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156. Use of an electric ear syringe in the emergency department.

Author

Jones, I and Moulton, C

Abstract

OBJECTIVES: To introduce an electric ear syringe into an emergency department and evaluate its use in the removal of foreign bodies from the external auditory canal. METHODS: Report of the use of a new device (the Propulse electric ear syringe) in an emergency department with a retrospective audit of the management of all cases of aural foreign bodies during one year. RESULTS: Almost 60% of the 84 patients who presented with foreign bodies in the auditory canal were children. Staff chose to treat over half of all patients with aural foreign bodies with the electric ear syringe. The overall success rates for the removal of the foreign bodies were: electric syringe, 93% in adults and 88% in children and instrumentation, 68% in adults and 50% in children. CONCLUSIONS: Irrigation with an electric ear syringe is an effective method of removing foreign bodies from the external auditory canal. The device tested was safe, inexpensive, easy to use, and readily acceptable to both adults and children. The availability of an electric ear syringe in an emergency department can avoid the need for specialist referral and the subsequent removal of foreign bodies under general anaesthesia. [ABSTRACT FROM PUBLISHER]

Published
1998
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159. Andes Insurance Company.

Author

BUCHANAN, R., BUTLER, JOSEPH C., BULLOCK, A. D., MURPHY, SAM'L M., GAITHER, ALFRED, POST, H. A. V., MITCHELL, ROBERT, WESSEL, AGUSTUS, LONG, ALEXANDER, MOULTON, C. W., and BENNETT, J. B.

Published
1870

164. Management of Asymptomatic Sporadic Nonfunctioning Pancreatic Neuroendocrine Neoplasms (ASPEN) ≤2 cm: Study Protocol for a Prospective Observational Study

Author

Stefano Partelli, John K. Ramage, Sara Massironi, Alessandro Zerbi, Hong Beom Kim, Patricia Niccoli, Francesco Panzuto, Luca Landoni, Ales Tomazic, Toni Ibrahim, Gregory Kaltsas, Emilio Bertani, Alain Sauvanet, Eva Segelov, Martyn Caplin, Jorgelina Coppa, Thomas Armstrong, Martin O. Weickert, Giovanni Butturini, Stefan Staettner, Florian Boesch, Mauro Cives, Carol Anne Moulton, Jin He, Andreas Selberherr, Orit Twito, Antonio Castaldi, Claudio Giovanni De Angelis, Sebastien Gaujoux, Hussein Almeamar, Andrea Frilling, Emanuel Vigia, Colin Wilson, Francesca Muffatti, Raj Srirajaskanthan, Pietro Invernizzi, Andrea Lania, Wooil Kwon, Jacques Ewald, Maria Rinzivillo, Chiara Nessi, Lojze M. Smid, Andrea Gardini, Marina Tsoli, Edgardo E. Picardi, Olivia Hentic, Daniel Croagh, Christos Toumpanakis, Davide Citterio, Emma Ramsey, Barbara Mosterman, Paolo Regi, Silvia Gasteiger, Roberta E. Rossi, Valeria Smiroldo, Jin-Young Jang, Massimo Falconi, Partelli, S, Ramage, J, Massironi, S, Zerbi, A, Kim, H, Niccoli, P, Panzuto, F, Landoni, L, Tomazic, A, Ibrahim, T, Kaltsas, G, Bertani, E, Sauvanet, A, Segelov, E, Caplin, M, Coppa, J, Armstrong, T, Weickert, M, Butturini, G, Staettner, S, Boesch, F, Cives, M, Moulton, C, He, J, Selberherr, A, Twito, O, Castaldi, A, De Angelis, C, Gaujoux, S, Almeamar, H, Frilling, A, Vigia, E, Wilson, C, Muffatti, F, Srirajaskanthan, R, Invernizzi, P, Lania, A, Kwon, W, Ewald, J, Rinzivillo, M, Nessi, C, Smid, L, Gardini, A, Tsoli, M, Picardi, E, Hentic, O, Croagh, D, Toumpanakis, C, Citterio, D, Ramsey, E, Mosterman, B, Regi, P, Gasteiger, S, Rossi, R, Smiroldo, V, Jang, J, Falconi, M, Partelli, Stefano, Ramage, John K, Massironi, Sara, Zerbi, Alessandro, Kim, Hong Beom, Niccoli, Patricia, Panzuto, Francesco, Landoni, Luca, Tomazic, Ale, Ibrahim, Toni, Kaltsas, Gregory, Bertani, Emilio, Sauvanet, Alain, Segelov, Eva, Caplin, Martyn, Coppa, Jorgelina, Armstrong, Thoma, Weickert, Martin O, Butturini, Giovanni, Staettner, Stefan, Boesch, Florian, Cives, Mauro, Moulton, Carol Anne, He, Jin, Selberherr, Andrea, Twito, Orit, Castaldi, Antonio, De Angelis, Claudio Giovanni, Gaujoux, Sebastien, Almeamar, Hussein, Frilling, Andrea, Vigia, Emanuel, Wilson, Colin, Muffatti, Francesca, Srirajaskanthan, Raj, Invernizzi, Pietro, Lania, Andrea, Kwon, Wooil, Ewald, Jacque, Rinzivillo, Maria, Nessi, Chiara, Smid, Lojze M, Gardini, Andrea, Tsoli, Marina, Picardi, Edgardo E, Hentic, Olivia, Croagh, Daniel, Toumpanakis, Christo, Citterio, Davide, Ramsey, Emma, Mosterman, Barbara, Regi, Paolo, Gasteiger, Silvia, Rossi, Roberta E, Smiroldo, Valeria, Jang, Jin-Young, and Falconi, Massimo

Subjects
lcsh:R5-920, medicine.medical_specialty, Surgical approach, business.industry, Optimal treatment, Nodule (medicine), General Medicine, small nonfunctioning pancreatic neuroendocrine neoplasm, Asymptomatic, NF-PanNEN_2 cm, HCC CHBPT, ASPEN study, surgery, Study Protocol, aspen study, follow-up, management, nf-pannen_2 cm, surveillance, medicine, Medicine, Observational study, Radiology, medicine.symptom, lcsh:Medicine (General), business
Abstract

Introduction: The optimal treatment for small, asymptomatic, nonfunctioning pancreatic neuroendocrine neoplasms (NF-PanNEN) is still controversial. European Neuroendocrine Tumor Society (ENETS) guidelines recommend a watchful strategy for asymptomatic NF-PanNEN Methods: ASPEN is a prospective international observational multicentric cohort study supported by ENETS. The study is registered in ClinicalTrials.gov with the identification code NCT03084770. Based on the incidence of NF-PanNEN the number of expected patients to be enrolled in the ASPEN study is 1,000 during the study period (2017–2022). Primary endpoint is disease/progression-free survival, defined as the time from study enrolment to the first evidence of progression (active surveillance group) or recurrence of disease (surgery group) or death from disease. Inclusion criteria are: age >18 years, the presence of asymptomatic sporadic NF-PanNEN ≤2 cm proven by a positive fine-needle aspiration (FNA) or by the presence of a measurable nodule on high-quality imaging techniques that is positive at 68Gallium DOTATOC-PET scan.Conclusion: The ASPEN study is designed to investigate if an active surveillance of asymptomatic NF-PanNEN ≤2 cm is safe as compared to surgical approach.

Published
2020

166. Navigating the nano-bio immune interface: advancements and challenges in CNS nanotherapeutics.

Author

Moulton C, Baroni A, Quagliarini E, Leone L, Digiacomo L, Morotti M, Caracciolo G, Podda MV, and Tasciotti E

Subjects
Humans, Animals, Central Nervous System Diseases immunology, Central Nervous System Diseases therapy, Central Nervous System Diseases drug therapy, Nanomedicine methods, Nanoparticles, Central Nervous System immunology
Abstract

In recent years, significant advancements have been made in utilizing nanoparticles (NPs) to modulate immune responses within the central nervous system (CNS), offering new opportunities for nanotherapeutic interventions in neurological disorders. NPs can serve as carriers for immunomodulatory agents or platforms for delivering nucleic acid-based therapeutics to regulate gene expression and modulate immune responses. Several studies have demonstrated the efficacy of NP-mediated immune modulation in preclinical models of neurological diseases, including multiple sclerosis, stroke, Alzheimer's disease, and Parkinson's disease. While challenges remain, advancements in NPs engineering and design have led to the development of NPs using diverse strategies to overcome these challenges. The nano-bio interface with the immune system is key in the conceptualization of NPs to efficiently act as nanotherapeutics in the CNS. The biomolecular corona plays a pivotal role in dictating NPs behavior and immune recognition within the CNS, giving researchers the opportunity to optimize NPs design and surface modifications to minimize immunogenicity and enhance biocompatibility. Here, we review how NPs interact with the CNS immune system, focusing on immunosurveillance of NPs, NP-induced immune reprogramming and the impact of the biomolecular corona on NPs behavior in CNS immune responses. The integration of NPs into CNS nanotherapeutics offers promising opportunities for addressing the complex challenges of acute and chronic neurological conditions and pathologies, also in the context of preventive and rehabilitative medicine. By harnessing the nano-bio immune interface and understanding the significance of the biomolecular corona, researchers can develop targeted, safe, and effective nanotherapeutic interventions for a wide range of CNS disorders to improve treatment and rehabilitation. These advancements have the potential to revolutionize the treatment landscape of neurological diseases, offering promising solutions for improved patient care and quality of life in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Moulton, Baroni, Quagliarini, Leone, Digiacomo, Morotti, Caracciolo, Podda and Tasciotti.)

Published
2024
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167. Impact of Physical Activity on DNA Methylation Signatures in Breast Cancer Patients: A Systematic Review with Bioinformatic Analysis.

Author

Moulton C, Lisi V, Silvestri M, Ceci R, Grazioli E, Sgrò P, Caporossi D, and Dimauro I

Abstract

Breast cancer (BC) continues to significantly impact women worldwide. Numerous studies show that physical activity (PA) significantly enhances the quality of life, aids recovery, and improves survival rates in BC patients. PA's influence extends to altering DNA methylation patterns on both a global and gene-specific scale, potentially reverting abnormal DNA methylation, associated with carcinogenesis and various pathologies. This review consolidates the findings of the current literature, highlighting PA's impact on DNA methylation in BC patients. Our systematic analysis indicates that PA may elevate global DNA methylation within tumour tissues. Furthermore, it appears to modify gene-specific promoter methylation across a wide spectrum of genes in various tissues. Through bioinformatic analysis, to investigate the functional enrichment of these affected genes, we identified a predominant enrichment in metabolic pathways, cell cycle regulation, cell cycle checkpoints, mitosis, cellular stress responses, and molecular functions governing diverse binding processes. The Human Protein Atlas corroborates this enrichment, indicating gene functionality across 266 tissues, notably within various breast tissues. This systematic review unveils PA's capacity to systematically alter DNA methylation patterns across multiple tissues, particularly in BC patients. Emphasising its influence on crucial biological processes and functions, this alteration holds potential for restoring normal cellular functionality and the cell cycle. This reversal of cancer-associated patterns could potentially enhance recovery and improve survival outcomes.

Published
2024
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168. Physical Activity and Epigenetic Aging in Breast Cancer Treatment.

Author

Moulton C, Grazioli E, Ibáñez-Cabellos JS, Murri A, Cerulli C, Silvestri M, Caporossi D, Pallardó FV, García-Giménez JL, Magno S, Rossi C, Duranti G, Mena-Molla S, Parisi A, and Dimauro I

Subjects
Humans, Female, Middle Aged, Aged, Adult, Promoter Regions, Genetic, Telomere genetics, Breast Neoplasms genetics, Breast Neoplasms therapy, Epigenesis, Genetic, Exercise, DNA Methylation, Aging genetics, Fatty Acid Elongases genetics
Abstract

Biological age, reflecting the cumulative damage in the body over a lifespan, is a dynamic measure more indicative of individual health than chronological age. Accelerated aging, when biological age surpasses chronological age, is implicated in poorer clinical outcomes, especially for breast cancer (BC) survivors undergoing treatments. This preliminary study investigates the impact of a 16-week online supervised physical activity (PA) intervention on biological age in post-surgery female BC patients. Telomere length was measured using qPCR, and the ELOVL2-based epigenetic clock was assessed via DNA methylation pyrosequencing of the ELOVL2 promoter region. Telomere length remained unchanged, but the ELOVL2 epigenetic clock indicated a significant decrease in biological age in the PA group, suggesting the potential of PA interventions to reverse accelerated aging processes in BC survivors. The exercise group showed improved cardiovascular fitness, highlighting PA's health impact. Finally, the reduction in biological age, as measured by the ELOVL2 epigenetic clock, was significantly associated with improvements in cardiovascular fitness and handgrip strength, supporting improved recovery. Epigenetic clocks can potentially assess health status and recovery progress in BC patients, identifying at-risk individuals in clinical practice. This study provides potential and valuable insights into how PA benefits BC survivors' health, supporting the immediate benefits of a 16-week exercise intervention in mitigating accelerated aging. The findings could suggest a holistic approach to improving the health and recovery of post-surgery BC patients.

Published
2024
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169. The impact of physical activity on promoter-specific methylation of genes involved in the redox-status and disease progression: A longitudinal study on post-surgery female breast cancer patients undergoing medical treatment.

Author

Moulton C, Murri A, Benotti G, Fantini C, Duranti G, Ceci R, Grazioli E, Cerulli C, Sgrò P, Rossi C, Magno S, Di Luigi L, Caporossi D, Parisi A, and Dimauro I

Subjects
Humans, Female, Quality of Life, Longitudinal Studies, DNA Methylation, Exercise, Oxidation-Reduction, Antioxidants therapeutic use, Antioxidants metabolism, Disease Progression, RNA, Messenger metabolism, Mixed Function Oxygenases genetics, Proto-Oncogene Proteins genetics, Breast Neoplasms drug therapy, Breast Neoplasms genetics, Breast Neoplasms surgery
Abstract

Most anticancer treatments act on oxidative-stress pathways by producing reactive oxygen species (ROS) to kill cancer cells, commonly resulting in consequential drug-induced systemic cytotoxicity. Physical activity (PA) has arisen as an integrative cancer therapy, having positive health effects, including in redox-homeostasis. Here, we investigated the impact of an online supervised PA program on promoter-specific DNA methylation, and corresponding gene expression/activity, in 3 antioxidants- (SOD1, SOD2, and CAT) and 3 breast cancer (BC)-related genes (BRCA1, L3MBTL1 and RASSF1A) in a population-based sample of women diagnosed with primary BC, undergoing medical treatment. We further examined mechanisms involved in methylating and demethylating pathways, predicted biological pathways and interactions of exercise-modulated molecules, and the functional relevance of modulated antioxidant markers on parameters related to aerobic capacity/endurance, physical fatigue and quality of life (QoL). PA maintained levels of SOD activity in blood plasma, and at the cellular level significantly increased SOD2 mRNA (≈+77 %), contrary to their depletion due to medical treatment. This change was inversely correlated with DNA methylation in SOD2 promoter (≈-20 %). Similarly, we found a significant effect of PA only on L3MBTL1 promoter methylation (≈-25 %), which was inversely correlated with its mRNA (≈+43 %). Finally, PA increased TET1 mRNA levels (≈+15 %) and decreased expression of DNMT3B mRNA (≈-28 %). Our results suggest that PA-modulated DNA methylation affects several signalling pathways/biological activities involved in the cellular oxidative stress response, chromatin organization/regulation, antioxidant activity and DNA/protein binding. These changes may positively impact clinical outcomes and improve the response to cancer treatment in post-surgery BC patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2024
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170. Relationship between Euthyroidism and Muscle Mass and Strength: A Systematic Review.

Author

Greco F, Moulton C, Antinozzi C, Lista M, Di Luigi L, Dimauro I, and Sgrò P

Subjects
Male, Humans, Aged, Thyroid Hormones, Thyrotropin, Muscles, Triiodothyronine, Thyroxine
Abstract

Thyroid hormones play a crucial role in skeletal muscle development, suggesting that thyroid function may influence muscle mass and muscle strength, which are both fundamental health-related indicators of several age-related consequences. However, whether there is a relationship between thyroid hormones, muscle mass, and muscle strength in individuals without thyroid dysfunctions is still unknown. Therefore, this systematic review aims to investigate whether thyroid hormones are related to muscle mass and strength parameters in euthyroid individuals. Three databases were searched (PubMed, Scopus, Web of Science) up to February 14, 2022, for peer-reviewed papers published in English. The search results were conducted independently by two different reviewers. The review included 13 studies with a total of 241,044 participants. All studies were observational: twelve studies measured thyroid stimulating hormone, ten and thirteen studies measured free triiodothyronine and free thyroxine, four studies analyzed the thyroid hormone ratio. The assessment methods for muscle mass were computed tomography, dual-energy X-ray absorptiometry and bioimpedance analysis, whereas hand dynamometer for muscle strength. Low levels within the normal range of free triiodothyronine, high levels within the normal range of free thyroxine, and lower thyroid hormone ratio may contribute to a reduced muscle function, which seems more evident in older males., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Published
2023
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171. Evaluation of junior doctors' retention of knowledge and skills after simulation training in shockable rhythm cardiac arrest in a low-resource setting in Nepal.

Author

Shrestha R, Indrasena BSH, Subedi P, Lamsal D, Moulton C, and Aylott J

Abstract

Aims: To test junior doctors' abilities to retain advanced life support psychomotor skills and theoretical knowledge in management of shockable rhythm cardiac arrest., Methods: A repeated measure pre-post study design was used with 43 junior doctors, recruited after notifying them with robust method of attraction through flyers, brochures, email and phone calls. Written and performance tests, initial pre-test, immediate post-training, 30-days post-training and 60-days post-training, using simulation-based scenarios with a low-fidelity manikin were used with recording performance of ALS., Instrumentation: Resuscitation Council UK ALS algorithms and guidelines 1 were used in a simulated testing environment., Results: There was a highly significant improvement in knowledge immediately after training ( p  < 0.00), with a net gain of marks from a mean value of 63.2% before training to 87.7% after training by 24.5% (95% CI 19.4, 29.6).There was a gradual decline of retained knowledge with time from immediate post-training over, 30-days and 60-days post-training ( p  < 0.00). The simulation pre-training assessments and immediate post-training assessments results were statistically significant ( p  < .00). The mean difference was 44.1% (95% CI 50.11, 38.10). There was a statistically significant decline of the competency with time ( p  < .00). Unlike for the knowledge test, the drop was significant on the 30th day ( p  < .00) with a mean difference of -10.5% (95% CI -13.55, -7.40)., Conclusion: The training of junior doctors in shockable rhythm cardiac arrest in a low resource setting, improved knowledge and skills in the participants after training. However, retention of knowledge declined at 30 days and more significantly after 60 days and retention of skill was declined more significantly at 30 days., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Published
2023
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172. Steady-state redox status in circulating extracellular vesicles: A proof-of-principle study on the role of fitness level and short-term aerobic training in healthy young males.

Author

Lisi V, Moulton C, Fantini C, Grazioli E, Guidotti F, Sgrò P, Dimauro I, Capranica L, Parisi A, Di Luigi L, and Caporossi D

Subjects
Male, Humans, Catalase metabolism, Pilot Projects, Oxidation-Reduction, Exercise, Extracellular Vesicles metabolism
Abstract

Considering the role of redox homeostasis in exercise-induced signaling and adaptation, this study focuses on the exercise training-related intercellular communication of redox status mediated by circulating extracellular vesicles (EVs). 19 healthy young males were divided into trained (TG, 7) and untrained (UG, 12) subjects based on their VO 2MAX . The UG subjects were further randomly distributed in experimental (UG EX , N = 7) and control (UG CTRL , N = 5) groups. The steady state of plasma EVs in TG and UG EX have been characterized for total number and size, as well as cargo redox status (antioxidants, transcription factors, HSPs) before, 3 and 24 h after a single bout of aerobic exercise (30', 70% HRM). Plasma EVs from UG EX and UG CTRL have been further characterized after 24 h from the last session of a 5-day consecutive aerobic training or no training, respectively. No differences were detected in the EVs' size and distribution at baseline in TG and UG EX (p>0.05), while the EVs cargo of UG EX showed a significantly higher concentration of protein carbonyl, Catalase, SOD2, and HSF1 compared to TG (p<0.05). 5 days of consecutive aerobic training in UG EX did not determine major changes in the steady-state number and size of EVs. The post-training levels of protein carbonyl, HSF1, Catalase, and SOD2 in EVs cargo of UG EX resulted significantly lower compared with UG EX before training and UG CTRL , resembling the steady-state levels in circulating EVs of TG subjects. Altogether, these preliminary data indicate that individual aerobic capacity influences the redox status of circulating EVs, and that short-term aerobic training impacts the steady-state redox status of EVs. Taking this pilot study as a paradigm for physio-pathological stimuli impacting redox homeostasis, our results offer new insights into the utilization of circulating EVs as biomarkers of exercise efficacy and of early impairment of oxidative-stress related diseases., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2023
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173. Online Home-Based Physical Activity Counteracts Changes of Redox-Status Biomarkers and Fitness Profiles during Treatment Programs in Postsurgery Female Breast Cancer Patients.

Author

Moulton C, Grazioli E, Antinozzi C, Fantini C, Cerulli C, Murri A, Duranti G, Ceci R, Vulpiani MC, Pellegrini P, Nusca SM, Cavaliere F, Fabbri S, Sgrò P, Di Luigi L, Caporossi D, Parisi A, and Dimauro I

Abstract

Breast cancer (BC) is one of the most commonly diagnosed types of cancer in women. Oxidative stress may contribute to cancer etiology through several mechanisms. A large body of evidence indicates that physical activity (PA) has positive effects on different aspects of BC evolution, including mitigation of negative effects induced by medical treatment. With the aim to verify the capacity of PA to counteract negative effects of BC treatment on systemic redox homeostasis in postsurgery female BC patients, we have examined the modulation of circulating levels of oxidative stress and inflammation markers. Moreover, we evaluated the impacts on physical fitness and mental well-being by measuring functional parameters, body mass index, body composition, health-related quality of life (QoL), and fatigue. Our investigation revealed that PA was effective in maintaining plasma levels of superoxide dismutase (SOD) activity and tGSH, as well as peripheral blood mononuclear cells' (PBMCs) mRNA levels of SOD1 and heat-shock protein 27. Moreover, we found a significant decrease in plasma interleukin-6 (≈0.57 ± 0.23-fold change, p < 0.05) and increases in both interleukin-10 (≈1.15 ± 0.35-fold change, p < 0.05) and PBMCs' mRNA level of SOD2 (≈1.87 ± 0.36-fold change, p < 0.05). Finally, PA improves functional parameters (6 min walking test, ≈+6.50%, p < 0.01; Borg, ≈-58.18%, p < 0.01; sit-and-reach, ≈+250.00%, p < 0.01; scratch right, ≈-24.12%, and left, ≈-18.81%, p < 0.01) and body composition (free fat mass, ≈+2.80%, p < 0.05; fat mass, ≈-6.93%, p < 0.05) as well as the QoL (physical function, ≈+5.78%, p < 0.05) and fatigue (cognitive fatigue, ≈-60%, p < 0.05) parameters. These results suggest that a specific PA program not only is effective in improving functional and anthropometric parameters but may also activate cellular responses through a multitude of actions in postsurgery BC patients undergoing adjuvant therapy. These may include modulation of gene expression and protein activity and impacting several signaling pathways/biological activities involved in tumor-cell growth; metastasis; and inflammation, as well as moderating distress symptoms known to negatively affect QoL., Competing Interests: The authors declare no conflicts of interest. The funders had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Published
2023
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174. 'Better together: collaborative working between emergency medicine and critical care': 1 year on, is this framework still relevant?

Author

Keating L, Creamer R, Huff R, and Moulton C

Subjects
Humans, Critical Care, Emergency Medicine
Abstract

In 2021 the Royal College of Emergency Medicine and the Faculty of Intensive Care Medicine collaborated to launch the 'Better together' framework to improve outcomes for critically unwell patients in the resuscitation room. One year on from the launch, it remains more relevant than ever.

Published
2022
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175. Possible futures of acute medical care in the NHS: a multispecialty approach.

Author

Dean J, Jones M, Dyer P, Moulton C, Price V, and Lasserson D

Abstract

Changing population demographics and needs are resulting in a continual rise in acute medical admissions. This review draws on the observations of the NHS GIRFT programme across England. Fundamental aspects of acute medical care are not universally provided, resulting in preventable hospitalisation and over-use of emergency departments. Such aspects include care outside hospitals; appropriately sized, staffed, located and configured acute medical units; multispeciality same-day emergency care (SDEC) pathways; multidisciplinary care on wards; and readmission prevention. 'Hospital at home' services are developing, and require local evaluation. SDEC is expanding. Digital technologies make it possible to provide acute care in and across more settings. Addressing the fundamentals of acute medical care, evaluating new service opportunities, strong clinical and managerial partnerships, better data for analytics, and a multispeciality, multiprofessional approach will enable a better level of care to be achieved., (© Royal College of Physicians 2022. All rights reserved.)

Published
2022
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176. Association between delays to patient admission from the emergency department and all-cause 30-day mortality.

Author

Jones S, Moulton C, Swift S, Molyneux P, Black S, Mason N, Oakley R, and Mann C

Subjects
Cross-Sectional Studies, Crowding, Hospital Mortality, Humans, Length of Stay, Retrospective Studies, Emergency Service, Hospital, Patient Admission
Abstract

Background: Delays to timely admission from emergency departments (EDs) are known to harm patients., Objective: To assess and quantify the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England., Methods: A cross-sectional, retrospective observational study was carried out of patients admitted from every type 1 (major) ED in England between April 2016 and March 2018. The primary outcome was death from all causes within 30 days of admission. Observed mortality was compared with expected mortality, as calculated using a logistic regression model to adjust for sex, age, deprivation, comorbidities, hour of day, month, previous ED attendances/emergency admissions and crowding in the department at the time of the attendance., Results: Between April 2016 and March 2018, 26 738 514 people attended an ED, with 7 472 480 patients admitted relating to 5 249 891 individual patients, who constituted the study's dataset. A total of 433 962 deaths occurred within 30 days. The overall crude 30-day mortality rate was 8.71% (95% CI 8.69% to 8.74%). A statistically significant linear increase in mortality was found from 5 hours after time of arrival at the ED up to 12 hours (when accurate data collection ceased) (p<0.001). The greatest change in the 30-day standardised mortality ratio was an 8% increase, occurring in the patient cohort that waited in the ED for more than 6 to 8 hours from the time of arrival., Conclusions: Delays to hospital inpatient admission for patients in excess of 5 hours from time of arrival at the ED are associated with an increase in all-cause 30-day mortality. Between 5 and 12 hours, delays cause a predictable dose-response effect. For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death., Competing Interests: Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author). The authors who work for Methods Analytics declare the paragraph given below: Methods Analytics has undertaken work previously on behalf of NHS England, NHS Improvement, CCGs, trusts and local authorities investigating apparent issues with mortality rates as well as analysis pertaining to service redesign within emergency and urgent care settings. Methods Analytics have also undertaken analytical work for NHS England’s “Getting It Right First Time” programme (GIRFT) to develop the emergency medicine provider level data pack, which includes metrics concerning hospital mortality., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2022
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177. Forecasting the Requirement for Nonelective Hospital Beds in the National Health Service of the United Kingdom: Model Development Study.

Author

Shah K, Sharma A, Moulton C, Swift S, Mann C, and Jones S

Abstract

Background: Over the last decade, increasing numbers of emergency department attendances and an even greater increase in emergency admissions have placed severe strain on the bed capacity of the National Health Service (NHS) of the United Kingdom. The result has been overcrowded emergency departments with patients experiencing long wait times for admission to an appropriate hospital bed. Nevertheless, scheduling issues can still result in significant underutilization of bed capacity. Bed occupancy rates may not correlate well with bed availability. More accurate and reliable long-term prediction of bed requirements will help anticipate the future needs of a hospital's catchment population, thus resulting in greater efficiencies and better patient care., Objective: This study aimed to evaluate widely used automated time-series forecasting techniques to predict short-term daily nonelective bed occupancy at all trusts in the NHS. These techniques were used to develop a simple yet accurate national health system-level forecasting framework that can be utilized at a low cost and by health care administrators who do not have statistical modeling expertise., Methods: Bed occupancy models that accounted for patterns in occupancy were created for each trust in the NHS. Daily nonelective midnight trust occupancy data from April 2011 to March 2017 for 121 NHS trusts were utilized to generate these models. Forecasts were generated using the three most widely used automated forecasting techniques: exponential smoothing; Seasonal Autoregressive Integrated Moving Average; and Trigonometric, Box-Cox transform, autoregressive moving average errors, and Trend and Seasonal components. The NHS Modernisation Agency's recommended forecasting method prior to 2020 was also replicated., Results: The accuracy of the models varied on the basis of the season during which occupancy was forecasted. For the summer season, percent root-mean-square error values for each model remained relatively stable across the 6 forecasted weeks. However, only the trend and seasonal components model (median error=2.45% for 6 weeks) outperformed the NHS Modernisation Agency's recommended method (median error=2.63% for 6 weeks). In contrast, during the winter season, the percent root-mean-square error values increased as we forecasted further into the future. Exponential smoothing generated the most accurate forecasts (median error=4.91% over 4 weeks), but all models outperformed the NHS Modernisation Agency's recommended method prior to 2020 (median error=8.5% over 4 weeks)., Conclusions: It is possible to create automated models, similar to those recently published by the NHS, which can be used at a hospital level for a large national health care system to predict nonelective bed admissions and thus schedule elective procedures., (©Kanan Shah, Akarsh Sharma, Chris Moulton, Simon Swift, Clifford Mann, Simon Jones. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 30.09.2021.)

Published
2021
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178. Variability in COVID-19 in-hospital mortality rates between national health service trusts and regions in England: A national observational study for the Getting It Right First Time Programme.

Author

Gray WK, Navaratnam AV, Day J, Babu P, Mackinnon S, Adelaja I, Bartlett-Pestell S, Moulton C, Mann C, Batchelor A, Swart M, Snowden C, Dyer P, Jones M, Allen M, Hopper A, Rayman G, Kar P, Wheeler A, Eve-Jones S, Fong KJ, Machin JT, Wendon J, and Briggs TWR

Abstract

Background: A key first step in optimising COVID-19 patient outcomes during future case-surges is to learn from the experience within individual hospitals during the early stages of the pandemic. The aim of this study was to investigate the extent of variation in COVID-19 outcomes between National Health Service (NHS) hospital trusts and regions in England using data from March-July 2020., Methods: This was a retrospective observational study using the Hospital Episode Statistics administrative dataset. Patients aged ≥ 18 years who had a diagnosis of COVID-19 during a hospital stay in England that was completed between March 1st and July 31st, 2020 were included. In-hospital mortality was the primary outcome of interest. In secondary analysis, critical care admission, length of stay and mortality within 30 days of discharge were also investigated. Multilevel logistic regression was used to adjust for covariates., Findings: There were 86,356 patients with a confirmed diagnosis of COVID-19 included in the study, of whom 22,944 (26.6%) died in hospital with COVID-19 as the primary cause of death. After adjusting for covariates, the extent of the variation in-hospital mortality rates between hospital trusts and regions was relatively modest. Trusts with the largest baseline number of beds and a greater proportion of patients admitted to critical care had the lowest in-hospital mortality rates., Interpretation: There is little evidence of clustering of deaths within hospital trusts. There may be opportunities to learn from the experience of individual trusts to help prepare hospitals for future case-surges., Competing Interests: The authors declare that there is no conflict of interest., (© 2021 The Authors.)

Published
2021
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179. Macular pigment optical density is positively associated with academic performance among preadolescent children.

Author

Barnett SM, Khan NA, Walk AM, Raine LB, Moulton C, Cohen NJ, Kramer AF, Hammond BR Jr, Renzi-Hammond L, and Hillman CH

Subjects
Absorptiometry, Photon, Body Composition, Child, Diet, Female, Humans, Intelligence Tests, Lutein administration & dosage, Lutein analysis, Male, Nutrition Assessment, Photometry, Randomized Controlled Trials as Topic, Xanthophylls administration & dosage, Xanthophylls analysis, Academic Performance, Macular Pigment analysis, Retina chemistry
Abstract

Objective: Macular pigment optical density (MPOD) - a non-invasive indicator of retinal xanthophylls and correlate of brain lutein - has been associated with superior cognitive function among adult populations. Given that lutein accumulation in the brain occurs in early life, it is possible that the cognitive implications of greater MPOD may be evident in childhood., Methods: Participants aged 8-9 years (n = 56) completed MPOD measurements via heterochromatic flicker photometry. Academic performance was assessed using the Kaufman Test of Academic and Educational Achievement II (KTEA). Habitual dietary intake of L and Z was measured among a subsample of participants (n = 35) using averaged 3-day food records. Stepwise hierarchical regression models were developed to determine the relationship between MPOD and academic achievement tests, following the adjustment of key covariates including sex, aerobic fitness, body composition, and intelligence quotient (IQ)., Results: The regression analyses revealed that MPOD improved the model, beyond the covariates, for overall academic achievement (ΔR 2  = 0.10, P < 0.01), mathematics (ΔR 2  = 0.07, P = 0.02), and written language composite standard scores (ΔR 2  = 0.15, P < 0.01)., Discussion: This is the first study to demonstrate that retinal L and Z, measured as MPOD, is positively related to academic achievement in children, even after accounting for the robust effects of IQ and other demographic factors. These findings extend the positive associations observed between MPOD and cognitive abilities to a pediatric population. Trail registration: The Fitness Improves Thinking in Kids 2 (FITKids2) trial was registered at www.clinicaltrials.gov as NCT01619826.

Published
2018
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180. Canadian Surgery Forum 2018: St. John's, NL Sept. 13-15, 2018.

Author

Jayaraman S, Lee L, Mata J, Droeser R, Kaneva P, Liberman S, Charlebois P, Stein B, Fried G, Feldman L, Schellenberg M, Inaba K, Cheng V, Bardes J, Lam L, Benjamin E, Matsushima K, Demetriades D, Schellenberg M, Inaba K, Cho J, Strumwasser A, Grabo D, Bir C, Eastman A, Demetriades D, Schellenberg M, Inaba K, Bardes J, Orozco N, Chen J, Park C, Kang T, Demetriades D, Jung J, Elfassy J, Grantcharov T, Jung J, Grantcharov T, Jung J, Grantcharov T, Taylor J, Stem M, Yu D, Chen S, Fang S, Gearhart S, Safar B, Efron J, Serrano P, Parpia S, McCarty D, Solis N, Valencia M, Jibrael S, Wei A, Gallinger S, Simunovic M, Hummadi A, Rabie M, Al Skaini M, Shamshad H, Shah S, Verhoeff K, Glen P, Taheri A, Min B, Tsang B, Fawcett V, Widder S, Yang M, Wanis K, Gilani O, Vogt K, Ott M, VanKoughnett J, Vinden C, Balvardi S, St Louis E, Yousef Y, Toobaie A, Guadagno E, Baird R, Poenaru D, Kleiman A, Mador B, Widder S, Serrano P, Moulton C, Lee E, Li C, Beyfuss K, Solomon H, Sela N, McAlister V, Ritter A, Gallinger S, Hallet J, Tsang M, Martel G, Jalink D, Husien M, Gu C, Levine M, Otiti S, Nginyangi J, Yeo C, Ring J, Holden M, Ungi T, Fichtinger G, Zevin B, Fang B, Dang J, Karmali S, Serrano P, Kim M, Zhang B, Duceppe E, Rieder S, Maeda A, Okrainec A, Jackson T, Kegel F, Lachance S, Landry T, Feldman L, Fried G, Mueller C, Lee L, Kegel F, Kegel F, Lachance S, Lee L, Joharifard S, Nyiemah E, Howe C, Dobboh C, Kortimai LG, Kabeto A, Beste J, Garraway N, Riviello R, Hameed S, Shinde S, Marcil G, Prasad S, Arminan J, Debru E, Church N, Gill R, Mitchell P, Delisle M, Chernos C, Park J, Hardy K, Vergis A, Guez M, Hong D, Guez M, Hong D, Koichopolos J, Hilsden R, Thompson D, Myslik F, Vandeline J, Leeper R, Doumouras A, Govind S, Hong D, Govind S, Valanci S, Alhassan N, Lee L, Feldman L, Fried G, Mueller C, Wong T, Nadkarni N, Chia S, Seow D, Carter D, Li C, Valencia M, Ruo L, Parpia S, Simunovic M, Levine O, Serrano P, Vogt K, Allen L, Murphy P, van Heest R, Saleh F, Widder S, Minor S, Engels P, Joos E, Wang C, Nenshi R, Meschino M, Laane C, Parry N, Hameed M, Lacoul A, Lee L, Chrystoja C, Ramjist J, Sutradhar R, Lix L, Simunovic M, Baxter N, Urbach D, Ahlin J, Patel S, Nanji S, Merchant S, Lajkosz K, Brogly S, Groome P, Sutherland J, Liu G, Crump T, Bair M, Karimuddin A, Sutherland J, Peterson A, Karimuddin A, Liu G, Crump T, Koichopolos J, Hawel J, Shlomovitz E, Habaz I, Elnahas A, Alkhamesi N, Schlachta C, Akhtar-Danesh G, Doumouras A, Hong D, Daodu T, Nguyen V, Dearden R, Datta I, Hampton L, Kirkpatrick A, McKee J, Regehr J, Brindley P, Martin D, LaPorta A, Park J, Vergis A, Gillman L, DeGirolamo K, Hameed M, D'Souza K, Hartford L, Gray D, Murphy P, Hilsden R, Clarke C, Vogt K, Wigen R, Allen L, Garcia-Ochoa C, Gray S, Maciver A, Parry N, Van Koughnett J, Leslie K, Zwiep T, Ahn S, Greenberg J, Balaa F, McIsaac D, Musselman R, Raiche I, Williams L, Moloo H, Nguyen M, Naidu D, Karanicolas P, Nadler A, Raskin R, Khokhotva V, Poirier R, Plourde C, Paré A, Marchand M, Leclair M, Deshaies J, Hebbard P, Ratnayake I, Decker K, MacIntosh E, Najarali Z, Valencia M, Zhang B, Alhusaini A, Solis N, Duceppe E, Parpia S, Ruo L, Simunovic M, Serrano P, Murphy P, Murphy P, McClure A, Dakouo M, Vogt K, Vinden C, Behman R, Nathens A, Hong NL, Pechlivanoglou P, Karanicolas P, Lung K, Leslie K, Parry N, Vogt K, Leeper R, Simone P, Leslie K, Schemitsch E, Laane C, Chen L, Rosenkrantz L, Schuurman N, Hameed M, Joos E, George R, Shavit E, Pawliwec A, Rana Z, Laane C, Joos E, Evans D, Dawe P, Brown R, Hameed M, Lefebvre G, Devenny K, Héroux D, Bowman C, Mimeault R, Calder L, Baker L, Winter R, Cahill C, Fergusson D, Williams L, Schroeder T, Kahnamoui K, Elkheir S, Farrokhyar F, Wainman B, Hershorn O, Lim S, Hardy K, Vergis A, Arora A, Wright F, Nadler A, Escallon J, Gotlib L, Allen M, Gawad N, Raîche I, Jeyakumar G, Li D, Aarts M, Meschino M, Giles A, Dumitra T, Alam R, Fiore J, Mata J, Fried G, Vassiliou M, Mueller C, Lee L, Feldman L, Al Busaidi O, Brobbey A, Stelfox T, Chowdhury T, Kortbeek J, Ball C, AlShahwan N, Fraser S, Gawad N, Tran A, Martel A, Baxter N, Allen M, Manhas N, Balaa F, Mannina D, Khokhotva V, Tran A, Gawad N, Martel A, Manhas N, Allen M, Balaa F, Behman R, Behman A, Haas B, Hong NL, Pechlivanoglou P, Karanicolas P, Gawad N, Fowler A, Mimeault R, Raiche I, Findlay-Shirras L, Decker K, Singh H, Biswanger N, Park J, Gosselin-Tardif A, Khalil MA, Gutierrez JM, Guigui A, Feldman L, Lee L, Mueller C, Ferri L, Roberts D, Stelfox T, Moore L, Holcomb J, Harvin J, Sadek J, Belanger P, Nadeau K, Mullen K, Aitkens D, Foss K, MacIsaac D, Williams L, Musselman R, Raiche I, Moloo H, Zhang S, Ring J, Methot M, Zevin B, Yu D, Hookey L, Patel S, Yates J, Perelman I, Saidenberg E, Khair S, Taylor J, Lampron J, Tinmouth A, Lim S, Hammond S, Park J, Hochman D, Lê M, Rabbani R, Abou-Setta A, Zarychanski R, Patel S, Yu D, Elsoh B, Goldacre B, Nash G, Trepanier M, Alhassan N, Wong-Chong N, Sabapathy C, Chaudhury P, Liberman S, Charlebois P, Stein B, Feldman L, Lee L, Bradley N, Dakin C, Holm N, Henderson W, Roche M, Sawka A, Tang E, Murphy P, Allen L, Huang B, Vogt K, Gimon T, Rochon R, Lipson M, Buie W, MacLean A, Lau E, Alkhamesi N, Schlachta C, Mocanu V, Dang J, Tavakoli I, Switzer N, Tian C, de Gara C, Birch D, Karmali S, Young P, Chiu C, Meneghetti A, Warnock G, Meloche M, Panton O, Istl A, Gan A, Colquhoun P, Habashi R, Stogryn S, Abou-Setta A, Metcalfe J, Hardy K, Clouston K, Vergis A, Zondervan N, McLaughlin K, Springer J, Doumouras A, Lee J, Amin N, Caddedu M, Eskicioglu C, Hong D, Cahill C, Fowler A, Warraich A, Moloo H, Musselman R, Raiche I, Williams L, Keren D, Kloos N, Gregg S, MacLean A, Mohamed R, Dixon E, Rochan R, Ball C, Taylor J, Stem M, Yu D, Chen S, Fang S, Gearhart S, Safar B, Efron J, Yu D, Stem M, Taylor J, Chen S, Fang S, Gearhart S, Safar B, Efron J, Domouras A, Springer J, Elkheir S, Eskicioglu C, Kelly S, Yang I, Forbes S, Wong-Chong N, Khalil MA, Garfinkle R, Bhatnagar S, Ghitulescu G, Vasilevsky C, Morin N, Boutros M, Garfinkle R, Wong-Chong N, Petrucci A, Sylla P, Wexner S, Bhatnagar S, Morin N, Boutros M, Garfinkle R, Sigler G, Morin N, Ghitulescu G, Bhatnagar S, Faria J, Gordon P, Vasilevsky C, Boutros M, Garfinkle R, Khalil MA, Bhatnagar S, Wong-Chong N, Azoulay L, Morin N, Vasilevsky C, Boutros M, Alhassan N, Wong-Chong N, Trepanier M, Chaudhury P, Liberman A, Charlebois P, Stein B, Lee L, Alhassan N, Yang M, Wong-Chong N, Liberman A, Charlebois P, Stein B, Fried G, Lee L, Khorasani S, de Buck van Overstraeten A, Kennedy E, Hong NL, Mata J, Fiore J, Pecorelli N, Mouldoveanu D, Gosselin-Tardiff A, Lee L, Liberman S, Stein B, Charlebois P, Feldman L, Chau J, Bhatnagar S, Khalil MA, Morin N, Vasilevsky C, Ghitulescu G, Faria J, Boutros M, Fournier FR, Bouchard P, Khalil MA, Bhatnagar S, Khalil JA, Vasilevsky C, Morin N, Ghitulescu G, Faria J, Boutros M, Khalil MA, Morin N, Vasilevsky C, Ghitulescu G, Motter J, Boutros M, Wong-Chong N, Mottl J, Hwang G, Kelly J, Nassif G, Albert M, Lee L, Monson J, Wong-Chong N, Lee L, Kelly J, Nassif G, Albert M, Monson J, McLeod J, Cha J, Raval M, Phang T, Brown C, Karimuddin A, Karimuddin A, Robertson R, Letarte F, Karimuddin A, Raval M, Phang T, Brown C, Antoun A, Sigler G, Garfinkle R, Morin N, Vasilevsky C, Pelsser V, Ghitulescu G, Boutros M, Hyun E, Clouston-Chambers K, Hochman D, Helewa R, Park J, Candy S, Mir Z, Hanna N, Zevin B, Patel S, Azin A, Hirpara D, Quereshy F, Jackson T, Okrainec A, O'Brien C, Chadi S, Punnen S, Raval M, Karimuddin A, Phang T, Brown C, Yoon H, Brown C, Karimuddin A, Raval M, Phang T, Xiong W, Stuart H, Andrews J, Selvam R, Wong S, Hopman W, MacDonald P, Patel S, Dossa F, Medeiros B, Keng C, Acuna S, Hamid J, Baxter N, Ghuman A, Kasteel N, Brown C, Karimuddin A, Raval M, Phang T, Dossa F, Baxter N, Buie D, McMullen T, Elwi A, MacLean T, Wang H, Coutinho F, Le Q, Shack L, Roy H, Kennedy R, Hanna N, Zevin B, Bunn J, Mir Z, Chung W, Elmi M, Wakeam E, Azin A, Presutti R, Keshavjee S, Cil T, McCready D, Cheung V, Schieman C, Bailey J, Nelson G, Batchelor T, Grondin S, Graham A, Safieddine N, Johnson S, Hanna W, Cheung V, Schieman C, Bailey J, Nelson G, Low D, Safieddine N, Grondin S, Seely A, Bedard E, Finley C, Nayak R, Brogly S, Lajkosz K, Lougheed D, Petsikas D, Kinio A, Resende VF, Anstee C, Seely A, Maziak D, Gilbert S, Shamji F, Sundaresan S, Villeneuve P, Ojah J, Ashrafi A, Najjar A, Yamani I, Sersar S, Batouk A, Parente D, Laliberte A, McInnis M, McDonald C, Hasnain Y, Yasufuku K, Safieddine N, Waddell T, Chopra N, Nicholson-Smith C, Malthaner R, Patel R, Doubova M, Robaidi H, Anstee C, Delic E, Fazekas A, Gilbert S, Maziak D, Shamji F, Sundaresan S, Villeneuve P, Seely A, Taylor J, Hanna W, Hughes K, Pinkney P, Lopez-Hernandez Y, Coret M, Schneider L, Agzarian J, Finley C, Tran A, Shargall Y, Mehta M, Pearce K, Hanna W, Schneider L, Farrokhyar F, Agzarian J, Finley C, Shargall Y, Gupta V, Coburn N, Kidane B, Hess K, Compton C, Ringash J, Darling G, Mahar A, Gupta V, Kidane B, Ringash J, Sutradhar R, Darling G, Coburn N, Thomas P, Vernon J, Shargall Y, Schieman C, Finley C, Agzarian J, Hanna W, Spicer J, Renaud S, Seitlinger J, Al Lawati Y, Guerrera F, Falcoz P, Massard G, Ferri L, Hylton D, Huang J, Turner S, French D, Wen C, Masters J, Kidane B, Spicer J, Taylor J, Finley C, Shargall Y, Fahim C, Farrokhyar F, Yasufuku K, Agzarian J, Hanna W, Spicer J, Renaud S, Seitlinger J, St-Pierre D, Garfinkle R, Al Lawati Y, Guerrera F, Ruffini E, Falcoz P, Massard G, Ferri L, Agzarian J, Inra M, Abdelsattar Z, Allen M, Cassivi S, Nichols F 3rd, Wigle D, Blackmon S, Shen K, Gowing S, Robaidi H, Anstee C, Seely A, Beigee FS, Sheikhy K, Dezfouli AA, Shargall Y, Lopez-Hernandez Y, Schnurr T, Schneider L, Linkins L, Crowther M, Agzarian J, Hanna W, Finley C, Waddell T, de Perrot M, Uddin S, Douketis J, Taylor J, Finley C, Shargall Y, Agzarian J, Hanna W, Martel A, Angka L, Jeong A, Sadiq M, Kilgour M, de Souza CT, Baker L, Kennedy M, Auer R, Hallet J, Adam R, Karanicolas P, Memeo R, Goéré D, Piardi T, Lermite E, Turrini O, Lemke M, Li J, Dixon E, Tun-Abraham M, Hernandez-Alejandro R, Bennett S, Martel G, Navarro F, Sa Cunha A, Pessaux P, Hallet J, Isenberg-Grzeda E, Kazdan J, Beyfuss K, Myrehaug S, Singh S, Chan D, Law C, Nessim C, Paull G, Ibrahim A, Sabri E, Rodriguez-Qizilbash S, Berger-Richardson D, Younan R, Hétu J, Wright F, Johnson-Obaseki S, Angarita F, Elmi M, Zhang Y, Hong NL, Govindarajan A, Taylor E, Bayat Z, Bischof D, McCart A, Elmi M, Wakeam E, Azin A, Presutti R, Keshavjee S, McCready D, Cil T, Elmi M, Sequeira S, Azin A, Elnahas A, McCready D, Cil T, Samman S, Cornacchi S, Foster G, Thabane L, Thomson S, Lovrics O, Martin S, Lovrics P, Latchana N, Davis L, Coburn N, Mahar A, Liu Y, Hammad A, Kagedan D, Earle C, Hallet J, Zhang Y, Elmi M, Angarita F, Hong NL, Pang G, Hong NL, Paull G, Kupper S, Kagedan D, Nessim C, Quan M, Wright F, Hsiao R, Bongers P, Lustgarten M, Goldstein D, Dhar P, Rotstein L, Pasternak J, Nostedt J, Gibson-Brokop L, McCall M, Schiller D, Park J, Ratnayake I, Hebbard P, Mukhi S, Mack L, Singh N, Chanco M, Hilchie-Pye A, Kenyon C, Mathieson A, Burke J, Nason R, Kupper S, Austin J, Brar M, Wright F, Quan M, Hurton S, Quan M, Kong S, Xu Y, Thibedeau M, Cheung W, Dort J, Karim S, Crump T, Bouchard-Fortier A, Jeong Y, Mahar A, Li Q, Bubis L, Gupta V, Coburn N, Hirpara D, O'Rourke C, Azin A, Quereshy F, Chadi S, Dharampal N, Smith K, Harvey A, Pashcke R, Rudmik L, Chandarana S, Buac S, Latosinsky S, Shahvary N, Gervais M, Leblanc G, Brackstone M, Guidolin K, Yaremko B, Gaede S, Lynn K, Kornecki A, Muscedere G, Shmuilovich O, BenNachum I, Mouawad M, Gelman N, Lock M, Jayaraman S, Jayaraman S, Daza J, Solis N, Parpia S, Gallinger S, Moulton C, Levine M, Serrano P, Horkoff M, Sutherland F, Dixon E, Ball C, Bathe O, Moser M, Shaw J, Beck G, Luo Y, Ahmed S, Wall C, Domes T, Jana K, Waugh E, Tsang M, Jayaraman S, Tang E, Baird J, Newell P, Hansen P, Gough M, Garcia-Ochoa C, McArthur E, Tun-Abraham M, Hawel J, Skaro A, Leslie K, Garcia-Ochoa C, McArthur E, Tun-Abraham M, Leslie K, Skaro A, Gauvin G, Goel N, Mutabdzic D, Lambreton F, Kilcoyne M, Nadler A, Ang K, Karachristos A, Cooper H, Hoffman J, Reddy S, Park L, Gilbert R, Shorr R, Workneh A, Bertens K, Abou-Khalil J, Balaa F, Martel G, Smith H, Bertens K, Levy J, Hammad A, Davis L, Gupta V, Jeong Y, Mahar A, Coburn N, Hallet J, Mahar A, Jayaraman S, Serrano P, Martel G, Beyfuss K, Coburn N, Piardi T, Pessaux P, Hallet J, Ellis J, Bakanisi B, Sadeghi M, Beyfuss K, Michaelson S, Karanicolas P, Law C, Nathens A, Coburn N, Giles A, Daza J, Doumouras A, Serrano P, Tandan V, Ruo L, Marcaccio M, Dath D, Connell M, Selvam R, Patel S, Kleiman A, Bennett A, Wasey N, Sorial R, Macdonald S, Johnson D, Klassen D, Leung C, Vergis A, Botkin C, Azin A, Hirpara D, Jackson T, Okrainec A, Elnahas A, Chadi S, Quereshy F, Bahasadri M, Saleh F, Bahasadri M, Saleh F, Saleh F, Bahasadri M, MacLellan S, Tan J, Jun H, Cheah H, Wong K, Harvey N, Smith A, Cassie S, Sun S, Vallis J, Twells L, Lester K, Gregory D, Vallis J, Lester K, Gregory D, Twells L, Dang J, Sun W, Switzer N, Raghavji F, Birch D, Karmali S, Dang J, Switzer N, Delisle M, Laffin M, Gill R, Birch D, Karmali S, Marcil G, Bourget-Murray J, Switzer N, Shinde S, Debru E, Church N, Reso A, Mitchell P, Gill R, Sun W, Dang J, Switzer N, Tian C, de Gara C, Birch D, Karmali S, Jarrar A, Eipe N, Budiansky A, Walsh C, Mamazza J, Rashid M, and Engels P

Published
2018
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181. Calculating the proportion of avoidable attendances at UK emergency departments: analysis of the Royal College of Emergency Medicine's Sentinel Site Survey data.

Author

Morris T, Mason SM, Moulton C, and O'Keeffe C

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care statistics & numerical data, Child, Child, Preschool, Emergency Medicine organization & administration, Emergency Service, Hospital organization & administration, Female, Humans, Infant, Male, Middle Aged, Pilot Projects, Surveys and Questionnaires, United Kingdom, Emergency Service, Hospital statistics & numerical data, Sentinel Surveillance
Abstract

Introduction: Avoidable attendances (AAs; defined as non-urgent, self-referred patients who could be managed more effectively and efficiently by other services) have been identified as a contributor to ED crowding. Internationally, AAs have been estimated to constitute 10%-90% of ED attendances, with the UK 2013 Urgent and Emergency Care Review suggesting a figure of 40%., Methods: This pilot study used data from the Royal College of Emergency Medicine's Sentinel Site Survey to estimate the proportion of AAs in 12 EDs across England on a standard day (20 March 2014). AAs were defined by an expert panel using questions from the survey. All patients attending the EDs were recorded with details of investigations and treatments received, and the proportion of patients meeting criteria for AA was calculated., Results: Visits for 3044 patients were included. Based on these criteria, a mean of 19.4% (95% CI 18.0% to 20.8%) of attendances could be deemed avoidable. The lowest proportion of AAs reported was 10.7%, while the highest was 44.3%. Younger age was a significant predictor of AA with mean age of 38.6 years for all patients attending compared with 24.6 years for patients attending avoidably (p≤0.001)., Discussion: The proportion of AAs in this study was lower than many estimates in the literature, including that reported by the 2013 Urgent and Emergency Care Review. This suggests the ED is the most appropriate healthcare setting for many patients due to comprehensive investigations, treatments and capability for urgent referrals.The proportion of AAs is dependent on the defining criteria used, highlighting the need for a standardised, universal definition of an appropriate/avoidable ED attendance. This is essential to understanding how AAs contribute to the overall issue of crowding., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2018
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182. The association between depressive symptoms and insulin resistance, inflammation and adiposity in men and women.

Author

Webb M, Davies M, Ashra N, Bodicoat D, Brady E, Webb D, Moulton C, Ismail K, and Khunti K

Subjects
Aged, C-Reactive Protein metabolism, Cohort Studies, Cross-Sectional Studies, Depression physiopathology, Female, Humans, Male, Middle Aged, Tumor Necrosis Factor-alpha blood, Adiposity, Depression complications, Inflammation complications, Insulin Resistance
Abstract

Introduction: Depression has been shown to be associated with elevated leptin levels, low-grade inflammation and insulin resistance. These derangements are often measured in mixed gender cohorts despite the different body compositions and hormonal environments of men and women and gender-specific prevalence and responses to depression., Methods: A cross-sectional analysis was carried out on a cohort of 639 participants from the ADDITION-Leicester dataset to assess differences in markers of diabetes risk, cardiovascular risk and inflammation in depressed and non-depressed individuals. Depressive symptoms were determined using the WHO (Five) well-being index. Multivariate linear and logistic regression analyses were adjusted for age, sex, ethnicity, body mass index, smoking, social deprivation and activity levels for continuous and binary variables respectively. Further analysis included stratifying the data by gender as well as assessing the interaction between depression and gender by including an interaction term in the model., Results: Women with depressive symptoms had a 5.3% larger waist circumference (p = 0.003), 28.7% higher HOMA IR levels (p = 0.026), 6.6% higher log-leptin levels (p = 0.01) and 22.37% higher TNF-α levels (p = 0.015) compared with women without. Conversely, depressive symptoms in men were associated with 7.8% lower body fat % (p = 0.015) but 48.7% higher CRP levels (p = 0.031) compared to men without. However, interaction analysis failed to show a significant difference between men and women., Conclusions: Depressive symptoms are associated with metabolic derangements. Whilst women tended to show elevations in biomarkers related to an increased risk of type 2 diabetes (HOMA IR, leptin and TNF-α), men showed a marked increase in the cardiovascular disease risk biomarker CRP. However, perhaps due to the cohort size, interaction analysis did not show a significant gender difference.

Published
2017
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184. Investigating incretin-based therapies as a novel treatment for depression in type 2 diabetes: Findings from the South London Diabetes (SOUL-D) Study.

Author

Moulton CD, Pickup JC, Amiel SA, Winkley K, and Ismail K

Subjects
Adult, Affect drug effects, Aged, Biomarkers blood, C-Reactive Protein metabolism, Case-Control Studies, Depression blood, Depression diagnosis, Depression psychology, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 diagnosis, Female, Humans, Incretins adverse effects, Inflammation Mediators blood, London, Male, Middle Aged, Prospective Studies, Time Factors, Treatment Outcome, Antidepressive Agents therapeutic use, Depression drug therapy, Diabetes Mellitus, Type 2 drug therapy, Hypoglycemic Agents therapeutic use, Incretins therapeutic use
Abstract

We aimed to investigate the association between incretin-based therapies and 1-year change in depressive symptoms in a cohort of 1735 patients with newly diagnosed type 2 diabetes. The incretin group experienced significant reduction in depressive symptoms compared to controls. This was independent of HbA1c and may be mediated by an anti-inflammatory mechanism., (Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.)

Published
2016
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185. Developing a new look.

Author

Pourquié O, Brown K, and Moulton C

Subjects
Internet, Periodicals as Topic economics, Publishing organization & administration, Editorial Policies, Periodicals as Topic trends, Publishing trends
Published
2015
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186. Canadian Surgery Forum: Abstracts of presentations to the Annual Meetings of the Canadian Association of Bariatric Physicians and Surgeons, Canadian Association of General Surgeons, Canadian Association of Thoracic Surgeons, Canadian Hepato-Pancreato-Biliary Association, Canadian Society of Surgical Oncology, Canadian Society of Colon and Rectal Surgeons, Vancouver, BC, Sept. 17-21, 2013.

Author

Gill RS, Apte S, Majumdar S, Agborsangaya C, Rueda-Clausen C, Birch D, Karmali S, Klarenbach S, Sharma A, Padwal RS, Pace D, Twells L, Smith C, Boone D, Manning K, Lester K, Dillon C, Midozi W, Murphy R, Bartlett L, Gregory D, Bazzarelli A, Wu R, Haggar F, Neville A, Yelle J, Raiche I, Mamazza J, Smith A, Saleh F, Elnahas A, Jackson T, Quereshy F, Penner T, Urbach D, Okrainec A, Saleh F, Munshi A, Alford T, Sheppard C, Karmali S, de Gara C, Birch D, Sheppard C, Whitlock K, de Gara C, Karmali S, Birch D, Dykstra M, Switzer N, Sheppard C, Gill KWR, Shi X, Karmali S, Doumouras A, Saleh F, Hong D, Saleh F, Doumouras A, Hong D, Alabbas H, Krotneva S, Ramjaun A, Eguale T, Meguerditchian A, Hallet J, Pronina I, Hanif A, Yohanathan L, Wallace D, Callum J, Lin Y, McLeod R, Coburn N, Livingston M, Mainprize D, Parry N, Ott M, Garfinkle R, Lee L, Cardin MJ, Spatz A, Morin N, Motter J, Jessula S, Grunbaum A, Kezouh A, Gordon P, Vasilevsky C, Morin N, Faria J, Ghitulescu G, Boutros M, Kleiman A, Farsi A, Petrucci A, Kezouh A, Vuong T, Gordon P, Vasilevsky C, Morin N, Faria J, Ghitulescu G, Boutros M, Elnahas A, Okrainec A, Jackson TD, Quereshy FA, Elnahas A, Okrainec A, Jackson TD, Quereshy FA, Keng C, Kelly S, Forbes S, Cadeddu M, Grubac V, Simunovic M, Eskicioglu C, Amin N, Yang I, Thabane L, DeNardi F, Tsai S, Coates A, Lovrics P, Fung A, Morris M, Saleem A, Wexner S, Vasilevsky C, Boutros M, Wu R, Stacey D, Scheer AS, Moloo H, Auer R, Tadros S, Friedlich M, Potter B, Boushey R, Letarte F, Bouchard A, Drolet S, Bouchard P, Berg A, Kubelik D, Moloo H, Schramm D, Skinner B, Sundaresan S, Lindsay L, Pearsall E, McKenzie M, McLeod R, Bussières A, Bouchard A, Drolet S, Chernos C, Crocker E, Hochman D, Chernos C, Crocker E, Hochman D, Recsky M, Brown C, Chernos C, Crocker E, Hochman D, Schellenberg A, Christian F, Haggar F, Rashid S, Wu R, Mamazza J, Moloo H, Raiche I, Klingbeil K, Brar M, Daigle R, Datta I, Heine J, Buie WD, MacLean A, Boulanger-Gobeil C, Dion G, Letarte F, Grégoire RC, Bouchard A, Drolet S, Howe B, Colquhoun P, Ott M, Leslie K, Brown C, Hochman D, Raval M, Moloo H, Phang T, Bouchard A, Williams L, Drolet S, Boushey R, Brown C, Phang T, Karimuddin A, Raval M, Armstrong J, Lubanovic M, Peck D, Colquhoun P, Taylor B, Saleem A, Stern G, Faria J, Krouchev R, Champagne-Parent G, Trottier V, Joos E, Smithson L, Morrell J, Kowalik U, Flynn W, Guo WA, Switzer N, Dykstra M, Lim RGS, Lester E, de Gara C, Shi X, Birch D, Karmali S, Hallet J, Yohanathan L, Wallace D, Callum J, Lin Y, McCluskey S, Rizoli S, McLeod R, Coburn N, Madani A, Watanabe Y, Vassiliou MC, Fuchshuber P, Jones DB, Schwaitzberg SD, Fried GM, Feldman LS, Pace D, Borgaonokar M, Boone D, McGrath J, Hickey N, Lougheed M, Evans B, Fallows G, Pace D, Borgaonokar M, Hickey N, McGrath J, Fallows G, Lougheed M, Evans B, Boone D, Bogach J, Farrokhyar F, Marcaccio M, Kelly S, Steigerwald S, Park J, Hardy K, Gillman L, Vergis A, Steigerwald S, Park J, Hardy K, Gillman L, Vergis A, Steigerwald S, Park J, Hardy K, Gillman L, Vergis A, Chan T, Bleszynski MS, Buczkowski AK, Fung F, Cornacchi S, Vanniyasingam T, Dao D, Thabane L, Simunovic M, Hodgson N, O'Brien M, Reid S, Heller B, Lovrics P, Hardy P, Bilanski S, Roy H, Burbridge B, Toprak A, Jones S, Winthrop A, McEwen L, Boulanger-Gobeil C, Gagné J, Watanabe Y, Bilgic E, Ritter EM, Schwaitzberg S, Kaneva P, Korndorffer JR Jr, Scott DJ, Okrainec A, O'Donnell M, Feldman LS, Fried GM, Vassiliou MC, Manji F, Ott M, Kidane B, MacDougall T, Champion C, Lampron J, Saidenberg E, Okumura K, Kubota T, Kishida A, Ball C, Eberle T, Dixon E, Mutabdzic D, Patel P, Zilbert N, Seemann N, Murnaghan L, Moulton C, Dharampal N, Cameron C, Dixon E, Ghali W, Quan ML, Anantha RV, Mazzuca D, Xu S, Porcelli S, Fraser D, Martin C, Welch I, Mele T, Haeryfar SMM, McCormick J, Anantha RV, Jegatheswaran J, Pepe D, Priestap F, Delport J, Haeryfar M, McCormick J, Mele T, Wallace D, Hallet J, El-Sedfy A, Gotlib-Conn L, Nathens AB, Smith AJ, Ahmed N, Coburn NG, Pepe D, Anantha R, Jegatheswaran J, Mele T, McCormick J, Stogryn S, Metcalfe J, Vergis A, Hardy K, Seyednejad N, Konkin DE, Goecke M, Ambrosini L, Saleh F, Jimenez M, Byrne J, Gnanasegaram J, Quereshy F, Penner T, Jackson T, Okrainec A, Rivard J, Vergis A, Unger B, Gillman L, Hardy K, Park J, Bleszynski M, Chan T, Buczkowski A, Greenberg J, Hsu J, Nathens A, Bawazeer M, Coburn N, Friedrich J, Marshall J, Huang H, McLeod R, Khokhotva M, Zalev A, Grantcharov T, McKenzie M, Aarts M, Gotlib L, McCluskey S, Okrainec A, Pearsall E, Siddiqui N, McLeod R, Zilbert N, St-Martin L, Mutabdzic D, Gallinger S, Regehr G, Moulton CA, Peralta R, Parchani A, Consunji R, ElMenyar A, Abdelrahman H, Zarour A, Al Thani H, Li D, de Mestral C, Alali A, Nathens A, Louridas M, Shore E, Seemann N, Grantcharov T, Szasz P, Louridas M, de Montbrun S, Harris K, Grantcharov T, Hilsden R, Moffat B, Ott M, Parry N, Byrne J, Saleh F, Ambrosini L, Jimenez C, Gnanasegaram J, Quereshy F, Jackson T, Okrainec A, Hong D, Pescarus R, Khan R, Anvari M, Cadeddu M, Mui C, Martimianakis MA, Espin S, Robinson L, Patel P, Lorello G, Everett T, Murnaghan ML, Moulton CA, Yanchar N, Havenga M, Butler M, Maggisano M, Pearsall E, Huang H, Nathens A, Morris A, Nelson S, McLeod R, Bailey J, Davis P, Levy A, Molinari M, Johnson P, Nadler A, Ahmed N, Escallon J, Wright F, Young P, Salim S, Compston C, Mueller T, Khadaroo R, Hoffman N, Okrainec A, Quereshy F, Tse A, Jackson T, Al-Adra DP, Gill RS, Axford SJ, Shi X, Kneteman N, Liau S, Levy J, Garfinkle R, Camlioglu E, Vanounou T, Hallet J, Zih F, Wong J, Cheng E, Hanna S, Coburn N, Karanicolas P, Law C, Liang S, Jayaraman S, Liang S, Jayaraman S, Chan T, DeGirolamo K, Bleszynski M, Dhingra V, Chung SW, Scudamore CH, Buczkowski AK, Zih F, Hallet J, Deobald R, Scheer A, Law C, Coburn N, Karanicolas P, Allam H, Al Dosouky M, Farooq A, El Nagar A, Vijay A, Luo Y, Shaw J, Moser M, Kanthan R, Jrearz R, Hart R, Jayaraman S, Lowry B, El Moghazy W, Meeberg G, Kneteman N, O'Malley L, Menard A, Jalink D, Nanji S, Segedi M, Serrano Aybar P, Leung K, Dhani N, Kim J, Gallinger S, Moore M, Hedley D, Kryzanowska M, McGilvray I, Abou Khalil J, Chaudhury P, Barkun J, Abou Khalil J, Dumitra S, Ball C, Dixon E, Barkun J, Abdelhafid EA, Chagnon F, Sestier F, Cyr D, Truong J, Lam-McCulloch J, Cleary S, Karanicolas P, Sisson D, Jalink D, Nanji S, Rose JB, Rocha F, Alseidi A, Biehl T, Helton S, Heneghan R, Haufe S, Hagensen A, Leicester K, Cranny M, London A, Helton S, Broughton J, McKay A, Lipschitz J, Cantor M, Moffatt D, Abdoh A, Cheng E, Kulyk I, Hallet J, Truong J, Hanna S, Law C, Coburn N, Tarshis J, Lin Y, Karanicolas PJ, Nanji S, Biagi JJ, Chen J, Mackillop WJ, Booth CM, Abramowitz D, Hallet J, Strickland M, Liang V, Law C, Jayaraman S, Emmerton-Coughlin H, Meschino M, Mujoomdar A, Bashir O, Leslie K, Hernandez-Alejandro R, Rocha F, Gluck M, Irani S, Gan SI, Larsen M, Kozarek R, Ross A, Koller J, Alemi F, Damle S, Biehl T, Alseidi A, Lin B, Picozzi V, Helton S, Rocha F, Bertens K, Clancy T, Swanson R, Hawel J, Pineda K, Romsa GJ, Hernandez Alejandro R, Porter SHG, Levy A, Molinari M, Hurton S, Porter G, Walsh M, Molinari M, Martel G, Aubin J, Balaa FK, Lapointe R, Vandenbroucke-Menu F, Hallet J, Singh S, Saskin R, Liu N, Law C, Bouchard-Fortier A, Temple WJ, Mack LA, McKevitt E, Dingee C, Pao J, Warburton R, Brown C, Kuusk U, Racz JM, Cleghorn MC, Jimenez MC, Atenafu EG, Jackson TD, Okrainec A, Venkat Raghavan L, Quereshy FA, Rabie ME, Hummadi A, Al Shuraim M, Al Skaini MS, Al Qahtani S, Al Qahtani AS, Elhakeem I, Tsang ME, Cannell AJ, Swallow CJ, Chung PW, Dickson BC, Griffin AM, Bell RS, Wunder JS, Ferguson PC, Gladdy RA, Covelli A, Baxter N, Fitch M, Wright F, Cordeiro E, Dixon M, Coburn N, Holloway C, Hamilton T, Cannell A, Kim M, Catton C, Blackstein M, Dickson B, Gladdy R, Swallow C, Austin J, Lam N, Quinn R, Quan ML, Gauvin G, Yeo C, Ungi T, Fichtinger G, Nanji S, Rudan J, Engel J, Moore S, Kasaian K, Jones S, Melck A, Wiseman S, Warburton R, Pao J, McKevitt E, Dingee C, Bovill E, Van Laeken N, Kuusk U, Arnaout A, Aubin JM, Namazi M, Robertson S, Gravel D, Ayroud Y, Rockwell G, Kulyk I, Cheng ES, Hallet J, Truong J, Hanna S, Law C, Coburn N, Tarshis J, Lin Y, Karanicolas PJ, Yeung C, Namazi M, Deslauriers V, Haggar F, Arnaout A, Kuusk U, Seyednejad N, McKevitt E, Dingee C, Wiseman S, Jones D, Aloraini A, Gowing S, Cools-Lartigue J, Leimanis M, Tabah R, Ferri L, McGuire A, Sundaresan S, Seely A, Maziak D, Villeneuve J, Gilbert S, Kuritzky A, Aswad B, Machan J, Ng T, McGuire A, Sekhon H, Gilbert S, Maziak D, Sundaresan S, Villeneuve P, Seely A, Shamji F, Gazala S, Kim J, Roa W, Razzak R, Gosh S, Guo L, Joy A, Nijjar T, Wong E, Bedard E, Sadegh Beigee F, Pojhan S, Daneshvar Kakhaki A, Sheikhy K, Reza Saghebi S, Abbasidezfouli A, Poon J, MacGregor J, Graham A, McFadden S, Gelfand G, Coughlin S, Plourde M, Guidolin K, Fortin D, Malthaner R, Inculet R, Esmail T, McCarthy P, Gonzalez M, Krueger T, Masters J, Berg E, Forsyth M, Ojah J, Sytnik P, Donaleshen J, Gottschalk T, Srinathan S, Finley C, Camposilvan I, Schneider L, Akhtar-Danesh N, Hanna W, Schieman C, Shargall Y, Ashrafi A, Kearns M, Bond J, Ong S, Bong T, Hafizi A, De Waele M, Schieman C, Finley C, Schneider L, Schnurr T, Farrokhyar F, Hanna W, Nair P, and Shargall Y

Published
2014
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187. Better data, better planning: the College of Emergency Medicine sentinel sites project.

Author

Moulton C, Mann C, and Tempest M

Subjects
Data Collection methods, Delivery of Health Care, Humans, Needs Assessment, Surveys and Questionnaires, United Kingdom, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Patient Care Management methods, Patient Care Management standards, Quality Assurance, Health Care organization & administration
Abstract

This article describes the College of Emergency Medicine's initial attempt to gather high quality data from its own 'sentinel sites' rather than relying on more comprehensive national data of dubious quality. Such information is essential to inform and guide the planning of urgent and emergency care services in the future.

Published
2014
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188. Perfect pitch reconsidered.

Author

Moulton C

Subjects
Humans, Auditory Perception physiology, Learning physiology, Models, Biological, Music
Abstract

Perfect pitch, or absolute pitch (AP), is defined as the ability to identify or produce the pitch of a sound without need for a reference pitch, and is generally regarded as a valuable asset to the musician. However, there has been no recent review of the literature examining its aetiology and its utility taking into account emerging scientific advances in AP research, notably in functional imaging. This review analyses the key empirical research on AP, focusing on genetic and neuroimaging studies. The review concludes that: AP probably has a genetic predisposition, although this is based on limited evidence; early musical training is almost certainly essential for AP acquisition; and, although there is evidence that it may be relevant to speech processing, AP can interfere with relative pitch, an ability on which humans rely to communicate effectively. The review calls into question the value of AP to musicians and non-musicians alike., (© 2014 Royal College of Physicians.)

Published
2014
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189. Ethical development.

Author

Pourquié O, Brown K, and Moulton C

Subjects
Authorship standards, Humans, Reproducibility of Results, Developmental Biology ethics, Peer Review, Research trends, Publications ethics
Published
2014
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190. Planned versus unplanned portal vein resections during pancreaticoduodenectomy for adenocarcinoma.

Author

Kim PT, Wei AC, Atenafu EG, Cavallucci D, Cleary SP, Moulton CA, Greig PD, Gallinger S, Serra S, and McGilvray ID

Subjects
Blood Loss, Surgical, Blood Vessel Prosthesis Implantation methods, Female, Humans, Length of Stay, Male, Middle Aged, Neoplasm Invasiveness, Operative Time, Patient Care Planning, Portal Vein injuries, Postoperative Complications etiology, Treatment Outcome, Vascular Neoplasms surgery, Adenocarcinoma surgery, Mesenteric Veins surgery, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Portal Vein surgery
Abstract

Background: The management of portal vein (PV) involvement by pancreatic adenocarcinoma during pancreaticoduodenectomy (PD) is controversial. The aim of this study was to compare the outcomes of unplanned and planned PV resections as part of PD., Methods: An analysis of PD over 11 years was performed. Patients who had undergone PV resection (PV-PD) were identified, and categorized into those who had undergone planned or unplanned resection. Postoperative and oncological outcomes were compared., Results: Of 249 patients who underwent PD for pancreatic adenocarcinoma, 66 (26·5 per cent) had PV-PD, including 27 (41 per cent) planned and 39 (59 per cent) unplanned PV resections. Twenty-five of 27 planned PV resections were circumferential PV-PD, whereas 25 of 39 unplanned PV resections were partial PV-PD. Planned PV resections were performed in slightly younger patients (mean(s.d.) 60(9) versus 65(10) years; P = 0·031), and associated with longer operating times (mean(s.d.) 602(131) versus 458(83) min; P < 0·001) and more major complications (26 versus 5 per cent; P = 0·026). Planned PV resections were associated with a lower rate of positive margins (4 versus 44 per cent; P < 0·001) despite being carried out for larger tumours (mean(s.d.) 3·9(1·4) versus 2·9(1·0) cm; P = 0·002). There was no difference in survival between the two groups (P = 0·998). On multivariable analysis, margin status was a significant predictor of survival., Conclusion: Although planned PV resections for pancreatic adenocarcinoma were associated with higher rates of postoperative morbidity than unplanned resections, R0 resection rates were better., (© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.)

Published
2013
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191. Canadian Surgery Forum.

Author

Fayez R, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, AlMuntashery A, Fayez R, Demyttenaere S, Christou N, Court O, Bodie G, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Almamar A, Sharma A, Karmali S, Birch DW, Gill RS, Majumdar SR, Wang X, Tuepah R, Klarenbach SW, Birch DW, Karmali S, Sharma AM, Padwal RJ, Raîche I, Smith C, Haggar F, Moloo H, Poulin EC, Martel G, Yelle JD, Mamazza J, Mueller CL, Jackson TD, Penner T, Pitzul K, Urbach DR, Okrainec A, AlMuntashery A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Fayez R, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, AlMuntashery A, Fayez R, Demyttenaere S, Court O, Christou N, Moustarah F, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Khokhotva M, Grantcharov T, Anvari M, Sharma A, Yusuf S, Kwong J, Okrainec A, Pitzul KB, Urbach DR, Jackson T, Elkassem S, Lindsay D, Sullivan P, Smith L, Bonrath E, Zevin B, Dedy N, Grantcharov TP, Zevin B, Bonrath EM, Aggarwal R, Grantcharov T, Sockalingam S, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Smith C, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Smith C, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Whitlock KA, Gill RS, Ali T, Shi X, Birch DW, Karmali S, Gill RS, Whitlock KA, Shi X, Sarkhosh K, Birch DW, Karmali S, Suri M, Turner JM, Nation PN, Wizzard P, Brubaker PL, Gisalet DL, Wales PW, Palter VN, Grantcharov TP, Wakeam E, Tien H, Spencer F, Brenneman F, Khan RSA, Kowal J, Wiseman SM, Martelli V, Fraser SA, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Malik A, Bell C, Stukel T, Urbach DR, Young PY, Mueller TF, Lucykx VA, Lukowski CM, Compston CA, Churchill TA, Khadaroo RG, Daigle C, Grantcharov T, McCreery G, Vogt K, Dubois L, Gray D, Seth R, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Paskar D, Crawford S, Parry N, Leslie K, Sudarshan M, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman LS, Khwaja K, Richardson D, Porter G, Johnson P, Haggar F, Boushey R, Moloo H, Raiche I, Mamazza J, Davis VW, Schiller DE, Eurich D, Sawyer MB, Rivard J, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Agzarian J, Prodger J, Kelly W, Kelly S, Prodger D, Racz J, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Winocour J, Al-Ali K, Briggs K, George R, Zilbert NR, Murnaghan ML, Leung A, Regehr G, Moulton CA, Decker C, Neumann K, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Gosney JE Jr, Burkle FM Jr, Redmond AD, McQueen K, Wissanji H, Desrosiers E, Gilbert A, Chadi SA, Leslie K, Ott MC, Alhabboubi M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Partridge E, Aikins C, Alhabboubi M, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Olszewski M, Roberts N, Moulton CA, Murnaghan ML, Cil T, Chan R, Marshall J, Pederson K, Erichsen S, White J, Nadler A, Aarts MA, Okrainec A, Victor JC, Pearsall E, McLeod RS, Hameed U, Jackson TD, Okrainec A, Penner TP, Urbach DR, Brotherhood H, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Menezes AS, Gill RS, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, MacDonald B, Mercer D, Hopman W, Rakovich G, Latulippe JF, Hilsden R, Knowles S, Moffat B, Parry N, Leslie K, Merani S, Switzer N, Khadaroo RG, Tul Y, Widder S, Davis P, Molinari M, Levy A, Johnson P, Davis PJB, Bailey J, Molinari M, Hayden J, Johnson P, Cools-Lartigue J, Benlolo S, Marcus V, Ferri L, Ojah J, Finley R, Anderson D, Julien F, Gagné JP, Carter D, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Pitt D, Aubin JM, Banks BA, Mew D, McConnell Y, Rudovics A, Classen D, Kanthan S, Ravichandran P, Croome KP, Kovacs MJ, Lazo-Langner A, Hernandez-Alejandro R, Anantha R, Vogt K, Crawford S, Parry N, Leslie K, Aad I, Kholdebarin R, Khoshgoo N, Iwasiow BM, Keijzer R, Aird LNF, Brown CJ, Wong SL, Isa D, Pace D, Payne JRM, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo RG, Hallet J, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon AF, Mailloux O, Farries L, Hardy P, Muirhead RM, Raiche I, Masters J, Haggar F, Poulin HMEC, Martel G, Mamazza J, Botkin C, Milbrandt C, Keijzer R, Morency D, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Berger-Richardson D, Kurashima Y, Kaneva P, Feldman LS, Fried GM, Vassiliou MC, Isa AD, Kwan AH, Dupuis I, Fraser SA, Schweigert M, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein HJ, Koubi S, Borgaonkar M, Ernjakovic M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong WL, McCready DR, Grant K, Clifton J, Mayo J, Finley R, Cools-Lartigue J, Noreau-Nguyen M, Mulder DS, Ferri LE, Carrott P, Markar S, Hong J, Low DE, Stafford T, Maslow A, Davignon K, Ng T, Malthaner R, Tan L, Aruranian J, Kosa S, Sudarshan M, Ferri LE, Hanna WC, Murphy G, Allison F, Moshonov H, Darling GE, Waddell TK, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul NS, Pierre AF, Lee L, Darling G, Pedneault C, Marcus V, Mulder DS, Ferri LE, Markar S, Low D, Razzak R, Roa W, Löbenberg R, McEwan S, Bédard EL, Bharadwaj SC, Louie BE, Farivar AS, McHugh SP, Aye RW, Ashrafi AS, Tan-Tam C, De Vera M, Bond RJ, Ong SR, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi SY, Ouellette D, Wakil N, Rakovich G, Beauchamps G, Markar S, Preston S, Baker C, Low D, Bottoni DA, Campbell G, Malthaner RA, Knickle C, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin S, Coughlin HE, Roth L, Bhandari M, Malthaner R, Gazala S, Johnson J, Kutsogiannis J, Bédard E, Gazala S, Rammohan K, Stewart K, Bédard E, Donahoe L, Buduhan G, Walker K, Gruchy J, Xu Z, Buduhan G, Li C, Ferri LE, Mulder DS, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman LS, Alnasser S, Av R, Mayrand S, Franco E, Ferri LE, Schweigert M, Dubecz A, Renz M, Stadlhuber RJ, Ofner D, Stein HJ, Schweigert M, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein HJ, Zhuruk A, Croome K, Leeper R, Hernandez R, Hanouf A, Livingstone S, Sapp J, Woodhall D, Alwayn I, Vanounou T, Bergman S, Karanicolas P, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Aubin JM, Rekman JF, Fairfull-Smith RJ, Mimeault R, Balaa FK, Martel G, Yeung JC, Boehnert MS, Bazerbachi F, Knaak JM, Selzner N, McGilvray ID, Rotstein OD, Adeyi OA, Levy GA, Keshavjee S, Grant DR, Selzner M, Dumitra S, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Simoneau E, Jamal MH, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Vanounou TT, Groeschl RT, Geller DA, Marsh JW, Gamblin TC, Howe B, Croome K, Hawel J, Croome K, Quan D, Hernandez R, Jang JH, Kim PTW, Greig PD, Gallinger S, Moulton CA, Wei AC, Fischer SE, Cleary SP, Bertens K, Vogt KN, Hernandez-Alejandro R, Gray DK, Rekman JF, Aubin JM, Fairfull-Smith JJ, Mimeault R, Balaa FK, Martel G, Wei AC, Devitt KS, Ramjaun A, Gallingher S, Dumitra S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Koubi S, Borgaonkar M, Ouellet JF, Tanyingoh D, Dixon E, Kaplan GG, Myers RP, Howard TJ, Sutherland FR, Zyromski NJ, Ball CG, Wei AC, Coburn N, Moulton CA, Cleary SP, Law CH, Greig P, Steven G, Covelli A, Baxter N, Fitch M, Wright F, Maniar R, Hochman DJ, Wirtzfeld DA, McKay A, Yaffe CS, Yip B, Silverman R, Park J, Sun S, McConnell YJ, Temple WJ, Mack LA, Davis VW, Schiller DE, Bathe OF, Sawyer MB, Brackstone M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Boissonneault R, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Kim SHH, Cornacchi SD, Heller B, Farrokhyar F, Babra M, Lovrics PJ, Baliski C, Liberto C, Gazala S, Ghosh S, McLean R, Schiller D, Hameed U, Jackson TD, Okrainec A, Penner TP, Urbach DR, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Arnaout A, Seely J, Smylie J, Knight K, Robertson S, Watters J, Wedman D, Zhang T, Arneout A, Nostedt M, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe CS, Silverman R, Park J, Hebbard P, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan ML, Shetty SJ, Natarajan B, Govindarajan V, Thomas P, Loggie BW, Dixon M, Brar S, Mahar A, Law C, Coburn N, Wei AC, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Baxter NN, Gagliardi AR, Kennedy ED, Urbach DR, Dixon M, Brar S, Mahar A, Law C, Coburn N, Kazazian K, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Lemke M, Ko YJ, Rowsell C, Law CHL, Wells B, Saskin R, Quan ML, Musselman RP, Xie M, McLaughlin K, Marginean C, Moyana TN, Moloo H, Boushey RP, Auer RC, Zih FSW, Razik R, Haase E, Mathieson A, Smith AJ, Swallow CJ, Menezes AS, Barnes A, Scheer AS, Moloo H, Boushey RP, Sabri E, Auer RAC, Nassif M, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian AN, Leon-Carlyle M, Brown JA, Hamm J, Phang PT, Raval MJ, Brown CJ, Wei AC, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Taylor B, Urbach DR, Krotneva S, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Bradley NL, Hamm JD, Wiseman SM, Trabulsi N, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Trabulsi N, Riedel KE, Winslade NE, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Chin-Lenn L, Pasieka J, Cheng H, McMillan C, Lipa J, Snell L, Petrucci AM, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Sandhu L, Tomlinson G, Kennedy ED, Wei A, Baxter NN, Urbach DR, Neville A, Liberman AS, Charlebois P, Stein B, Ncuti A, Vassiliou MC, Fried GM, Feldman LS, Lee L, Capretti G, Power A, Liberman AS, Charlebois P, Stein B, Kaneva P, Carli F, Fried GM, Feldman LS, Li C, Carli F, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Yang I, Boushey R, Moloo H, Prabhu KL, Vu L, Chan S, Phang PT, Gown A, Jones S, Wiseman S, Melich G, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Knowles S, Lumb K, Colquhoun P, Richardson D, Porter G, Johnson P, Borowiec AM, Baxter NN, Schmocker S, Huang H, Victor JC, Krzyzanowska MK, Brierley J, McLeod RS, Kennedy ED, Hallet J, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire RC, Boissonneault R, Vuong T, Loungnarath R, DeBroux E, Liberman AS, Charlebois P, Stein B, Richard C, Kolozsvari NO, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou MC, Fried GM, Feldman LS, Hallet J, Milot H, Drolet S, Bouchard A, Grégoire RC, Tuttle P, Powell R, Fowler A, Mathieson A, VanHouwelingen L, Martin K, Vogt K, Ott MC, Haggar F, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Boulanger-Gobeil C, Bouchard A, Gagné JP, Grégoire RC, Thibault C, Bouchard P, Chan BP, Gomes T, Musselman RP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Boushey RP, AlObeed O, Chan BP, Armstrong JBP, Fergusson DA, Forster AJ, Boushey RP, Richardson D, Porter G, Johnson P, Musselman RP, Gomes T, Chan BP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Al-Obaid O, Boushey RP, Melich G, Lim DR, Min BS, Baik SH, Gordon PH, Kim NK, Phang PT, Lo A, Pinsk I, Brown C, Raval M, Goldstein LJ, Cheng H, Wen C, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Lebrun A, Bouchard A, Chadi SA, Parry NG, Leslie K, and Ott MC

Published
2012
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192. Putting feet first.

Author

Moulton C

Subjects
Diabetic Foot nursing, Humans, Patient Education as Topic, United Kingdom, Amputation, Surgical statistics & numerical data, Diabetic Foot surgery, Quality of Health Care
Published
2012
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193. Canadian Surgery Forum: Abstracts of presentations to the Annual Meetings of the Canadian Association of Bariatric Physicians and Surgeons, Canadian Association of General Surgeons, Canadian Association of Thoracic Surgeons, Canadian Hepato-Pancreato-Biliary Society, Canadian Society of Surgical Oncology, Canadian Society of Colon and Rectal Surgeons, London, Ont. Sept. 15-18, 2011.

Author

Chiu JC, Shi X, Karmali S, Birch DW, Apriasz I, Alkhamesi NA, Lal A, Schlachta CM, Christou NV, Elkassem S, Lindsay D, Smith L, Sullivan P, Sockalingam S, Hawa R, Wnuk S, Jackson T, Okrainec A, Fayez R, Christou NV, Court O, Mueller C, Okrainec A, Sockalingham S, Jackson T, Mueller C, Swanson T, Daigle C, Okrainec A, Pitzul K, Penner T, Urbach DR, Jackson T, Sandhu L, Maciver A, McCall M, Edgar R, Thiesen A, Bigam D, Churchill T, Shapiro AMJ, Luu S, Regehr G, Murnaghan ML, Gallinger S, Moulton CA, Palter V, Grantcharov T, Dath D, Hoogenes J, Matsumoto E, Szalay D, Fox A, Pitzul K, Bhojani F, Kaplan M, Wei A, McGilvray I, Cleary SP, Okrainec A, Alqahtani A, Parsyan A, Payne R, Tabah R, Anantha R, Vogt K, Crawford S, Parry N, Leslie K, Ochs A, Matthew K, Khadaroo R, Churchill T, Lavoie JM, Zalai C, Vasilevsky CA, Booy J, Takata J, Tomlinson G, Urbach DR, Lim D, Tomlinson C, LaBossiere J, Rommens K, Birch DW, Brenneman F, MacLellan S, Simpson J, Asai K, Elgadi K, Ali S, Sawyer J, Helewa R, Turner D, Wirtzfeld D, Park J, Czaykowski P, Mak G, Hochman D, McKay A, Gill R, Al-Adra D, Shi X, Sample C, Armstrong J, Lester L, Vogt K, Brackstone M, Lee L, Kaneva P, Liberman S, Charlebois P, Stein B, Fried G, Feldman L, Kanji A, Sharon E, Asai K, Jacks L, McCready D, Ghazarian D, Leong WL, Wu R, Okrainec A, Penner T, Ball C, Kirkpatrick A, Vasquez A, Balakrishnan L, Miller G, Awan S, Azadeh NR, Hoogenes J, Dath D, Jain V, Busato GM, Cristea O, Landau J, Moreland R, Johnson M, Ramage D, Browning D, Ullah S, Cristea O, Bodrogi A, Johnson M, McAlister V, Palisoc J, Anderson J, Kiladze R, Ciar J, Bancel I, Pitzul K, Leake PA, Okrainec A, Dalvi A, McLean R, Stephen W, Loeb M, Smith R, Christoffersen E, Forbes S, Kidane B, Vogt K, Vinden C, Ahmadi N, Dubois L, McKenzie M, Baxter N, Brown C, Chaudhury P, Dixon E, Fitzgerald W, Henteleff H, Kirkpatrick A, Latosinsky S, MacLean A, McLeod R, Pearsall E, Aarts MA, Meghji Z, McLeod R, Okrainec A, Tran T, Kaneva P, Fried G, Mayo N, Feldman L, Newman D, Bergman S, Cummings BA, Delisle M, Whitehead V, Chertkow H, Chan T, Cicero M, Perampaladas K, Bandukwala T, Struble J, Moser M, Young P, Groeneveld A, Chan P, Smith S, Khadaroo R, Buczkowski A, Hameed M, Tan-Tam C, Meneghetti A, Simons R, Panton N, Elnahas A, Ghaderi I, Madani A, de Gara C, Schlachta CM, Kalechstein S, Pitzul K, Henao O, Okrainec A, Paskar D, Croome K, Hernandez R, Knapp G, Howatt N, Foster S, Cameron B, Austin J, Mack L, Temple W, Puloski S, Schachar N, Gill T, Doris P, Tecson A, Kolozsvari N, Andalib A, Kaneva P, Cao J, Vassiliou M, Fried G, Feldman L, Kolozsvari N, Kaneva P, Vassiliou M, Fried G, Feldman L, Kolozsvari N, Kaneva P, Brace C, Chartrand G, Vaillancourt M, Cao J, Banaszek D, Vassiliou M, Fried G, Feldman L, Fraser S, Bergman S, Deobald R, Chad J, Di Gregorio C, Johnstone J, Kenyon C, Lees M, Auger-Dufour E, Fried G, Feldman L, Ferri L, Vassiliou M, Alqahtani A, Perlman R, Holcroft C, Gordon PH, Szilagyi A, Iradukunda D, Moser MAJ, Rodych N, Shaw JM, Ahmed N, Chiu M, Kurabi B, Qureshi A, Nathens A, Conn LG, Pandya A, Kitto S, Ma G, Pooni A, Forbes S, Eskicioglu C, Pearsall E, Brenneman F, McLeod R, Rockx MA, McAlister V, Roberts D, Ouellet J, Kirkpatrick A, Lall R, Sutherland F, Ball C, Chackungal S, Knowlton LM, Dahn B, McQueen K, Morrison JA, Lent B, Brown J, Fluit M, Herbert C, Deen S, Deutschmann M, McFadden S, Gelfand G, Bosch D, Grimmer L, Milman S, Ng T, Gill R, Perry T, Abele J, Bedard E, Schiller D, Coughlin S, Stewart TC, Parry N, Gray D, Williamson J, Malthaner R, Bottoni D, Perri M, Trejos AL, Naish M, Patel R, Malthaner R, Ashrafi A, Bond J, Ong S, Yamashita M, Ahmadi S, Abdulmosen M, Miller J, Finley C, Ostrander K, Shargall Y, Lee L, Hanley S, Robineau C, Sirois C, Mulder D, Ferri L, Humphrey R, Inculet R, Fortin D, Arab A, Malthaner R, Ashrafi A, Bond J, Ong S, Yamashita M, Ahmadi S, McGuire A, Reid K, Petsikas D, Hopman W, Basi A, Basi S, Irshad K, Hanna W, Croome KP, Marotta P, McAlister V, Quan D, Wall W, Hernandez-Alejandro R, de Mestral C, Zagorski B, Rotstein O, Gomez D, Haas B, Laupacis A, Sharma S, Bridge J, Nathens A, Bhojani F, Fox A, Pitzul K, Moulton CA, Wei A, Okrainec A, Cleary S, Bertens K, Croome KP, Mujoomdar A, Peck D, Rankin R, Quan D, Kakani N, Hernandez-Alejandro R, Suri R, Marcaccio M, Ruo L, Jamal M, Khalil JA, Simoneau-Beaudry E, Dumitra S, Edwards M, Yousef Y, Jiffry MA, Metrakos P, Tchervenkov J, Doi S, Barkun J, Obayan A, Meiers S, Keith R, Elkassem S, Church N, Mitchell P, Turbide C, Dixon E, Debru E, Shum J, Wall WJ, Maniar R, Hochman D, Wirtzfeld D, Yaffe C, Yip B, McKay A, Silverman R, Park J, Francescutti V, Rivera L, Kane JM, Skitzki JJ, Lovrics P, Hodgson N, O'Brien MA, Thabane L, Cornacchi S, Heller B, Reid S, Sanders K, Kittmer T, Simunovic M, Duhaime S, Fong B, Deria M, Acton C, El-Maadawy M, Lad S, Arnaout A, Omole M, Pemberton J, Lovrics P, Bischof D, Stotland P, Hagen J, Swallow C, Klein L, Van Koughnett JA, Ahmad T, Ainsworth P, Brackstone M, Kanagaratnam S, Groot G, VanderBeek L, Francescutti V, Farrokhyar F, Strang B, Kahnamoui K, MacLellan S, MacKay H, Ringash J, Jacks L, Kassam Z, Khalili I, Conrad T, Okrainec A, Chagpar R, Xing Y, You N, Yi-Ju C, Feig B, Chang G, Cormie J, Gervais MK, Sideris L, Drolet P, Mitchell A, Leblanc G, Dubé P, Merchant S, Knowling M, Cheifetz R, Raval M, Heidary B, Kalikias S, Raval D, Phang T, Brown C, Scheer A, O'Connor A, Chan B, Moloo H, Poulin E, Mamazza J, Auer R, Boushey R, Hardy K, Vergis A, Sullivan P, Musselman R, Gomes T, Chan B, Auer R, Moloo H, Poulin E, Mamazza J, Al-Khayal K, Al-Omran M, Mamdani M, AlObeed O, Boushey R, Martel G, Crawford A, Barkun J, Ramsay C, Fergusson D, Boushey R, Williams L, Crawford A, McLaughlin K, Mackey M, Moloo H, Mamazza J, Poulin E, Friedlich M, Boushey R, Auer R, Bellolio F, Cohen Z, MacRae H, O'Connor B, Huang H, Victor JC, McLeod R, Hardy K, Pitzul K, Kwong J, Vergis A, Urbach D, Okrainec A, Vogt K, Dubois L, Vinden C, Chan B, Scheer A, Menezes A, Moloo H, Poulin E, Boushey R, Mamazza J, Bellolio F, MacRae H, Cohen Z, O'Connor B, Huang H, McLeod R, Godbout-Simard C, Azar J, Psaradellis F, Sampalis J, Morin N, Brown C, Kalikias S, Heidary B, Raval D, Phang PT, Raval M, Archibald A, Hurlbut D, Vanner S, Zalai C, Vasilevsky CA, Simunovic M, Cadeddu M, Forbes S, Kelly S, Stephen W, Grubac V, Marcinow M, Coates A, Aslani N, Phang PT, Raval M, Brown C, Scheer A, Carrier M, Boushey R, Asmis T, Wells P, Jonker D, Auer R, Azer N, Gill R, de Gara C, Birch DW, Karmali S, Roxin G, Drolet S, MacLean A, Buie WD, Heine J, Agzarian J, Forbes S, Stephen W, Kelly S, Churchill P, Corner T, Kelly S, Forbes S, Lindsay L, Stephen W, Scheer A, O'Connor A, Chan B, Moloo H, Poulin E, Mamazza J, Auer R, Boushey R, Denis J, Hochman D, Recsky M, Phang PT, Raval M, Cheung W, Brown C, Alkhamesi N, Schlachta CM, Tiwari T, Brown C, Raval MJ, and Phang PT

Published
2011

194. A percolation-like model for simulating inter-cellular diffusion in the context of bystander signalling in tumour.

Author

Moulton CR, Fleming AJ, and Ebert MA

Subjects
Animals, Cell Movement radiation effects, Computer Simulation, Diffusion, Humans, Radiation Dosage, Bystander Effect physiology, Bystander Effect radiation effects, Cell Transformation, Neoplastic radiation effects, Models, Biological, Neoplasms physiopathology
Abstract

Despite ongoing active research, the role of the radiation bystander effect in modifying local tissue response to an ionising radiation dose remains unclear. The present study aims to provide new insight by simulating the diffusion-mediated inter-cellular communication processes in 2D and 3D cell-like structures to calculate likely signal ranges in the diffusion limited case. Random walks of individual signalling molecules were tracked between cells with inclusion of molecule-receptor interactions. The resulting diffusion anomaly is a function of cell density, signal uptake probability and the spatial arrangement of cells local to the signal origin. Uptake probability effects dominate percolation effects in disordered media. Diffusion through 2D structures is more conducive to anomalous diffusion than diffusion through 3D structures. Values for time-dependent diffusion constants and permeability are derived for typical simulation parameters. Even at low signal uptake probabilities the communication range is restricted to a mean value of less than 100 μm owing to complete signal uptake by 600 s. This should be considered in light of the potential influence of signal relaying, flow-dynamics or vasculature-mediated signalling.

Published
2011
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195. Canadian Surgery Forum.

Author

Atlas H, Safa N, Denis R, Garneau P, Moustarah F, Marceau S, Lebel S, Biertho L, Hould F, Marceau P, Biron S, Anvari M, Sharma A, Goldsmith CH, Lacobellis G, Cadeddu M, Misra M, Taylor V, Tarride J, Hubert E, Tiboni M, Hong D, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Graham PJ, Kaban GK, Vizhul A, Birch DW, Menezes AC, Shi X, Karmali S, Seth R, MacKenzie L, Kus A, Bell J, Carrier M, Atkins H, Boushey R, Auer R, Croome KP, Yamashita M, Aarts MA, Okrainec A, Glicksman A, Pearsall E, Pitzul K, Huang H, McLeod RS, Sarkhosh K, Robertson M, Boctor D, Lam V, Sigalet D, Johner A, Faulds J, Wiseman SM, Pemberton J, Gordon ML, Prashad C, Rambaran M, Cameron B, Neville A, Sarosi GA Jr, Wei Y, Gibbs JO, Reda DJ, McCarthy M Jr, Fitzgibbons RJ Jr, Barkun JST, Fenech DS, Forbes S, Pearsall E, Chung J, Glickman A, Victor JC, Nathens A, McLeod RS, Fitzmaurice GJ, Mone F, Brown R, Cranley B, Conlon EF, Todd RAJ, O'Donnell ME, Tran TT, Kaneva PA, Finch LE, Fried GM, Mayo NE, Feldman LS, VanHouwellingen L, Vogt KN, Stewart TC, Williamson J, Parry N, DeRose G, Gray D, Harriman S, Rodych N, Hayes P, Moser M, Jamal MH, Doi S, Rousseau M, Snell L, Meterissian S, Zolfaghari S, Friedlich MS, Kurashima Y, Al-Sabah S, Kaneva PA, Feldman LS, Fried GM, Vassiliou MC, Tran TT, Kaneva PA, Mayo NE, Fried GM, Feldman LS, Pearsall E, Sheth U, Fenech D, McKenzie M, Victor JC, McLeod RS, Ghaderi I, Vaillancourt M, Sroka G, Kaneva PA, Vassiliou MC, Seagull FJ, Sutton E, Godinez C, George I, Park A, Choy I, Okrainec A, Brintzenhoff R, Prabhu A, Heniford BT, Stefanidis D, Fried GM, Feldman LS, Igric A, Vogt KN, Girotti M, Parry NG, Vinden C, Kim SHH, Zhang NN, Russo JJ, El-Salfiti IK, Kowalczuk M, Rajaee AN, Bal M, Gill MS, Lysecki PJ, Hoogenes J, Dath D, Nassar AK, Reid S, Mohaisen KN, Winch J, Omar D, Hanna WC, Mulder DS, El-Hilali MM, Khwaja KA, Jamal MH, Rayment J, Doi SA, Megueditchian A, Meterissian S, Tso D, Langer M, Blair G, Butterworth S, Vaillancourt M, Vassiliou MC, Bergman S, Fried GM, Kaneva PA, Feldman LS, Davenport E, Haggar F, Trottier D, Huynh H, Soto C, Shamji FM, Seely A, Sundaresan S, Pagliarello G, Tadros S, Yelle JD, Maziak D, Moloo H, Poulin EC, Mamazza J, Knowlton LM, Chackungal S, MacQueen KA, Anvari M, Allen C, Goldsmith C, Ghaderi I, Madani A, de Gara C, Schlachta CM, Zakrison TL, Tee MC, Chan S, Nguyen V, Yang J, Holmes D, Levine D, Bugis S, Wiseman SM, Sandhu L, Zhai J, Kennedy ED, Baxter NN, Gagliardi AR, Urbach DR, Wei AC, Sabalbal M, McAlister VC, Balayla J, Bergman S, Feldman LS, Ghitulescu G, Fraser SA, Daigle R, Urquart R, Cox M, Grunfeld E, Porter G, Hallet J, Labidi S, Clairoux A, Gagné JP, Gill RS, Manouchehri N, Liu JQ, Lee TF, Bigam DL, Cheung PY, Van Koughnett JA, Colquhoun PH, Gordon ML, Cornacchi S, Farrokhyar F, Hodgson N, Porter G, Quan ML, Wright F, Lovrics P, Datta I, Brar SS, Ball CG, Heine JA, Rothwell B, Crozier M, Ting H, Boone D, O'Regan N, Brown C, Bandrauk N, Hapgood J, Hogan M, McDonald LA, Da'as S, Sorensen PHB, Berman JN, Ameer A, Jamal M, Aljiffry M, Doi S, Hasanain M, Chaudhury P, Metrakos P, Tchervenkov J, Lapierre S, Mohammad W, Balaa N, Akil M, Mimeault R, Fairfull-Smith R, Teague BD, Butler MS, Garneau PY, Sample CB, Kapoor A, Cadeddu MO, Anvari M, Hanna WC, Jamal MH, Nguyen L, Fraser SA, Kwan K, Wallis CJD, Jones S, Fraser T, Masterso J, Blair G, Duffy D, Roberts DJ, Kirkpatrick AW, Datta I, Feliciano DV, Kortbeek JB, Laupland KB, Ball CG, Haggar F, Davenport E, Moloo H, Mamazza J, Manouchehri N, Bigam D, Churchill T, Joynt C, Cheung PY, Al-Sairafi R, Sample CB, Paquette F, Fraser SA, Feldman LS, Fried GM, Weissglas I, Ghitulescu G, Meterissian S, Bergman S, Al-Dohayan A, Al-Naami M, Bamehriz F, Madkhali A, Hallet J, LeBlanc M, Gilbert A, Daigle C, Tien G, Atkins MS, Zheng B, Tanin H, Swindells C, Meneghetti A, Panton ONM, Qayumi AK, Chhiv M, Drolet S, Sirois-Giguère É, Gilbert A, Doyle JD, Sheth U, Huang H, Pearsall E, McLeod RS, Nathens AB, Suri RR, Vora P, Kirby JM, Chan K, Smith S, Ruo L, Faryniuk A, Hochman D, Ball CG, Kirkpatrick AW, Broderick TJ, Williams DR, Kholdebarin R, Helewa R, Bracken J, Zabolotny B, Hochman D, Merchant S, Hameed M, Melck A, McGuire AL, Wilson C, Mercer D, Sharma B, Orzech N, Grantcharov T, Johner A, Taylor DC, Buczkowski AK, Chung SW, Lumb KJ, Trejos AL, Ward CDW, Naish MD, Patel RV, Schlachta CM, Davenport E, Haggar F, Moloo H, Boushey RP, Poulin EC, Mamazza J, Graybiel KM, Fernandes VT, Hoogenes J, Dath D, Mohammad W, Trottier D, Nadolny K, Poulin EC, Mamazza J, Balaa F, Diederichs B, Turner S, de Gara C, Ghitulescu GA, Filip I, Bergman S, Fraser S, Finley RJ, Mayo J, Clifton J, Yee J, Evans K, MacWilliams A, Lam S, English J, Finley C, Jacks L, Darling G, Hanna WC, Sudarshan M, Roberge D, David M, Waschke KA, Mayrand S, Ferri LE, Coughlin S, Emmerton-Coughlin H, Malthaner R, Grover HS, Basi S, Chiasson P, Basi S, Irshad K, Emmerton-Coughlin HMA, Vogt KN, Malthaner RA, Spicer JD, McDonald B, Perera R, Rousseau MC, Chan CHF, Hsu RYC, Giannias B, Ferri LE, Ahmed S, Birnbaum AE, Berz D, Fontaine JP, Dipetrillo TA, Ready NE, Ng T, Alhussaini A, Oberoi M, Threader J, Villeneuve J, Gilbert S, Shamji FM, Sundaresan S, Maziak D, Seely A, Rammohan KS, Hunt I, Chuck A, Gazala S, Valji A, Stewart K, Bedard ELR, Plourde M, Fortin D, Arab A, Inculet RI, Malthaner RA, Bharadwaj SC, Hamin T, Tan LA, Unruh HW, Srinathan SK, McGuire AL, Petsikas D, Reid K, Hopman W, Levine P, Rousseau M, Spicer J, Ferri LE, Ashrafi AS, Bond RJ, Ong SR, Ahmadi SY, Partington SL, Graham AJ, Owen S, Kelly EJ, Gelfand G, Grondin SC, McFadden SD, Paolucci EO, Weeks SG, Davis PJ, Molinari M, Topp T, Walsh MJ, Simoneau E, Hassanain M, Cabrera T, Chaudhury P, Dumitra S, Aljiffry M, Feteih I, Leduc S, Rivera J, Jamal M, Valenti D, Metrakos P, Elgadi K, Cherniak W, Chan D, Wei AC, Gallinger S, Mohammad W, Mimeault R, Fairfull-Smith R, Auer R, Balaa F, Kwan J, Hassanain M, Chaudhury P, Dey C, Gadahadh R, Salman A, Simoneau E, Meti N, Aljiffry M, Jamal M, Cabrera T, Bouganim N, Kavan P, Alcindor T, Valenti D, Metrakos P, Brar B, Sutherland F, Bégin A, Bourdonnais D, Lapointe R, Plasse M, Létourneau R, Roy A, Dagenais M, Vandenbroucke-Menu F, Bégin A, Bourdonnais D, Lapointe R, Plasse M, Létourneau R, Dagenais M, Roy A, Vandenbroucke-Menu F, Bégin A, Ismail S, Vandenbroucke-Menu F, Létourneau R, Plasse M, Roy A, Dagenais M, Lapointe R, Greco EF, Nanji S, Shah SA, Wei AC, Greig PD, Gallinger S, Cleary SP, Al-Adra DP, Anderson C, Nanji S, Ryan P, Guindi M, Selvarajah S, Greig P, McGilvray I, Taylor B, Wei A, Moulton C, Cleary SP, Gallinger S, Sandroussi C, Brace C, Kennedy E, Baxter N, Gallinger S, Wei AC, Yamashita T, Leslie K, McLean SR, Karsanji D, Dixon E, Sutherland FR, Bathe OF, Suri RR, Marcaccio MJ, Ruo L, Jamal MH, Simoneau E, Khalil JA, Hassanain M, Chaudhury P, Tchervenkov J, Metrakos P, Doi SA, Barkun JS, Barnett C, Marcaccio MJ, Hankinson JJ, Ruo L, Alawashez A, Ellsmere J, Neville A, Boutros M, Barkun J, Wiebe ME, Sandhu L, Takata JL, Kennedy ED, Baxter NN, Gagliardi AR, Urbach DR, Wei AC, Chan G, Kocha W, Reid R, Wall W, Quan D, Lovrics P, Hodgson N, Ghola G, Franic S, Goldsmith C, McCready D, Cornacchi S, Garnett A, Reedijk M, Scheer AS, McSparron JI, Schulman AR, Tuorto S, Gonen M, Gonsalves J, Fong Y, Auer RAC, Francescutti V, Coates A, Thabane L, Goldsmith CH, Levine M, Simunovic M, Richardson DP, Porter G, Johnson PM, Leon-Carlyle M, Schmocker S, O'Connor BI, Victor JC, Baxter NN, Smith AJ, McLeod RS, Kennedy ED, Chan CHF, Arabzadeh A, DeMarte L, Spicer JD, Turbide C, Brodt P, Beauchemin N, Ferri LE, Zih F, Panzarella T, Hummel C, Petronis J, McCart A, Swallow C, Mathieson A, Ridgway PF, Ko YJ, Smith AJ, Gieni M, Dickson L, Sne N, Avram R, Farrokhyar F, Smith M, Giacomantonio C, Hoskin D, Doyon C, Martin G, Patocskai E, Brar SS, Wright F, Okrainec A, Smith AJ, Bischof DA, Maier B, Fitch M, Wright FC, Baliski CR, Kluftinger A, MacLeod M, Kwong S, Racz JM, Fortin A, Latosinsky S, Messenger DE, Kirsch R, McLeod RS, Aslani N, Heidary B, Prabhu KL, Raval M, Phang PT, Brow C, Richardson DP, Porter G, Johnson PM, Moloo H, Haggar F, Duhaime S, Hutton B, Grimshaw J, Coyle D, Poulin EC, Mamazza J, Boushey RP, Paun BC, Shaheen AAM, Dixon E, Maclean AR, Buie WD, Moustarah F, Talarico J, Zink J, Gatmaitan P, Schauer P, Chand B, Brethauer S, Martel G, Duhaime S, Ramsay CR, Barkun JS, Ferguson DA, Boushey RP, Palter VN, MacRae HM, Grantcharov TP, Messenger DE, Victor JC, O'Connor BI, MacRae HM, McLeod RS, Al-Sabah S, Feldman LS, Charlebois P, Stein B, Kaneva PA, Fried GM, Liberman AS, Borowiec AM, Karmal S, Apriasz I, Mysliwiec B, Hussain N, Ott M, Reynolds R, Lum A, Williams LJ, Morash R, Shin S, Smylie J, Moloo H, Auer R, Poulin EC, Mamazza J, Watters J, Fung-Kee-Fung M, Boushey RP, Pelletier JS, de Gara CJ, White J, Ghosh S, Schiller D, Drolet S, Paolucci EO, Heine J, Buie WD, Maclean AR, Barnes A, Liang S, Auer R, Moloo H, Mamazza J, Poulin EC, Boushey RP, Klevan AE, Dalvi AA, Ramsay JA, Stephen WJ, Nhan C, Driman DK, Raby M, Smith AJ, Hunter A, Srigley J, McLeod RS, Zolfaghari S, Auer R, Moloo H, Mamazza J, Friedlich M, Poulin EC, Stern HS, Boushey RP, Scheer AS, Boushey RP, Liang S, Doucette S, O'Connor AM, and Moher D

Published
2010

196. Hydrogelation and self-assembly of Fmoc-tripeptides: unexpected influence of sequence on self-assembled fibril structure, and hydrogel modulus and anisotropy.

Author

Cheng G, Castelletto V, Moulton CM, Newby GE, and Hamley IW

Subjects
Anisotropy, Circular Dichroism, Cryoelectron Microscopy, Fluorenes chemistry, Leucine analogs & derivatives, Leucine chemistry, Microscopy, Microscopy, Electron, Transmission, Spectroscopy, Fourier Transform Infrared, Spectrum Analysis, Raman, Valine chemistry, X-Ray Diffraction, Hydrogel, Polyethylene Glycol Dimethacrylate chemistry, Peptides chemical synthesis, Peptides chemistry
Abstract

The self-assembly and hydrogelation properties of two Fmoc-tripeptides [Fmoc = N-(fluorenyl-9-methoxycarbonyl)] are investigated, in borate buffer and other basic solutions. A remarkable difference in self-assembly properties is observed comparing Fmoc-VLK(Boc) with Fmoc-K(Boc)LV, both containing K protected by N(epsilon)-tert-butyloxycarbonate (Boc). In borate buffer, the former peptide forms highly anisotropic fibrils which show local alignment, and the hydrogels show flow-aligning properties. In contrast, Fmoc-K(Boc)LV forms highly branched fibrils that produce isotropic hydrogels with a much higher modulus (G' > 10(4) Pa), and lower concentration for hydrogel formation. The distinct self-assembled structures are ascribed to conformational differences, as revealed by secondary structure probes (CD, FTIR, Raman spectroscopy) and X-ray diffraction. Fmoc-VLK(Boc) forms well-defined beta-sheets with a cross-beta X-ray diffraction pattern, whereas Fmoc-KLV(Boc) forms unoriented assemblies with multiple stacked sheets. Interchange of the K and V residues when inverting the tripeptide sequence thus leads to substantial differences in self-assembled structures, suggesting a promising approach to control hydrogel properties.

Published
2010
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197. Self-assembly of a modified amyloid peptide fragment: pH-responsiveness and nematic phase formation.

Author

Hamley IW, Castelletto V, Moulton C, Myatt D, Siligardi G, Oliveira CL, Pedersen JS, Abutbul I, and Danino D

Subjects
Circular Dichroism, Cryoelectron Microscopy, Hydrogen-Ion Concentration, Mass Spectrometry, Spectroscopy, Fourier Transform Infrared, X-Ray Diffraction, Amyloid beta-Peptides chemistry, Peptide Fragments biosynthesis, Peptide Fragments chemistry
Abstract

The self-assembly of peptide YYKLVFFC based on a fragment of the amyloid beta (A beta) peptide, A beta 16-20, KLVFF has been studied in aqueous solution. The peptide is designed with multiple functional residues to examine the interplay between aromatic interactions and charge on the self-assembly, as well as specific transformations such as the pH-induced phenol-phenolate transition of the tyrosine residue. Circular dichroism (CD) and Fourier-transform infrared (FTIR) spectroscopies are used to investigate the conditions for beta-sheet self-assembly and the role of aromatic interactions in the CD spectrum as a function of pH and concentration. The formation of well-defined fibrils at pH 4.7 is confirmed by cryo-TEM (transmission electron microscope) and negative stain TEM. The morphology changes at higher pH, and aggregates of short twisted fibrils are observed at pH 11. Polarized optical microscopy shows birefringence at a low concentration (1 wt.-%) of YYKLVFFC in aqueous solution, and small-angle X-ray scattering was used to probe nematic phase formation in more detail. A pH-induced transition from nematic to isotropic phases is observed on increasing pH that appears to be correlated to a reduction in aggregate anisotropy upon increasing pH.

Published
2010
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198. Highly Asymmetric Phase Diagram of a Poly(1,2-octylene oxide)-Poly(ethylene oxide) Diblock Copolymer System Comprising a Brush-Like Poly(1,2-octylene oxide) Block.

Author

Hamley IW, O'Driscoll BM, Lotze G, Moulton C, Allgaier J, and Frielinghaus H

Abstract

The phase diagram of a series of poly(1,2-octylene oxide)-poly(ethylene oxide) (POO-PEO) diblock copolymers is determined by small-angle X-ray scattering. The Flory-Huggins interaction parameter was measured by small-angle neutron scattering. The phase diagram is highly asymmetric due to large conformational asymmetry that results from the hexyl side chains in the POO block. Non-lamellar phases (hexagonal and gyroid) are observed near f(PEO)  = 0.5, and the lamellar phase is observed for f(PEO)  ≥ 0.5., (Copyright © 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Published
2009
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199. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009.

Author

Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, and McLeod RS

Published
2009

200. Emergency intubation for acutely ill and injured patients.

Author

Lecky F, Bryden D, Little R, Tong N, and Moulton C

Subjects
Acute Disease, Adult, Child, Emergencies, Emergency Medical Technicians, Emergency Medicine, Humans, Randomized Controlled Trials as Topic, Airway Obstruction therapy, Heart Arrest therapy, Intubation, Intratracheal methods, Wounds and Injuries therapy
Abstract

Background: Emergency intubation has been widely advocated as a life saving procedure in severe acute illness and injury associated with real or potential compromises to the patient's airway and ventilation. However, some initial data have suggested a lack of observed benefit., Objectives: To determine in acutely ill and injured patients who have real or anticipated problems in maintaining an adequate airway whether emergency endotracheal intubation, as opposed to other airway management techniques, improves the outcome in terms of survival, degree of disability at discharge or length of stay and complications occurring in hospital., Search Strategy: We searched the Cochrane Injuries Group Specialised Register (December 2006), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4), MEDLINE (1950 to November 2006), EMBASE (1980 to week 50, December 2006), National Research Register (Issue 4, 2006), CINAHL (1980 to December 2006), BIDS (to December 2006) and ICNARC (to December 2006). We also examined reference lists of articles for relevant material and contacted experts in the field. Non-English language publications were searched for and examined., Selection Criteria: All randomised (RCTs) or controlled clinical trials involving the emergency use of endotracheal intubation in the injured or acutely ill patient were examined., Data Collection and Analysis: The full texts of 452 studies were reviewed independently by two authors using a standard form. Where the review authors felt a study may be relevant for inclusion in the final review or disagreed, the authors examined the study and a collective decision was made regarding its inclusion or exclusion from the review. The results were not combined in a meta-analysis due to the heterogeneity of patients, practitioners and alternatives to intubation that were used., Main Results: We identified three eligible RCTs carried out in urban environments. Two trials involved adults with non-traumatic out-of-hospital cardiac arrest. One of these trials found a non-significant survival disadvantage in patients randomised to receive a physician-operated intubation versus a combi-tube (RR 0.44, 95% CI 0.09 to 1.99). The second trial detected a non-significant survival disadvantage in patients randomised to paramedic intubation versus an oesophageal gastric airway (RR 0.86, 95% CI 0.39 to 1.90). The third included study was a trial of children requiring airway intervention in the prehospital environment. The results indicated no difference in survival (OR 0.82, 95% CI 0.61 to 1.11) or neurologic outcome (OR 0.87, 95% CI 0.62 to 1.22) between paramedic intubation versus bag-valve-mask ventilation and later hospital intubation by emergency physicians; however, only 42% of the children randomised to paramedic endotracheal intubation actually received it., Authors' Conclusions: The efficacy of emergency intubation as currently practised has not been rigorously studied. The skill level of the operator may be key in determining efficacy. In non-traumatic cardiac arrest, it is unlikely that intubation carries the same life saving benefit as early defibrillation and bystander cardiopulmonary resuscitation (CPR). In trauma and paediatric patients, the current evidence base provides no imperative to extend the practice of prehospital intubation in urban systems. It would be ethical and pertinent to initiate a large, high quality randomised trial comparing the efficacy of competently practised emergency intubation with basic bag-valve-mask manoeuvres (BVM) in urban adult out-of-hospital non-traumatic cardiac arrest.

Published
2008
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