_subject, Population, medicine.disease, Ophthalmology, Trachoma, Hygiene, Environmental health, parasitic diseases, medicine, Neglected tropical diseases, Latrine, education, business, Trichiasis, media_common
Abstract: PURPOSE: There are several settlements in the Northern and Western Regions of Uganda serving refugees from South Sudan and Democratic Republic of Congo (DRC), respectively. Trachoma prevalence surveys were conducted in a number of those settlements with the aim of determining whether interventions for trachoma are required. METHODS: An evaluation unit (EU) was defined as all refugee settlements in one district. Cross-sectional population-based trachoma prevalence survey methodologies designed to adhere to World Health Organization recommendations were deployed in 11 EUs to assess prevalence of trachomatous inflammation-follicular (TF) in 1-9-year-olds and trachomatous trichiasis (TT) unknown to the health system in ≥15-year-olds. Household-level water, sanitation and hygiene coverage was also assessed in study populations. RESULTS: A total of 40,892 people were examined across 11 EUs between 2018 and 2020. The prevalence of TF in 1-9-year-olds was
Published: 2021

38. Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Author: Thomas M. Drake, Matthew J. Lee, Adele E. Sayers, John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Mike Bradburn, Michael Davies, Zaed Hamady, Daniel Hind, Marianne Hollyman, Sarah Hare, Ellen Lee, John Northover, Christopher Lewis, Paul J. Marriott, Nick Maynard, Malcolm McFall, Aravinth Muragananthan, David Murray, Pritam Singh, Gillian Tierney, Azmina Verjee, Ciaran Walsh, Jonathan RL. Wild, Timothy Wilson, S. Abbott, Y. Abdulaal, S. Afshar, M. Akhtar, D. Anderson, S. Appleton, D. Bandyopadhyay, G. Bashir, N. Behar, S. Bhandari, G. Branagan, R. Boulton, C. Borg, G. Bouras, J. Boyle, H. Brewer, L. Brown, C. Briggs, M. Cartmell, S. Chan, N. Chandratreya, P. Conaghan, J. Cornish, D. Cotton, P. Coyne, J. Crozier, T. Cook, P. Cunha, N. Curtis, A. Day, S. Dayal, R. Dennis, P. Dent, H. Dowson, R. Fallaize, S. Farag, M. El Farran, G. Faulkner, P. Giordano, T. Grey, V. Halahakoon, J. Hannay, A. Harikrishnan, S. Holtham, P. Hawkin, C. Hall, L. Hancock, J. Hartley, F. Howse, R. Kallam, G. Kakaniaris, S. Kelly, S. Lockwood, D. Leinhardt, B. Levy, R. Lal, T. Lazim, J. Lund, R. Lunevicius, P. Mathur, K. Maude, D. McArthur, B. McIlroy, A. Miles, S. Moug, M. Mondragon-Pritchard, D. Messenger, M. Mullan, A. Myers, K. Muhammad, C. Mason, J. Sarveswaran, V. Shatkar, B. Singh, B. Skelly, S. Subramonia, M. Swinscoe, B. Thava, C. Thorn, S. Panagiotopoulos, P. Patel, J. Phillips, I. Peristerakis, A. Qureshi, M. Saunders, P. Shah, A. Sheel, S. Siddiqui, P. Skaife, N. Smart, I. Smith, L. Stevenson, N. Stylianides, J. Steinke, B. Stubbs, R. Thompson, M. Varcada, D. Vimalachandran, I. Virlos, J. Watfah, N. Watson, M. Walker, N. Ventham, H. West, J. Wilson, S. Wijeyekoon, J. Ah-Chuen, T. Ahmed, F. Akram, E. Aldred, A. Ali, M. Aly, A. Amajuoyi, V. Amin, A. Andreou, A. Ansari, R. Ardley, F. Arshad, O. Ashour, A. Asour, F. Ayoub, H. Azeem, B. Azhar, C. Baillie, J. Barker, B. Barkham, R. Baron, J. Barrie, E. Barry-Yarrow, N. Battersby, G. Bazoua, C. Berger, S. Bhasin, S. Biggs, C. Bisset, N. Blencowe, A. Boddy, C. Boereboom, M. Bogdan, R. Bogle, P. Bohra, H. Bolkan, M. Boyer, J. Broadhurst, E. Brown, J. Brown, K. Burns, K. Butcher, C. Capper, T. Cash, J. Chapman, S. Chapman, A. Charalabopoulos, C. Cheek, S. Chok, W. Choong, J. Chowdhury, P. Coe, G. Conn, N. Cook, S. Cooper, C. Cox, R. Crook, G. Cuffolo, L. da Silva, B. Das, M. Davenport, J. Davies, T. Davies, S. Dean, G. Demetriou, F. Dengu, H. Dent, G. Di Benedetto, S. Dindyal, E. Donnelly, E. Douka, C. Downham, H. Edent, K. Edgerton, M. El-Sharif, O. Elamin, N. Elsaid, J. Evans, M. Evans, R. Ewe, A. Ewing, H. Ferguson, O. Fisher, J. Fletcher, A. Forouzanfar, A. Foster, R. Fox, N. Francis, V. Fretwell, D. Fung, E. Gammeri, J. Garnham, A. Geraghty, A. Gilbert, M. Gill, M. Gillespie, J. Glasbey, A. Golder, N. Green, E. Groundwater, T. Grove, H. Habib, J. Haddow, C. Halkias, A. Hampson, T. Hanna, R. Harries, K. Harvey, J. Hawkins, R. Healy, R. Heartshorne, S. Heller, L. Hendra, P. Herrod, N. Heywood, G. Hicks, P. Ng, C. Hope, P. Hopley, T. Hossain, S. Hossaini, T. Hubbard, A. Humphreys, H. Ikram, M. Ioannis, M. Iqbal, J. Jatania, P. Jenkinson, S. Jokhan, A. Jones, C. Jones, L. Jones, H. Joshi, K. Joshi, M. Joy, P. Jull, E. Kane, R. Kanitkar, S. Kauser, F. Kazmi, M. Kedrzycki, J. Kendall, T. Khan, G. King, A. Kisiel, C. Kitsis, I. Kolawole, S. Kosasih, A. Kosti, A. Kotb, A. Lau, G. Lafaurie, A. Lazzaro, R. Lefroy, H. Lennon, K. Leong, E. Lim, J. Lim, S. Lindley, D. Liu, P. Lloyd, D. Locker, C. Lowe, A. Lunt, S. Lutfi, A. Luther, S. Luwemba, P. Mahankali-Rao, D. Mai, S. Majid, A. Malik, N. Manu, R. Mapara, C. Martin, J. Martin, L. Massey, J. Mathias, S. McCain, S. McCluney, A. McNair, P. Mekhail, J. Merchant, L. Merker, S. Mir, P. Mistry, V. Miu, M. Moat, E. Mohamed, I. Mohamed, N. Moore, L. Moretti, H. Morris, T. Morrison, J. Moss, D. Mountford, R. Moynihan, D. Muldoon-Smith, J. Mulholland, E. Murgitroyd, K. Murugaiyan, I. Mykoniatis, G. Nana, T. Nash, A. Nassar, R. Newton, K. Nguyen, F. Nicholas, M. Noor, J. Nowers, C. Nugent, A. Nunn, J. O'Callaghan, R. O'Hara, A. O'Neill, J. Olivier, D. Osei-Bordom, L. Osgood, B. Panchasara, R. Parks, H. Patel, K. Pawelec, C. Payne, K. Pearson, G. Perin, B. Petronio, L. Phelan, C. Pisaneschi, J. Pitt, L. Ponchietti, A. Powell, A. Powell-Chandler, N. Pranesh, V. Proctor, N. Qureshi, M. Rahman, Z. Rai, S. Ramcharan, K. Rangarajan, M. Rashid, H. Reader, A. Rehman, S. Rehan, C. Rengifo, N. Richardson, A. Robinson, D. Robinson, B. Rossi, F. Rutherford, I. Sadien, T. Saghir, K. Sahnan, G. Salahia, B. Scott, K. Scott, A. Seager, S. Seal, E. Sezen, F. Shaban, M. Shahmohammadi, A. Shamsiddinova, S. Shankar, A. Sharpe, T. Shields, M. Shinkwin, J. Shurmer, A. Siddika, R. Simson, S. Singh, J. Sivaraj, A. Skinner, C. Smart, F. Smith, R. Smith, A. Sreedhar, E. Stewart-Parker, M. Stott, N. Symons, T. Taj, J. Tam, K. Tan, S. Tani, D. Tao, K. Thippeswamy, C. Thomas, E. Thompson, C. Thompson-Reil, F. Tongo, G. Toth, A. Turnbull, J. Turnbull, T. Wade, A. Wafi, K. Waite, N. Walker, T. Walker, U. Walsh, S. Wardle, R. Warner, J. Watt, J. Watts, J. Wayman, C. Weegenaar, M. West, M. Whyler, L. Whitehurst, M. Wiggans, G. Williams, R. Williams, A. Williamson, J. Williamson, A. Winter, L. Wolpert, J. Wong, G. van Boxel, E. Yeap, S. Zaman, B. Zappa, D. Zosimas, O. Anderson, A. Athem, M. Athersmith, T. Badenoch, S. Barker, S. Bellam, T. Boam, M. Boland, L. Blake, O. Brown, M. Butler, B. Byrne, L. Campbell, M. Chow, K. Da Costa, J. Cutting, M. Deputy, L. Devoto, P. Doody, N. Ekpete, M. Eljaafari, K. Exarchou, M. Faoury, E. Farinella, C. Gill, M. Goh, T. Gregoir, S. Growcott, S. Gunasekaran, G. Harris, R. Heard, B. Hobson, N. Iqbal, R. Jain, P. Kang, M. Khan, S. Korambayil, S. Kouris, K. Kshatriya, S. Kumar, K. Lee, S. Mahroof, K. Malik, K. Mann, S. Mansour, R. Martin, S. McKay, N. McKinley, D. McWhirter, K. Mellor, A. Mishra, K. Mockford, V. Morrison-Jones, C. Ng, R. Nunn, S. O'Neill, O. Oke, N. Obeid, R. Patel, S. Patel, K. Plunkett-Reed, M. Pouzi, S. Pywell, E. Richards, P. Sinclair, N. Slim, G. Spence, M. Swinkin, W. Tahir, K. Takacs, N. Tanner, M. Taylor, C. Valero, M. Venn, M. Venza, T. Yeong, and Nicola S. Fearnhead
Subjects: Male, medicine.medical_specialty, Colorectal cancer, 030230 surgery, Malignancy, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Internal medicine, Intestinal Neoplasms, Intestine, Small, Humans, Medicine, Prospective Studies, Aged, business.industry, Mortality rate, Hazard ratio, Cancer, General Medicine, medicine.disease, United Kingdom, Bowel obstruction, Oncology, Abdominal Neoplasms, 030220 oncology & carcinogenesis, Cohort, Female, Surgery, business, Intestinal Obstruction, Cohort study
Abstract: Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.
Published: 2019
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39. Application of a multiplex salivary immunoassay to detect sporadic incident norovirus infections

Author: Kevin Oshima, Andrey I. Egorov, Elizabeth Sams, Jennifer N. Styles, Trevor R. Plunkett, Swinburne A. J. Augustine, Alfred P. Dufour, Edward Hudgens, Stephanie DeFlorio-Barker, Shannon M. Griffin, and Timothy J. Wade
Subjects: Adult, Male, 0301 basic medicine, Saliva, Adolescent, Epidemiology, viruses, 030106 microbiology, lcsh:Medicine, medicine.disease_cause, Article, law.invention, Young Adult, 03 medical and health sciences, fluids and secretions, Antigen, law, medicine, Humans, Multiplex, Prospective Studies, Child, Prospective cohort study, lcsh:Science, Caliciviridae Infections, Immunoassay, Multidisciplinary, medicine.diagnostic_test, business.industry, Norovirus, lcsh:R, Infant, Newborn, Infant, virus diseases, Diarrhea, 030104 developmental biology, Viral infection, Child, Preschool, Immunology, Recombinant DNA, Female, lcsh:Q, medicine.symptom, business
Abstract: Norovirus is one of the most common causes of gastroenteritis. Following infection, anti-norovirus salivary immunoglobulin G (IgG) rises steeply within 2 weeks and remains elevated for several months; this immunoconversion can serve as an indicator of infection. We used a multiplex salivary immunoassay to study norovirus infections among 483 visitors to a Lake Michigan beach in 2015. Saliva was collected on the day of the beach visit (S1); after 10–14 days (S2); and after 30–40 days (S3). Luminex microspheres were coupled to recombinant antigens of genogroup I (GI) and II (GII) noroviruses and incubated with saliva. Immunoconversion was defined as at least 4-fold increase in anti-norovirus IgG antibody response from S1 to S2 and a 3-fold increase from S1 to S3. Ten (2.1%) immunoconverted to either GI (2) or GII (8) norovirus. Among those who immunoconverted, 40% reported at least one gastrointestinal symptom and 33% reported diarrhea, compared to 15% (p = 0.06) and 8% (p = 0.04) among those who did not immunoconvert, respectively. The two participants who immunoconverted to GI norovirus both swallowed water during swimming (p = 0.08). This study demonstrated the utility of a non-invasive salivary immunoassay to detect norovirus infections and an efficient approach to study infectious agents in large cohorts.
Published: 2019
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40. Guidelines on suicide amongst anaesthetists 2019

Author: A. Hennessy, A. McGlennan, R. H. Coetzee, K. Pappenheim, A. Rowland, S. R. Shinde, P. Keats, K. Asanati, K. Harding, C. Gerada, N. Kumar, A. Cole-King, K. Prior, E. Plunkett, Keith Hawton, and S. M. Yentis
Subjects: Suicide Prevention, Coping (psychology), medicine.medical_specialty, Poison control, Guidelines as Topic, Suicide prevention, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030202 anesthesiology, Injury prevention, medicine, Humans, 030212 general & internal medicine, business.industry, Mental Disorders, Human factors and ergonomics, United Kingdom, Suicide, Distress, Anesthesiology and Pain Medicine, Increased risk, Family medicine, Anesthetists, business, Stress, Psychological
Abstract: Anaesthetists are thought to be at increased risk of suicide amongst the medical profession. The aims of the following guidelines are: increase awareness of suicide and associated vulnerabilities, risk factors and precipitants; to emphasise safe ways to respond to individuals in distress, both for them and for colleagues working alongside them; and to support individuals, departments and organisations in coping with a suicide.
Published: 2019
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41. Do brain mets grow while you wait? A volumetric natural history assessment of brain metastases from time of diagnosis to gamma knife treatment

Author: Robert J. Plunkett, Dheerendra Prasad, Kristopher Attwood, William E. Brady, and Tara A. Barone
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Radiosurgery, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), medicine, Humans, Neoplasm Metastasis, Radiation oncologist, Aged, Retrospective Studies, Lung, Brain Neoplasms, business.industry, Melanoma, Cancer, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Tumor Burden, Natural history, medicine.anatomical_structure, Neurology, 030220 oncology & carcinogenesis, Female, Surgery, Neurology (clinical), Radiology, Neurosurgery, business, 030217 neurology & neurosurgery, Brain metastasis
Abstract: Brain metastasis (BM) is a common neurologic complication of cancers such as lung, breast, and melanoma. Recently, there has been a shift in treatment of BM from whole brain radiation therapy to stereotactic radiosurgery (SRS) and the success is dependent on tumor volume. While most metastases grow over time, data on growth rate is lacking. Therefore, we document volume changes of metastases before treatment. We retrospectively reviewed MRI imaging records of 82 patients with a total of 294 BMs, treated in our cancer center by one neurosurgeon and one radiation oncologist with Gamma Knife SRS over a three-year period. We measured tumor volume at the time of diagnosis and compared with tumor volume on the day of treatment. Volumes were compared using the Wilcoxon signed-rank test. Lung, melanoma and breast made up the majority of metastases diagnosed. More than 75% of tumors grew and these changes in volume and percent changes in volume were statistically significant. Thirty percent of tumors doubled in size before treatment. Patients with the largest mean pretreatment tumor size were urgently treated within 6 days, yet still demonstrated the largest change in volume. This study is one of the first to document volume changes of brain metastases from the time of diagnosis to SRS treatment. Our results indicate that brain metastases can grow rapidly and it is imperative that we streamline patient management processes to minimize delays in treating patients with SRS, since outcomes are dependent on tumor size.
Published: 2019
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42. Palliative care in cirrhosis with decompensation

Author: Angela Plunkett, Marianne Mortimore, and Phillip Good
Subjects: Adult, Liver Cirrhosis, Male, Advance care planning, medicine.medical_specialty, Poor prognosis, Palliative care, Cirrhosis, Pilot Projects, 030204 cardiovascular system & hematology, law.invention, Tertiary Care Centers, Advance Care Planning, 03 medical and health sciences, 0302 clinical medicine, law, Internal Medicine, Humans, Medicine, Decompensation, 030212 general & internal medicine, Intensive care medicine, Referral and Consultation, Specialist palliative care, Aged, Aged, 80 and over, Heart Failure, business.industry, Palliative Care, Symptom burden, Middle Aged, medicine.disease, Intensive care unit, Female, business
Abstract: Cirrhosis with decompensation has a poor prognosis, high symptom burden and causes carer stress. This pilot research in one tertiary hospital found that patients with cirrhosis with decompensation were infrequently referred to specialist palliative care. Despite this, they had a heavy symptom burden, high predicted mortality, frequent unplanned readmissions, long admissions and intensive care unit admissions. Few had adequate advance care planning.
Published: 2019
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43. Influence of maternal obesity and metabolic and vascular mediators in twin-twin transfusion syndrome

Author: Francesca Nardi, Philip Fitchev, Sarah E. Starnes, Carole Vogler, Susan E. Crawford, Chi-Hsung Wang, Beth A. Plunkett, and Constance Thorpe
Subjects: Adult, 0301 basic medicine, medicine.medical_specialty, Placenta, Twin reversed arterial perfusion, Intrauterine growth restriction, Overweight, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Pregnancy, Humans, Medicine, Obesity, Risk factor, Retrospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Retrospective cohort study, Fetofetal Transfusion, medicine.disease, 030104 developmental biology, Cohort, Pregnancy, Twin, Female, Animal Science and Zoology, medicine.symptom, business, Premature rupture of membranes, Developmental Biology
Abstract: Obesity is a risk factor for complications in singleton and twin pregnancies; however, there are limited data regarding maternal body mass index (BMI) in the setting of twin-twin transfusion syndrome (TTTS). We hypothesized that increased BMI in TTTS is associated with adverse perinatal outcomes and vascular pathology. A retrospective study of twin reversed arterial perfusion (n = 4), selective intrauterine growth restriction (n = 10) and TTTS (n = 33) was conducted. Treatment included fetoscopic laser photocoagulation (FLP) (n = 35) or Solomon technique (n = 12). Ex vivo placental intravascular injections, immunohistochemistry, and perinatal outcomes were compared by maternal BMI. In pregnancy complicated by TTTS, 16/33 women were obese (BMI > 30 kg/m2) and 11/33 were overweight (BMI 25–29.9 kg/m2). Women who were overweight or obese had an increased rate of premature rupture of membranes (PPROM), cesarean delivery, and/or concomitant co-morbidities when compared to the normal weight group. Duration of neonatal intensive care unit (NICU) admission was longer in neonates of overweight/obese women versus normal weight. Placental examination of FLP sites in the obese group showed larger infarcts, increased adipose triglyceride lipase, and a proangiogenic phenotype. Increased BMI is common in our TTTS cohort and it is associated with higher rate of co-morbidity, PPROM, prolonged NICU stay, and an imbalance of placental metabolic and vascular mediators.
Published: 2019
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44. Meds‐to‐Beds: The impact of a bedside medication delivery program on 30‐day readmissions

Author: David Benjamin Lash, Jeremiah Joson, Angela Mack, Jeffrey C. Jolliff, and Joshua Plunkett
Subjects: medicine.medical_specialty, Medication Reconciliation, business.industry, Medication therapy management, Emergency medicine, Pharmaceutical Science, Medicine, Pharmacology (medical), Pharmacy, business, Patient transfer
Published: 2019
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45. Understanding differences in allergen immunotherapy products and practices in North America and Europe

Author: William J. Lavery, Greg Plunkett, Robert E. Esch, Vera Mahler, Stefan Vieths, David I. Bernstein, and Jörg Kleine-Tebbe
Subjects: Allergy, Allergen immunotherapy, medicine.medical_specialty, business.industry, Immunology, Aeroallergen, Marketing authorization, medicine.disease_cause, medicine.disease, Dermatology, 03 medical and health sciences, Allergoid, 0302 clinical medicine, Allergen, 030228 respiratory system, Immunology and Allergy, media_common.cataloged_instance, Medicine, 030212 general & internal medicine, Allergists, European union, business, media_common
Abstract: Allergen immunotherapy (AIT) is thought to be clinically effective and safe in treating allergic rhinitis, asthma, and stinging insect allergy in Europe and North America. However, there are intercontinental differences in AIT therapeutic products in terms of their application and regulation. In North America unmodified standardized and nonstandardized aqueous aeroallergen extracts are approved and used almost exclusively for subcutaneous immunotherapy, whereas more product options are available in Europe, including adsorbed allergens, chemically modified allergens, or both. Both liquid extracts and tablets are approved for sublingual immunotherapy in Europe. Nevertheless, within the European Union, there are major differences in AIT products approved and used in individual countries. There are major differences in the clinical approach to subcutaneous immunotherapy in polysensitized patients; in the United States mixed extracts containing multiple aeroallergens are used, whereas European allergists preferably administer separate injections of single allergen sources or homologous groups deemed to be clinically relevant. Moreover, the regulatory approach differs between the European Union and United States. In contrast to the United States, where common allergen standards exist based on biologic activity, no common standards exist in Europe. In terms of development of new investigational products, the United States has followed the European example for phase II and III studies; no formal US Food and Drug Administration guidance has been issued.
Published: 2019
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46. Percutaneous Peripheral Nerve Stimulation for Pain Reduction and Improvements in Functional Outcomes in Chronic Low Back Pain

Author: Steven A. Cohen, Anthony Plunkett, Christopher A. Gilmore, Joseph W. Boggs, Meredith J McGee, Leonardo Kapural, and Steven R. Hanling
Subjects: Adult, Male, Percutaneous, Analgesic, 03 medical and health sciences, 0302 clinical medicine, Quality of life, 030202 anesthesiology, medicine, Back pain, Humans, Pain Management, Peripheral Nerves, Adverse effect, business.industry, Public Health, Environmental and Occupational Health, Chronic pain, General Medicine, Middle Aged, medicine.disease, Low back pain, Treatment Outcome, Opioid, Anesthesia, Transcutaneous Electric Nerve Stimulation, Female, Chronic Pain, medicine.symptom, business, Low Back Pain, 030217 neurology & neurosurgery, medicine.drug
Abstract: Chronic low back pain represents one of the most common sources of disability and a significant healthcare burden for the U.S. military. Present treatments for chronic back pain are often ineffective, poorly tolerated, invasive, destructive, and/or associated with complications and lead to the progression to invasive surgical procedures. There have been multiple calls for the development of a minimally invasive system that is effective without the risks or complications of existing surgical therapies, which could prevent the need for surgery and the recurrence of pain. The goal of this study was to evaluate a novel, minimally invasive approach using a percutaneous peripheral nerve stimulation (PNS) system designed to provide pain relief without surgery, to reduce complications, and provide a less-invasive treatment option. In nine subjects, percutaneous PNS improved participants’ function, as evidenced by clinically and statistically significant reductions in pain, disability, and pain interference. Subjects also experienced reductions in opioid and non-opioid analgesic medication usage and reported improvements in quality of life with treatment. There were no serious or unanticipated adverse events. These results demonstrate the potential of percutaneous PNS as a non-surgical therapy to treat chronic back pain without opioids.
Published: 2019
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47. In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire

Author: Lyn Palmer, Elizabeth S Draper, Padmanabhan Ramnarayan, Mark J. Peters, C R Lamming, Peter Davis, Adrian Plunkett, Barnaby R. Scholefield, Hannah Buckley, Hari Krishnan Kanthimathinathan, Lee Norman, and Richard G. Feltbower
Subjects: medicine.medical_specialty, Diabetic ketoacidosis, Coronavirus disease 2019 (COVID-19), COVID19, Critical Care and Intensive Care Medicine, Intensive Care Units, Pediatric, Case mix index, Patient Admission, Pandemic, medicine, Humans, Paediatric intensive care unit, Child, Pandemics, Admission patterns, 11 Medical and Health Sciences, Retrospective Studies, RC86-88.9, business.industry, Mortality rate, Research, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Retrospective cohort study, medicine.disease, Case mix, Emergency & Critical Care Medicine, Mental health, United Kingdom, Bronchiolitis, Emergency medicine, business, Ireland
Abstract: Background The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. Methods We performed a retrospective cohort study of all admissions to PICUs in children Results There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340–20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016–2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5–3.4) vs. 1.2 (0.5–3.4) %], length of stay [2.3 (1.0–5.5) vs. 2.4 (1.0–5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91–1.11, p = 0.93])] were similar between 2016–2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016–2019 (n = 711). Conclusions The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.
Published: 2021

48. Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled Pilot Study

Author: Steven P. Cohen, Robert J. Hackworth, James C. Eisenach, Alice M Vijjeswarapu, Joseph W. Boggs, Edward J. Mascha, Alparslan Turan, Scott R. Griffith, Brian M. Ilfeld, Dongsheng Yang, Amorn Wongsarnpigoon, Daniel I. Sessler, PAINfRE Investigators, Harold Gelfand, Anthony Plunkett, Sandeep Dhanjal, and Steven R. Hanling
Subjects: Male, Percutaneous, medicine.drug_class, Clinical Trials and Supportive Activities, Clinical Sciences, Pain, Pilot Projects, Article, 03 medical and health sciences, Substance Misuse, 0302 clinical medicine, Femoral nerve, 030202 anesthesiology, Clinical Research, Anesthesiology, Medicine, Humans, Peripheral Nerves, Postoperative, Pain, Postoperative, business.industry, Local anesthetic, Pain Research, Chronic pain, Neurosciences, Evaluation of treatments and therapeutic interventions, Middle Aged, medicine.disease, Neuromodulation (medicine), Anesthesiology and Pain Medicine, Treatment Outcome, Implantable Neurostimulators, Opioid, Anesthesia, 6.1 Pharmaceuticals, PAINfRE Investigators, Transcutaneous Electric Nerve Stimulation, Feasibility Studies, Female, Sciatic nerve, Chronic Pain, business, Drug Abuse (NIDA only), Brachial plexus, 030217 neurology & neurosurgery, medicine.drug
Abstract: Background Percutaneous peripheral nerve stimulation is an analgesic technique involving the percutaneous implantation of a lead followed by the delivery of electric current using an external pulse generator. Percutaneous peripheral nerve stimulation has been used extensively for chronic pain, but only uncontrolled series have been published for acute postoperative pain. The current multicenter study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent clinical trial and (2) estimate the treatment effect of percutaneous peripheral nerve stimulation on postoperative pain and opioid consumption. Methods Preoperatively, an electrical lead was percutaneously implanted to target the sciatic nerve for major foot/ankle surgery (e.g., hallux valgus correction), the femoral nerve for anterior cruciate ligament reconstruction, or the brachial plexus for rotator cuff repair, followed by a single injection of long-acting local anesthetic along the same nerve/plexus. Postoperatively, participants were randomized to 14 days of either electrical stimulation (n = 32) or sham stimulation (n = 34) using an external pulse generator in a double-masked fashion. The dual primary treatment effect outcome measures were (1) cumulative opioid consumption (in oral morphine equivalents) and (2) mean values of the “average” daily pain scores measured on the 0 to 10 Numeric Rating Scale within the first 7 postoperative days. Results During the first 7 postoperative days, opioid consumption in participants given active stimulation was a median (interquartile range) of 5 mg (0 to 30) versus 48 mg (25 to 90) in patients given sham treatment (ratio of geometric means, 0.20 [97.5% CI, 0.07 to 0.57]; P < 0.001). During this same period, the average pain intensity in patients given active stimulation was a mean ± SD of 1.1 ± 1.1 versus 3.1 ± 1.7 in those given sham (difference, −1.8 [97.5% CI, −2.6 to −0.9]; P < 0.001). Conclusions Percutaneous peripheral nerve stimulation reduced pain scores and opioid requirements free of systemic side effects during at least the initial week after ambulatory orthopedic surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
Published: 2021

49. Elevated Glucose Challenge Test in a Nondiabetic Index Pregnancy and Gestational Diabetes in a Subsequent Pregnancy

Author: Marci Adams, Annie Dude, Samantha de los Reyes, Beth A. Plunkett, and Emmet Hirsch
Subjects: Adult, medicine.medical_specialty, Disease, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Medicine, Glucose challenge test, Humans, 030212 general & internal medicine, Retrospective Studies, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Obstetrics and Gynecology, Retrospective cohort study, Hispanic or Latino, Glucose Tolerance Test, medicine.disease, Gestational diabetes, Pregnancy Complications, Diabetes, Gestational, Pregnancy Trimester, First, Logistic Models, Pediatrics, Perinatology and Child Health, Gestation, Female, Subsequent pregnancy, business, Body mass index
Abstract: Objective The aim of this study was to evaluate whether a 1-hour glucose challenge test (GCT) ≥140 mg/dL in a nondiabetic index pregnancy is associated with the development of gestational diabetes mellitus (GDM) in a subsequent pregnancy. Study Design We performed a retrospective cohort study from a single institution from June 2009 to December 2018. Women with a nondiabetic index singleton gestation who underwent a 1-hour GCT at 24 to 28 weeks and had a successive singleton delivery were included. GDM was defined by a 1-hour GCT of ≥ 200 mg/dL, ≥2 of 4 elevated values on a 3-hour GCT, or a diagnosis of GDM defined by International Classification of Disease codes in the electronic medical record. Univariable analyses were performed to evaluate the associations between an elevated 1-hour GCT result in the index pregnancy, maternal characteristics, and the development of GDM in the subsequent pregnancy. Variables found to be significant (p Results A total of 2,423 women were included. Of these, 340 (14.0%) had an elevated 1-hour GCT in the index pregnancy. Women with an elevated 1-hour GCT in the index pregnancy compared with those without were significantly more likely to be older, married, privately insured, of Hispanic ethnicity or Asian race, chronically hypertensive, have a higher body mass index (BMI), have a shorter inter-pregnancy interval, and to develop GDM in the subsequent pregnancy (14.4 vs. 3.3%, p Conclusion An elevated 1-hour GCT in a nondiabetic index pregnancy is associated with a fourfold increased risk of GDM in a subsequent pregnancy. Key Points
Published: 2021

50. Trainee doctors' experiences of learning and well-being while working in intensive care during the COVID-19 pandemic: a qualitative study using appreciative inquiry

Author: Christina Stamoulis, James Rudge, Emma Plunkett, Tomasz Torlinski, Jennifer Warren, Randeep Mullhi, and Carolyn Tarrant
Subjects: Appreciative inquiry, Critical Care, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Intensive care, Medicine, Humans, 030212 general & internal medicine, adult anaesthesia, Pandemics, Personal Protective Equipment, adult intensive & critical care, Qualitative Research, Medical education, business.industry, SARS-CoV-2, Intensive Care, COVID-19, General Medicine, education & training (see medical education & training), Personal development, Well-being, Working through, Basic needs, Thematic analysis, business, Qualitative research
Abstract: ObjectivesConcern about trainee work-related well-being has been raised in recent years and is the subject of several reviews, reports and research studies. This study aimed to understand the experiences of trainees working in a large intensive care unit during the first surge of the COVID-19 pandemic from an educational and operational perspective in order to highlight what worked and what could be improved.DesignA qualitative study using peer-to-peer semistructured interviews, developed using appreciative inquiry methodology, was conducted during July 2020. Responses were analysed using a thematic analysis technique.SettingA large, tertiary intensive care unit in the UK.ParticipantsAll trainees in anaesthesia and intensive care working on the intensive care unit during the first surge were invited to participate.ResultsForty interviews were conducted and four over-arching themes were identified. These were: feeling safe and supported; physical demands; the emotional burden of caring; and a sense of fulfilment, value and personal development. Positive aspects of the organisational response to the pandemic included communication, personal protective equipment supply, team working and well-being support. Suggestions for improvement focused on rest facilities, rota patterns and hierarchies, creating opportunities for reflection and ensuring continued educational and training opportunities despite operational demands.ConclusionsTrainees described opportunities for learning and fulfilment, as well as challenges, in working through a pandemic. Trainees described their needs and how well these were met during the pandemic. Ideas for improvement most frequently related to basic needs including safety and fatigue, but suggestions also related to supporting learning and development. The appreciative inquiry methodology of the project facilitated effective reflection on positive aspects of trainee experiences.
Published: 2021

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