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2. Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand

Author

Goetghebuer T, Hainaut M, Van der Kelen E, Delforge M, Warszawski J, Le Chenadec J, Ramos E, Dialla O, Wack T, Laurent C, Selmi L, Leymarie I, Benali F, Brossard M, Boufassa L, Floch-Tudal C, Firtion G, Hau I, Chace A, Bolot P, Blanche S, Granier M, Labrune P, Lachassine E, Dollfus C, Levine M, Fourcade C, Heller-Roussin B, Runel-Belliard C, Tricoire J, Monpoux F, Chirouze C, Reliquet V, Brouard J, Kebaili K, Fialaire P, Lalande M, Mazingue F, Partisani M, Koenigs C, Schultze-Strasser S, Baumann U, Niehues T, Neubert J, Kobbe R, Feiterna-Sperling C, Buchholz B, Notheis G, Spoulou V, Tovo P, Galli L, Chiappini E, Patrizia O, Larovere D, Ruggeri M, Faldella G, Baldi F, Badolato R, Montagnani C, Venturini E, Lisi C, Di Biagio A, Taramasso L, Giacomet V, Erba P, Esposito S, Lipreri R, Salvini F, Tagliabue C, Cellini M, Bruzzese E, Lo Vecchio A, Rampon O, Dona D, Romano A, Dodi I, Maccabruni A, Consolini R, Bernardi S, Genovese O, Olmeo P, Cristiano L, Mazza A, Garazzino S, Pellegatta A, Pajkrt D, Scherpbier H, Weijsenfeld A, van der Plas A, Jurriaans S, Back N, Zaaijer H, Berkhout B, Cornelissen M, Schinkel C, Wolthers K, Fraaij P, van Rossum A, van der Knaap L, Visser E, Boucher C, Koopmans M, van Kampen J, Pas S, Henriet S, de Flier M, van Aerde K, Strik-Albers R, Rahamat-Langendoen J, Stelma F, Scholvinck E, de Groot-de Jonge H, Niesters H, van Leer-Buter C, Knoester M, Bont L, Geelen S, Wolfs T, Nauta N, Ang C, van Houdt R, Pettersson A, Vandenbroucke-Grauls C, Reiss P, Bezemer D, van Sighem A, Smit C, Wit F, Boender T, Zaheri S, Hillebregt M, de Jong A, Bergsma D, Grivell S, Jansen A, Raethke M, Meijering R, de Groot L, van den Akker M, Bakker Y, Claessen E, El Berkaoui A, Koops J, Kruijne E, Lodewijk C, Munjishvili L, Peeck B, Ree C, Regtop R, Ruijs Y, Rutkens T, Schoorl M, Timmerman A, Tuijn E, Veenenberg L, van der Vliet S, Wisse A, Woudstra T, Tuk B, Marczynska M, Oldakowska A, Popielska J, Coupland U, Doroba M, Marques L, Teixeira C, Fernandes A, Prata F, Ene L, Gingaras C, Radoi R, Okhonskaia L, Voronin E, Miloenko M, Labutina S, Soler-Palacin P, Antoinette Frick M, Perez-Hoyos S, Mur A, Lopez N, Mendez M, Mayol L, Vallmanya T, Calavia O, Garcia L, Coll M, Pineda V, Rius N, Rovira N, Duenas J, Fortuny C, Noguera-Julian A, Jose Mellado M, Escosa L, Garcia Hortelano M, Sainz T, Isabel Gonzalez-Tome M, Rojo P, Blazquez D, Tomas Ramos J, Prieto L, Guillen S, Luisa Navarro M, Saavedra J, Santos M, Angeles Munoz M, Ruiz B, Fernandez Mc Phee C, Jimenez de Ory S, Alvarez S, Angel Roa M, Beceiro J, Martinez J, Badillo K, Apilanez M, Pocheville I, Garrote E, Colino E, Gomez Sirvent J, Garzon M, Roman V, Montesdeoca A, Mateo M, Jose Munoz M, Angulo R, Neth O, Falcon L, Terol P, Luis Santos J, Moreno D, Lendinez F, Grande A, Jose Romero F, Perez C, Lillo M, Losada B, Herranz M, Bustillo M, Guerrero C, Collado P, Antonio Couceiro J, Perez A, Isabel Piqueras A, Breton R, Segarra I, Gavilan C, Jareno E, Montesinos E, Dapena M, Alvarez C, Gloria Andres A, Marugan V, Ochoa C, Alfayate S, Isabel Menasalvas A, de Miguel E, Naver L, Soeria-Atmadja S, Hagas V, Aebi-Popp K, Asner S, Aubert V, Battegay M, Baumann M, Bernasconi E, Boni J, Brazzola P, Bucher H, Calmy A, Cavassini M, Ciuffi A, Duppenthaler A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Francini K, Furrer H, Fux C, Grawe C, Gunthard H, Haerry D, Hasse B, Hirsch H, Hoffmann M, Hosli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kovari H, Kouyos R, Ledergerber B, Martinetti G, de Tejada M, Metzner K, Muller, Nicca D, Paioni P, Pantaleo G, Polli C, Posfay-Barbe K, Rauch A, Rudin C, Schmid P, Scherrer A, Speck R, Tarr P, Lecompte T, Trkola A, Vernazza P, Wagner N, Wandeler G, Weber R, Wyler C, Yerly S, Techakunakorn P, Prachanukroh C, Hansudewechakul R, Wanchaitanawong V, Theansavettrakul S, Nanta S, Ngampiyaskul C, Phanomcheong S, Hongsiriwon S, Karnchanamayul W, Chacheongsao B, Kwanchaipanich R, Kanjanavanit S, Prapinklao S, Kamonpakorn N, Nantarukchaikul M, Adulyadej B, Layangool P, Mekmullica J, Lucksanapisitkul P, Watanayothin S, Lertpienthum N, Warachit B, Hanpinitsak S, Potchalongsin S, Thanasiri P, Krikajornkitti S, Attavinijtrakarn P, Srirojana S, Bunjongpak S, Puangsombat A, Na-Rajsima S, Ananpatharachai P, Akarathum N, Phuket V, Lawtongkum W, Kheunjan P, Suriyaboon T, Saipanya A, Than-in-at K, Jaisieng N, Suaysod R, Chailoet S, Naratee N, Kawilapat S, Kaleeva T, Baryshnikova Y, Soloha S, Bashkatova N, Raus I, Glutshenko O, Ruban Z, Prymak N, Kiseleva G, Bailey H, Lyall H, Butler K, Doerholt K, Foster C, Klein N, Menson E, Riordan A, Shingadia D, Tudor-Williams G, Tookey P, Welch S, Collins I, Cook C, Dobson D, Fairbrother K, Gibb D, Judd A, Harper L, Parrott F, Tostevin A, Van Looy N, Walsh A, Scott S, Vaughan Y, Laycock N, Bernatoniene J, Finn A, Hutchison L, Sharpe G, Williams A, Lyall E, Seery P, Lewis P, Miles K, Subramaniam B, Hutchinson L, Ward P, Sloper K, Gopal G, Doherty C, Hague R, Price V, Bamford A, Bundy H, Clapson M, Flynn J, Novelli V, Ainsley-Walker P, Tovey P, Gurtin D, Garside J, Fall A, Porter D, Segal S, Ball C, Hawkins S, Chetcuti P, Dowie M, Bandi S, McCabe A, Eisenhut M, Handforth J, Roy P, Flood T, Pickering A, Liebeschuetz S, Kavanagh C, Murphy C, Rowson K, Tan T, Daniels J, Lees Y, Kerr E, Thompson F, Le Provost M, Cliffe L, Smyth A, Stafford S, Freeman A, Reddy T, Fidler K, Christie S, Gordon A, Rogahn D, Harris S, Collinson A, Jones L, Offerman B, Van Someren V, Benson C, Riddell A, O'Connor R, Brown N, Ibberson L, Shackley F, Faust S, Hancock J, Donaghy S, Prime K, Sharland M, Storey S, Gorman S, Monrose C, Walters S, Cross R, Broomhall J, Scott D, Stroobant J, Bridgwood A, McMaster P, Evans J, Gardiner T, Jones R, Gardiner K, European Pregnancy Paediat HIV Coh, Stichting HIV Monitoring, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Department of Sciences for Woman and Child's Health, Florence University, Dipartimento di Pediatria, Azienda Ospedaliera di Padova, Université Grenoble Alpes - UFR Pharmacie (UGA UFRP), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Pediatrics, and Virology

Subjects
Male, 0301 basic medicine, Time Factors, HIV, antiretroviral therapy, children, second-line, switch, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Drug Resistance, INFANTS, HIV Infections, Cohort Studies, chemistry.chemical_compound, 0302 clinical medicine, Interquartile range, Antiretroviral Therapy, Highly Active, ADOLESCENTS, Cumulative incidence, Viral, Treatment Failure, 030212 general & internal medicine, Child, ComputingMilieux_MISCELLANEOUS, Antiretroviral therapy, Children, Second-line, Switch, Age Factors, Anti-HIV Agents, Child, Preschool, Drug Resistance, Viral, Drug Substitution, Europe, Female, Humans, Infant, Reverse Transcriptase Inhibitors, Thailand, Viral Load, Reverse-transcriptase inhibitor, Immunosuppression, OPEN-LABEL, VIROLOGICAL FAILURE, 3. Good health, Infectious Diseases, Viral load, medicine.drug, Microbiology (medical), medicine.medical_specialty, Efavirenz, Nevirapine, SCALE-UP, Article, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Internal medicine, medicine, Highly Active, Preschool, business.industry, HIV-1 DRUG-RESISTANCE, ADULTS, 030112 virology, RANDOMIZED-TRIAL, Regimen, INFECTED CHILDREN, VIRAL LOAD, chemistry, business
Abstract

Background. Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand.Methods. Children aged = 2 nucleoside reverse transcriptase inhibitors p[NRTIs] plus nonnucleoside reverse transcriptase inhibitor p[NNRTI] or boosted protease inhibitor p[PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of >= 1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks.Results. Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch.Conclusions. One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.

Published
2017
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4. Using CD4 percentage and age to optimize pediatric antiretroviral therapy initiation

Author

Yin, D.E., Warshaw, M.G., Miller, W.C., Castro, H., Fiscus, S.A., Harper, L.M., Harrison, L.J., Klein, N.J., Lewis, J., Melvin, A.J., Tudor Williams, G., Mckinney, R.E., Brouwers, P., Costello, D., Ferguson, E., Fiscus, S., Hodge, J., Hughes, M., Jennings, C., Melvin, A., Mckinney, R., Mofenson, L., Warshaw, M., Smith, M., Spector, S., Stiehm, E., Toye, M., Yogev, R., Babiker, A., Compagnucci, A., De Rossi, A., Giaquinto, C., Darbyshire, J., Debré, M., Gibb, D., Harper, L., Harrison, L., Klein, N., Pillay, D., Saidi, Y., Walker, A., Brody, B., Hill, C., Lepage, P., Modlin, J., Poziak, A., Rein, M., Robb, M., Fleming, T., Vella, S., Kim, K., Bologna, R., Mecikovsky, D., Pineda, N., Sen, L., Mangano, A., Marino, S., Galvez, C., Deluchi, G., Zöhrer, B., Zenz, W., Daghofer, E., Pfurtscheller, K., Pabst, B., Gomez, M., Mcneil, P., Jervis, M., Whyms, I., Kwolfe, D., Scott, S., Mussi Pinhata MM, Issac, M., Cervi, M., Negrini, B., Matsubara, T., de Souza CB, Gabaldi, J., Oliveira, R., Sapia, M., Abreu, T., Evangelista, L., Pala, A., Fernandes, I., Farias, I., Melo M, D.F., Carreira, H., Lira, L., Della Negra, M., Queiroz, W., Lian, Y., Pacola, D., Pinto, J., Ferreira, F., Kakehasi, F., Martins, L., Diniz, A., Lobato, V., Diniz, M., Cleto, S., Costa, S., Romeiro, J., Dollfus, C., Tabone, M., Courcoux, M., Vaudre, G., Dehée, A., Schnuriger, A., Le Gueyades, N., De Bortoli, C., Méchinaud, F., Reliquet, V., Arias, J., Rodallec, A., André, E., Falconi, I., Le Pelletier, A., Monpoux, F., Cottalorda, J., Mellul, S., Lachassinne, E., Galimand, J., Rouzioux, C., Chaix, M., Benabadji, Z., Pourrat, M., Firtion, G., Rivaux, D., Denon, M., Boudjoudi, N., Nganzali, F., Krivine, A., Méritet, J., Delommois, G., Norgeux, C., Guérin, C., Floch, C., Marty, L., Hichou, H., Tournier, V., Faye, A., Le Moal, I., Sellier, M., Dehache, L., Damond, F., Leleu, J., Beniken, D., Alexandre Castor, G., Neubert, J., Niehues, T., Laws, H., Huck, K., Gudowius, S., Siepermann, K., Loeffler, H., Bellert, S., Ortwin, A., Notheis, G., Wintergerst, U., Hoffman, F., Werthmann, A., Seyboldt, S., Schneider, L., Bucholz, B., Feiterna Sperling, C., Peiser, C., Nickel, R., Schmitz, T., Piening, T., Müller, C., Warncke, G., Wigger, M., Neubauer, R., Butler, K., Chong, A., Boulger, T., Menon, A., O'Connell, M., Barrett, L., Rochford, A., Goode, M., Hayes, E., Mcdonagh, S., Walsh, A., Doyle, A., Fanning, J., O'Connor, M., Byrne, M., O'Sullivan, N., Hyland, E., Giacomet, V., Viganò, A., Colombo, I., Trabattoni, D., Berzi, A., Badolato, R., Schumacher, F., Bennato, V., Brusati, M., Sorlini, A., Spinelli, E., Filisetti, M., Bertulli, C., Rampon, O., Zanchetta, M., Mazza, A., Stringari, G., Rossetti, G., Bernardi, S., Martino, A., Castelli Gattinara, G., Palma, P., Pontrelli, G., Tchidjou, H., Furcas, A., Frillici, C., Mazzei, A., Zoccano, A., Concato, C., Duiculescu, D., Oprea, C., Tardei, G., Abaab, F., Mardarescu, M., Draghicenoiu, R., Otelea, D., Alecsandru, L., Matusa, R., Rugina, S., Ilie, M., Netescu, S., Florea, C., Voicu, E., Poalelungi, D., Belmega, C., Vladau, L., Chiriac, A., Ramos Amador JT, Gonzalez Tomé MI, Rojo Conejo, P., Fernandez, M., Delgado Garcia, R., Ferrari, J., Garcia Lopez, M., Mellado Peña MJ, Martin Fontelos, P., Jimenez Nacher, I., Muñoz Fernandez MA, Jimenez, J., García Torre, A., Penin, M., Pineiro Perez, R., Garcia Mellado, I., Finn, A., Lajeunesse, M., Hutchison, E., Usher, J., Ball, L., Dunn, M., Sharland, M., Doerholt, K., Storey, S., Donaghy, S., Chakraborty, R., Wells, C., Buckberry, K., Rice, P., Mcmaster, P., Butler, P., O'Connell C, R., Shenton, J., Haley, H., Orendi, J., Stroobant, J., Navarante, L., Archer, P., Mazhude, C., Scott, D., O'Connell, R., Wong, J., Boddy, G., Shackley, F., Lakshman, R., Hobbs, J., Ball, G., Kudesia, G., Bane, J., Painter, D., Sloper, K., Shah, V., Cheng, A., Aali, A., Ball, C., Hawkins, S., Nayagam, D., Waters, A., Doshi, S., Liebeschuetz, S., Sodiende, B., Shingadia, D., Wong, S., Swan, J., Shah, Z., Collinson, A., Hayes, C., King, J., O'Connor, K., Lyall, H., Fidler, K., Walters, S., Foster, C., Hamadache, D., Newbould, C., Monrose, C., Campbell, S., Yeung, S., Cohen, J., Martinez Allier, N., Melvin, D., Dodge, J., Welch, S., Tatum, G., Gordon, A., Kaye, S., Muir, D., Patel, D., Novelli, V., Moshal, K., Lambert, J., Flynn, J., Farrelly, L., Clapson, M., Spencer, L., Depala, M., Jacobsen, M., Segal, S., Pollard, A., Kelly, D., Yeadon, S., Ohene Kena, B., Peng, Y., Dong, T., Jeffries, K., Snelling, M., Smyth, A., Smith, J., Ward, B., Jungmann, E., Ryan, C., Swaby, K., Buckton, A., Smit, E., Abrams, E., Champion, S., Fernandez, A., Calo, D., Garrovillo, L., Swaminathan, K., Alford, T., Frere, M., Navarra, J., Borkowsky, W., Deygoo, S., Hastings, T., Akleh, S., Ilmet, T., Mohan, K., Bowen, G., Emmanuel, P., Lujan Zimmerman, J., Rodriguez, C., Johnson, S., Marion, A., Graisbery, C., Casey, D., Lewis, G., Guzman Cottrill, J., Croteau, R., Acevedo Flores, M., Gonzalez, M., Angeli, L., Fabregas, L., Valentin, P., Weiner, L., Contello, K., Holz, W., Butler, M., Nachman, S., Kelly, M., Ferraro, D., Rana, S., Reed, C., Yeagley, E., Malheiro, A., Roa, J., Neely, M., Kovacs, A., Homans, J., Rodriguez Lozano, Y., Puga, A., Talero, G., Sellers, R., Lawrence, R., Weinberg, G., Murante, B., Laverty, S., Deveikis, A., Batra, J., Chen, T., Michalik, D., Deville, J., Elkins, K., Marks, S., Jackson Alvarez, J., Palm, J., Fineanganofo, I., Keuth, M., Deveikis, L., Tomosada, W., Van Dyke, R., Alchediak, T., Silio, M., Borne, C., Bradford, S., Eloby Childress, S., Nguyen, K., Rathore, M., Alvarez, A., Mirza, A., Mahmoudi, S., Burke, M., Febo, I., Lugo, L., Santos, R., Church, J., Dunaway, T., Rodier, C., Flynn, P., Patel, N., Discenza, S., Donohoe, M., Luzuriaga, K., Picard, D., Kline, M., Paul, M., Shearer, W., Mcmullen, C., Chadwick, E., Cagwin, E., Kabat, K., Dieudonne, A., Palumbo, P., Johnson, J., Gaur, S., Cerracchio, L., Foca, M., Jurgrau, A., Vasquez Bonilla, S., Silva, G., Gershon, A., Sullivan, J., Bryson, Y., Frenkel, L., Nelson, J., Aboulker, J., Hadjou, G., Léonardo, S., Riault, Y., Saïdi, Y., Buck, L., Forcat, S., Horton, J., Johnson, D., Moore, S., Taylor, C., Collins, D., Buskirk, S., Kamara, P., Nesel, C., Johnson, M., Ferreira, A., Tutko, J., Sprenger, H., Britto, P., Powell, C., Dersimonian, R., Handelsman, E., Ananworanich, J., Belfrage, E., Blanche, S., Bohlin, A., Burger, D., Clayden, P., De Groot, R., Di Biagio, A., Grosch Wörner, I., Hainault, M., Lallemant, M., Levy, J., Marczynska, M., Mellado Pena MJ, Nadal, D., Naver, L., Peckham, C., Popieska, J., Rosado, L., Rosso, R., Rudin, C., Scherpbier, H., Stevanovic, M., Thorne, C., Tovo, P., Valerius, N., Poole, C., Cole, S., and Mcculloh, R.J.

Subjects
CD4-Positive T-Lymphocytes, Male, medicine.medical_treatment, HIV (FISIOLOGIA), lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Treatment failure, Settore BIO/13 - Biologia Applicata, Antiretroviral Therapy, Highly Active, immunologic, Child, HIV, child, reconstitution, treatment failure, Adolescent, Anti-HIV Agents, CD4 Lymphocyte Count, Child, Preschool, Female, Follow-Up Studies, HIV-1, Humans, Infant, Infant, Newborn, Follow up studies, Immunosuppression, medicine.medical_specialty, Settore MED/17 - Malattie Infettive, Antiretroviral Therapy, World health, Article, Internal medicine, medicine, Highly Active, Preschool, Settore MED/04 - Patologia Generale, business.industry, Disease progression, Settore MED/46 - Scienze Tecniche di Medicina di Laboratorio, Newborn, Antiretroviral therapy, Confidence interval, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Immunologic, Reconstitution, Pediatrics, Perinatology and Child Health, Immunology, business
Abstract

BACKGROUND: Quantifying pediatric immunologic recovery by highly active antiretroviral therapy (HAART) initiation at different CD4 percentage (CD4%) and age thresholds may inform decisions about timing of treatment initiation. METHODS: HIV-1-infected, HAART-naive children in Europe and the Americas were followed from 2002 through 2009 in PENPACT-1. Data from 162 vertically infected children, with at least World Health Organization “mild” immunosuppression and CD4% RESULTS: Seventy-two percent of baseline immunosuppressed children recovered to normal within 4 years. Compared with “severe” immunosuppression, more children with “mild” immunosuppression (difference 36%, 95% confidence interval [CI]: 22% to 49%) or “advanced” immunosuppression (difference 20.8%, 95% CI: 5.8% to 35.9%) recovered a normal CD4%. For each 5-year increase in baseline age, the proportion of children achieving a normal CD4% declined by 19% (95% CI: 11% to 27%). Combining baseline CD4% and age effects resulted in >90% recovery when initiating HAART with “mild” immunosuppression at any age or “advanced” immunosuppression at age CONCLUSIONS: Initiating HAART at higher CD4% and younger ages maximizes potential for immunologic recovery. Guidelines should weigh immunologic benefits against long-term risks.

Published
2014

9. Crushing 101.

Author

Donaghy S. and Donaghy S.

Abstract

Critical factors that should be considered when selecting a mobile crusher include output needs, materials to be crushed, applications, and machine design. Hardness is the most important materials factor. Jaw crushers and cone crushers are used for hard abrasive materials. Jaw crushers use compressive force between a moveable jaw and stationary plate and are best for primary crushing, while cone crushers use squeezing or compression between convex and concave surfaces and are better for secondary crushing. Impact crushers are suitable for contaminated materials and are ideally suited for soft to medium rock. They consist of a rotor which throws material against curtain anvils. Plant production capacity and throughput should be taken into account in the choice of crusher, along with the necessity of producing different sizes of crushed product. Wheeled mobile crushers can be hauled to different locations while tracked mobile units are suitable for applications that require movement within a jobsite. Equipment should be durable and purchasing more expensive quality crushers can save on maintenance and repair costs., Critical factors that should be considered when selecting a mobile crusher include output needs, materials to be crushed, applications, and machine design. Hardness is the most important materials factor. Jaw crushers and cone crushers are used for hard abrasive materials. Jaw crushers use compressive force between a moveable jaw and stationary plate and are best for primary crushing, while cone crushers use squeezing or compression between convex and concave surfaces and are better for secondary crushing. Impact crushers are suitable for contaminated materials and are ideally suited for soft to medium rock. They consist of a rotor which throws material against curtain anvils. Plant production capacity and throughput should be taken into account in the choice of crusher, along with the necessity of producing different sizes of crushed product. Wheeled mobile crushers can be hauled to different locations while tracked mobile units are suitable for applications that require movement within a jobsite. Equipment should be durable and purchasing more expensive quality crushers can save on maintenance and repair costs.

10. From flintstone to finesse: selecting the right crusher for quarry operations.

Author

Donaghy S. and Donaghy S.

Abstract

The two main considerations in crusher selection are the application and the characteristics of the feed material. Jaw crushers are ideal for the primary crushing of hard, abrasive materials such as granite or recycled concrete to reduce the raw feed materials, usually down to 150 mm, and are efficient and less costly to operate, but are not suitable for smaller material sizing. Cone crushers are best suited for secondary crushing applications, usually to sizes of 100, 150 or 200 mm, but cannot accept all material sizes, will not produce a consistent cubical product and are not suitable for handling clay or metal mixed in with the rock or concrete feed material. Horizontal impact crushers are suitable for contaminated materials and can easily handle clay, dirt or metal in the feed material such as rebar, wire mesh or dowel pins. Horizontal-shaft impactors produce a uniform cubical product and can deliver high reduction ratios. Other factors to be considered in the selection process include the desired tonnes/h for a plant and the number of end-product specifications. Mobile crushers allow the crusher unit to be moved closer to the quarry face, reducing operating costs. Crusher engines and other components are considered in relation to the overall durability of the units., The two main considerations in crusher selection are the application and the characteristics of the feed material. Jaw crushers are ideal for the primary crushing of hard, abrasive materials such as granite or recycled concrete to reduce the raw feed materials, usually down to 150 mm, and are efficient and less costly to operate, but are not suitable for smaller material sizing. Cone crushers are best suited for secondary crushing applications, usually to sizes of 100, 150 or 200 mm, but cannot accept all material sizes, will not produce a consistent cubical product and are not suitable for handling clay or metal mixed in with the rock or concrete feed material. Horizontal impact crushers are suitable for contaminated materials and can easily handle clay, dirt or metal in the feed material such as rebar, wire mesh or dowel pins. Horizontal-shaft impactors produce a uniform cubical product and can deliver high reduction ratios. Other factors to be considered in the selection process include the desired tonnes/h for a plant and the number of end-product specifications. Mobile crushers allow the crusher unit to be moved closer to the quarry face, reducing operating costs. Crusher engines and other components are considered in relation to the overall durability of the units.

11. Sifting through the facts.

Author

Donaghy S. and Donaghy S.

Abstract

Factors that need to be taken into account by aggregate producers and contractors in quarrying, demolition and recycling operations when selecting a portable screening plant are discussed. These factors include screener type, i.e. scalper or standard screen, hopper size when pairing screener with loading machine such as wheel loader, addition of livehead or tipping grid above hopper, choice of apron or belt feeder, suitable screen medium (e.g. stainless steel, bofar bars, punch plates or finger decks), stockpile height, type of conveyor including impact- and sleigh-bed conveyors, and machine design. A representative example is provided for a company having projected sales of 750 000 tons/y using a screener operating for about 13 d/month and 8 h/d which would require a machine capable of screening ca. 600 t/h., Factors that need to be taken into account by aggregate producers and contractors in quarrying, demolition and recycling operations when selecting a portable screening plant are discussed. These factors include screener type, i.e. scalper or standard screen, hopper size when pairing screener with loading machine such as wheel loader, addition of livehead or tipping grid above hopper, choice of apron or belt feeder, suitable screen medium (e.g. stainless steel, bofar bars, punch plates or finger decks), stockpile height, type of conveyor including impact- and sleigh-bed conveyors, and machine design. A representative example is provided for a company having projected sales of 750 000 tons/y using a screener operating for about 13 d/month and 8 h/d which would require a machine capable of screening ca. 600 t/h.

12. Antibody to Hepatitis B Core Antigen and Its Significance in a Dialysis Population.

Author

Kottarathara, A., Beers, K., Yaziji, M., Zamudio, P., Donaghy, S., and Wadhwa, N.

Subjects
HEPATITIS associated antigen, HEMODIALYSIS, IMMUNOGLOBULINS, LIVER cancer, HOSPITAL care
Abstract

Background: Hepatitis B (HBV) is a potentially chronic disease that accounts for more than 80% of all cases of hepatocellular carcinoma. Dialysis patients are at a greater risk of contracting HBV than the general population due to their regular exposure to body fluids. Hepatitis B core antibody (anti-HBc) levels have been used to detect occult infection, but the available evidence is conflicting on the significance of this method. Methods: We performed a retrospective chart review of hospitalized patients receiving dialysis at an acute dialysis unit at our academic medical center over eleven months. Results: 575 charts were reviewed. Of those, 491 patients were on HD, 24 were on peritoneal dialysis (PD), and 60 were on continuous renal replacement therapy (CRRT). 82% of patients had known ESRD, and 28% of patients were being treated acutely. Hepatitis panel was checked on 574 of 575 patients over the 11 months during at least one of the hospitalizations during this period. Of those with serology results, 100% were HBsAg negative. 45% were anti-HBs positive and therefore presumed to be immunized against hepatitis B. 3% had borderline levels of anti- HBs. Anti-HBc was positive in 47 patients (8% of patients tested). Of those, 38 were also positive for Anti-HBs. PCR was checked on 43 patients and was universally negative. The average time between hepatitis panel initially being checked and confirmatory result by negative DNA PCR was 7.44 days, with the minimum time being 2.22 days. Conclusions: Our data suggests that anti-HBc is not a useful marker of active hepatitis B infection in our population. Further, the time interval between checking initial titers and confirming lack of active disease is time in which patients must be isolated, increasing cost and labor within acute dialysis units. [ABSTRACT FROM AUTHOR]

Published
2017
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13. Use of AV Fistula/Graft in End Stage Renal Disease Patients Receiving Continuous Renal Replacement Therapy.

Author

Zamudio, P. J., Kottarathara, A. J., Donaghy, S. M., Carroza, M. B., Longobucco, M. J., and Wadhwa, N. K.

Subjects
TREATMENT of chronic kidney failure, KIDNEY transplantation, MULTIPLE organ failure, CRITICAL care medicine, HEMODIALYSIS
Abstract

Background: Continuous renal replacement therapy (CRRT) is used frequently in end stage renal disease (ESRD) patients with multi-organ failure in a critical care setting. We report our experience using pre-existing functioning AV fistula/graft as an access in ESRD patients requiring CRRT. Methods: AV fistula/graft was used as an access in all 27 patients (15 males, 12 females; 23 AV fistulas, 4 AV grafts; mean age 63, range 32-90 years) who required CRRT from May 2012 to September 2016. Policy and procedures were established before using AV access for CRRT. Dialysis nursing staff placed 16 gauge plastic angiocatheters in the AV access, connected using 30" extension tubing (secured with an anchor) to the arterial and venous tubing of M100 set with AN69 hemofilter, using Prisma/Prismaflex CRRT system. Angiocatheters were changed every 72 hours with the change of M100 set with AN69 hemofilter or earlier if CRRT was discontinued. Prismasate BGK 4/2.5 was delivered at 500-1000 ml/hr as a dialysate and Prismasol BGK2/0 or 4/0 was infused at 1500-2000 ml/hr as replacement fluid. All patients received citrate anticoagulation. Data were collected retrospectively. Results: The indication for CRRT included septic shock in 13 patients, hemorrhagic shock in 9 patients and cardiogenic shock in 5 patients. The mean blood flow rate was 137 ± 26 ml/min. Minimum effluent rate of 20-25 ml/kg/hour was achieved in each patient. The total duration on CRRT was 2040 hours over 97 days, with a mean duration of 21.3 hours/day. All AV accesses were functioning after the CRRT was discontinued. Thirteen patients survived and received intermittent HD using AV access without complications after CRRT was discontinued. No AV access bleeding, infection or technical problems were observed. Conclusions: Our experience suggests, that use of preexisting AV fistula or graft as an access with an angiocatheter (connected via an extension tube while secured with a tubing anchor) for CRRT can be used safely, and obviates the need for a double lumen catheter for an access and its potential complications. In addition, the use of AV access may keep fistula or graft patent in these ESRD patients. [ABSTRACT FROM AUTHOR]

Published
2017
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17. Comparison of dual nucleoside-analogue reverse-transcriptase inhibitor regimens with HIV-1 who have not previously been treated: the PENTA 5 randomized trial

Author

J. P. Aboulker, A. Babiker, A. Compagnucci, J. H. Darbyshire, M. Debré, C. Giaquinto, D. M. Gibb, L. Harper, Y. Saidi, AS Walker, J. Darbyshire, D. Johnson, P. Kelleher, L. McGee, A Newberry, A. Poland, A. S. Walker, J P. Aboulker, I. Carrière, V. Eliette, S. Leonardo, M. Gersten, A. Jones, S. Blanche, A. B. Bohlin, K Butler, G. Castelli Gattinara, P. Clayden, R De Groot, A. Faye, C. Griscelli, I Grosch Wörner, C. Kind, H. Lyall, J. Levy, M. Mellado Pena, D. Nadal, C Peckham, J. T. Ramos Amador, L. Rosado, C. Rudin, H. Scherpbier, M Sharland, P. A. Tovo, G. Tudor Williams, N. Valerius, A. Volny Anne, U Wintergerst, V. Wahn, C. Hill, P Lepage, A. Pozniak, S. Vella, M. Hainaut, A. Peltier, S. Carlier, G. Zissis, M. Della Negra, W. Queiroz, L. P. Feitosa, D Oliveira, F. Mechinaud, F. Ballerau, A. Lepelletier, S. Billaudel, V. Ferre, I. Grosch Wörner, R. Weigel, K. Seel, C. Feiterna Sperling, D. Ohlendorf, G. Riße, C. Müller, T. Niehues, J. Ndagijimana, G. Horneff, N. Vente, R. Ganschow, T. Simon, R. Vossen, H Pfister, U. Wintergerst, G. Notheis, G. Strotmann, S Schlieben, K. Butler, E. Hayes, M. O’Mara, J. Fanning, F. Goggins, S. Moriarty, M. Byrne, L. Battisti, M. Duse, S. Timpano, E. Uberti, P. Crispino, P. Carrara, F. Fomia, A. Manca, L. Galli, M. de Martino, F. Fioredda, E. Pontali, M. Cellini, C. Baraldi, M. Portolani, M. Meacci, P. Pietrosemoli, R. Berni Canani, P. Laccetti, M. Gobbo, V. Giacomet, R. D’Elia, O. Rampon, E. Ruga, A. de Rossi, M. Zanchetta, D. Caselli, A. Maccabruni, E. Cattaneo, V Landini, S. Bernardi, A. Krzysztofiak, C. Tancredi, P. Rossi, L. Pansani, E. Palomba, C. Gabiano, A. Mazza, G. Rossetti, R. Nicolin, A. Timillero, F. Candeias, G Santos, M. L. Ramos Ribeiro, M. C. Almeida, M. H. Lourenço, R. Antunes, M. J. Mellado Pena, M L. Carillo de Albornoz, P. Martinez Santos, L. Ciria Calavia, J. Serra Devecchi, O. Delgado, N. Matamoros, A. Foot, H. Kershaw, C. Kelly, O. Caul, W. Tarnow Mordi, J. Petrie, A. McDowell, P. McIntyre, K. Appleyard, K. Sloper, V. Shah, K. Cheema, A. Aali, J. Mok, R. Russell, A. Brewster, N. Richardson, S. Burns, D. Gibb, V. Novelli, N. Klein, S. Ewen, V. Yeung, C. Ball, K. Himid, D. Nayagam, D. Graham, A. Barrie, K. Stringer, S. Jones, N. Weerasooriya, M. Zuckerman, P. Bracken, E. Cooper, T. Fisher, R. Barrie, U. Patel, V. Van Someren, K. Moshal, L. Perry, T. Gundlach, J. Norman, M. Sharland, M. Richardson, S. Donaghy, Z. Mitchla, C. Wells, J. Booth, A. Shipp, J. White, S. Head, S. Lambers, K. O’Hara, C. Stainsby, G. Du Mont, T. Solanki, S. Swanton, S. O’Shea, A. Tilsey, S. Kaye, A. Finn, S. Choo, R. Lakshman, L. Barr, G. Bell, A. Siddens, GUARINO, ALFREDO, SPAGNUOLO, MARIA IMMACOLATA, Aboulker, J. P., Babiker, A., Compagnucci, A., Darbyshire, J. H., Debré, M., Giaquinto, C., Gibb, D. M., Harper, L., Saidi, Y., Walker, A, Darbyshire, J., Johnson, D., Kelleher, P., Mcgee, L., Newberry, A, Poland, A., Walker, A. S., Aboulker, J P., Carrière, I., Eliette, V., Leonardo, S., Gersten, M., Jones, A., Blanche, S., Bohlin, A. B., Butler, K, Castelli Gattinara, G., Clayden, P., R De Groot, Faye, A., Griscelli, C., I Grosch Wörner, Kind, C., Lyall, H., Levy, J., Mellado Pena, M., Nadal, D., Peckham, C, Ramos Amador, J. T., Rosado, L., Rudin, C., Scherpbier, H., Sharland, M, Tovo, P. A., Tudor Williams, G., Valerius, N., Volny Anne, A., Wintergerst, U, Wahn, V., Hill, C., Lepage, P, Pozniak, A., Vella, S., Hainaut, M., Peltier, A., Carlier, S., Zissis, G., Della Negra, M., Queiroz, W., Feitosa, L. P., Oliveira, D, Mechinaud, F., Ballerau, F., Lepelletier, A., Billaudel, S., Ferre, V., Grosch Wörner, I., Weigel, R., Seel, K., Feiterna Sperling, C., Ohlendorf, D., Riße, G., Müller, C., Niehues, T., Ndagijimana, J., Horneff, G., Vente, N., Ganschow, R., Simon, T., Vossen, R., Pfister, H, Wintergerst, U., Notheis, G., Strotmann, G., Schlieben, S, Butler, K., Hayes, E., O’Mara, M., Fanning, J., Goggins, F., Moriarty, S., Byrne, M., Battisti, L., Duse, M., Timpano, S., Uberti, E., Crispino, P., Carrara, P., Fomia, F., Manca, A., Galli, L., de Martino, M., Fioredda, F., Pontali, E., Cellini, M., Baraldi, C., Portolani, M., Meacci, M., Pietrosemoli, P., Guarino, Alfredo, Spagnuolo, MARIA IMMACOLATA, Berni Canani, R., Laccetti, P., Gobbo, M., Giacomet, V., D’Elia, R., Rampon, O., Ruga, E., de Rossi, A., Zanchetta, M., Caselli, D., Maccabruni, A., Cattaneo, E., Landini, V, Bernardi, S., Krzysztofiak, A., Tancredi, C., Rossi, P., Pansani, L., Palomba, E., Gabiano, C., Mazza, A., Rossetti, G., Nicolin, R., Timillero, A., Candeias, F., Santos, G, Ramos Ribeiro, M. L., Almeida, M. C., Lourenço, M. H., Antunes, R., Mellado Pena, M. J., Carillo de Albornoz, M L., Martinez Santos, P., Ciria Calavia, L., Serra Devecchi, J., Delgado, O., Matamoros, N., Foot, A., Kershaw, H., Kelly, C., Caul, O., Tarnow Mordi, W., Petrie, J., Mcdowell, A., Mcintyre, P., Appleyard, K., Sloper, K., Shah, V., Cheema, K., Aali, A., Mok, J., Russell, R., Brewster, A., Richardson, N., Burns, S., Gibb, D., Novelli, V., Klein, N., Ewen, S., Yeung, V., Ball, C., Himid, K., Nayagam, D., Graham, D., Barrie, A., Stringer, K., Jones, S., Weerasooriya, N., Zuckerman, M., Bracken, P., Cooper, E., Fisher, T., Barrie, R., Patel, U., Van Someren, V., Moshal, K., Perry, L., Gundlach, T., Norman, J., Sharland, M., Richardson, M., Donaghy, S., Mitchla, Z., Wells, C., Booth, J., Shipp, A., White, J., Head, S., Lambers, S., O’Hara, K., Stainsby, C., Du Mont, G., Solanki, T., Swanton, S., O’Shea, S., Tilsey, A., Kaye, S., Finn, A., Choo, S., Lakshman, R., Barr, L., Bell, G., and Siddens, A.

Abstract

Introduction Treatment options for children with HIV-1 are limited. We aimed to compare activity and safety of three dualnucleoside analogue reverse-transcriptase inhibitor (NRTI) regimens with or without a protease inhibitor in previously untreated children with HIV-1. Methods In our multicentre trial, we randomly assigned 36 children to zidovudine and lamivudine, 45 to zidovudine and abacavir, and 47 to lamivudine and abacavir. Children who were symptomfree (n=55) were also randomly assigned to receive nelfinavir or placebo. Children with more advanced disease received open-label nelfinavir (73). Primary endpoints were change in plasma HIV-1 RNA at 24 and 48 weeks for the NRTI comparison and occurrence of serious adverse events for both randomised comparisons. Analyses were by intention to treat. Findings Children had a median CD4 percentage of 22% (IQR 15–29) and a mean HIV-1 RNA concentration of 5·0 log copies/mL (SD 0·8). One child was lost to follow-up and one died of sepsis. At 48 weeks, in the zidovudine/lamivudine, zidovudine/abacavir, and lamivudine/abacavir groups, mean HIV-1 RNA had decreased by 1·71, 2·19, and 2·63 log copies/mL, respectively (estimated in absence of nelfinavir) (p=0·02 after adjustment for baseline factors). One child had a hypersensitivity reaction to abacavir; and three with possible reactions stopped abacavir. There were 24 serious adverse events—six in the symptom-free children (all on nelfinavir), but none were attributed to nelfinavir. Interpretation Regimens containing abacavir were more effective than zidovudine/lamivudine. Such regimens could be combined with protease inhibitors and non-nucleoside reverse transcriptase inhibitors for safe and effective treatment of previously untreated children with HIV-1.

Published
2002

18. Implementing digital devices to maintain family connections during the COVID-19 pandemic: Experience of a large academic urban hospital.

Author

Ng G, Desai C, Gagliardi L, Donaghy S, and Prospero LD

Subjects
Humans, Family, SARS-CoV-2, Computers, Handheld, Pandemics, Canada, Academic Medical Centers, COVID-19 epidemiology, COVID-19 prevention & control, Hospitals, Urban organization & administration
Abstract

Introduction: The COVID-19 pandemic lockdown imposed drastic measures at hospitals internationally to rapidly pivot their approaches to patient care. Early on when the pandemic was declared, hospitals responded to local public health restrictions by limiting all non-essential visits for their patients. Digital devices allowed Canadians to remain connected with their friends and families during the imposed isolation restrictions. The aim of this clinical perspective is to share the experience with the immediate implementation of digital connections for patients by exploring the impact as well as to describe key learnings from the initiative., Methods: 150 iPads were distributed to clinical teams for use by patients, for either clinical care or for social connection. An iterative evaluation process, guided by quality improvement methodology, was followed which ensured that any changes to the iPad implementation process were responsive in real time. The evaluation measures included a clinician survey and collection of narratives from patients and clinicians., Results: All clinician respondents (n=7) indicated that the iPads were a valuable tool to support patients and families. Narratives from patients indicated that virtual connections brought joy to them especially given that they were isolated from their support systems during the initial days of COVID-19. Key learnings for the Implementation Team were: the importance in maintaining cognitive stimulation as an enabler to recovery for patients; staff members provide support beyond direct clinical care; technology needs to be harnessed to facilitate clinical care; technology should be leveraged to support clinical care; and interprofesssional collaboration of the entire Implementation Team is a key enabler of success., Conclusion: Since implementation, iPads have been integrated as a supporting digital tool for both social connections as well as clinical care as a result of the benefits seen during this initiative. The iPads have also been recognized as a tool to complement patient connection and care and currently being expanded as part of services to patients, families and their clinicians., (Copyright © 2023. Published by Elsevier Inc.)

Published
2024
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19. The influence of food packaging on independent eating in individuals with hand impairments.

Author

Hitzig SL, Donaghy S, Wang S, Tay C, Cimino SR, Szkudlarek S, Werle S, Lopez-Pollard W, and Linkewich E

Subjects
Humans, Male, Female, Middle Aged, Adult, Eating, Qualitative Research, Aged, Hand physiopathology, Interviews as Topic, Inpatients, Persons with Disabilities rehabilitation, Persons with Disabilities psychology, Food Packaging, Activities of Daily Living
Abstract

Purpose: Hand function plays a major role in the successful performance of activities of daily living (ADLs), such as eating. There is a lack of data exploring how persons with hand impairment manage food packaging and its impact on eating., Methods: A convenience sample of 12 inpatients with hand impairments undergoing rehabilitation participated in a qualitative interview where they were asked questions about their experiences with food packaging and independent eating, and asked to open a set of commonly available hospital food packages, first without any tools/aids, and then with tools/aids if they desired to use them. Audio data were transcribed and cross-referenced with video data. Data were analyzed using codebook thematic analysis., Results: An overarching theme of "Messiness" along with four major themes were identified: a) Inaccessibility of food packaging; b) Lack of control; c) Eating avoidance; and d) Preferred packaging and strategies., Conclusions: Inpatients with a hand impairment often experience several challenges with independent eating while in hospital as a result of their difficulties with hard to open food packaging. A greater consideration of universal design principles may be relevant for designers to make packaging more accessible.

Published
2024
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20. The Development and Integration of a Safety Officer Role to Facilitate Prevention of COVID-19 Virus Transmission in an Adult Inpatient Rehabilitation Setting Using Collaborative Change Leadership Methodology.

Author

Donaghy S, Shaffer J, and Schneider S

Subjects
Adult, Humans, Pandemics prevention & control, Inpatients, Leadership, Health Personnel, Personal Protective Equipment, SARS-CoV-2, COVID-19 prevention & control
Abstract

Background: With the onset of the COVID-19 pandemic, a large urban academic hospital responded by creating the temporary role of a "Safety Officer (SO)." The key task of the SO role was to supervise staff donning and doffing personal protective equipment (PPE) and provide real-time feedback on their performance. The support for safe donning and doffing would contribute to staff well-being by reducing their fear of infection transmission., Methods: A Collaborative Change Leadership (CCL) approach was used to facilitate the development, implementation, and evaluation of the role. This included an iterative feedback process with clinicians and safety officers to continually refine the role., Findings: Feedback indicated value in the initiative as increasing staff confidence about preventing virus transmission, as well as their sense of safety at work. Areas for future improvement included additional communication strategies for interprofessional teams and external partners, as well as planning around logistics to better support the safety officers in performing this new, temporary role., Conclusions/application to Practice: The Safety Officer role was able to help alleviate concerns regarding potential infection transmission and contribute positively to staff well-being., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2023
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22. Efficacy of 7 days per week inpatient admissions and rehabilitation therapy.

Author

DiSotto-Monastero M, Chen X, Fisch S, Donaghy S, and Gomez M

Subjects
Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Time Factors, Inpatients statistics & numerical data, Occupational Therapy organization & administration, Patient Admission statistics & numerical data, Physical Therapy Specialty organization & administration, Rehabilitation Centers organization & administration
Abstract

Objective: To evaluate the efficacy of 7 d/wk of inpatient admissions and rehabilitation therapy (7DART) in a rehabilitation hospital., Design: Cross-sectional, retrospective electronic data review., Setting: Rehabilitation hospital., Participants: Adult patients who participated in the 7DART program and were admitted and discharged between February 2009 and January 2010 (n=1808), and adult patients who received 5 d/wk of inpatient admissions and rehabilitation therapy (5DART), and were admitted and discharged between February 2008 and January 2009 (n=1692)., Interventions: Occupational therapy and physiotherapy during the weekends (7DART only)., Main Outcome Measures: FIM rating change from admission to discharge, length of hospital stay, rehabilitation workload per patient, and discharge destination., Results: There were 3500 patients admitted with a mean age ± SD of 72.1±13.3 years and a male-to-female ratio of 1:1.9. Under 7DART conditions, there was a 6.9% increase in admissions (7DART=1808 vs 5DART=1692, P=.006), an 86% increase in weekend admissions (255 vs 137, P<.001), a 13.2% increase in rehabilitation workload per patient (40.7 h vs 36 h, P<.001), and a 5.4% decrease in rehabilitation hospital stay (19.3 d vs 20.3 d, P=.043). Similar FIM rating changes were obtained from admission to discharge under both conditions (18.2 for 7DART vs 18.7 for 5DART, P=.099). Both groups resulted in 94% of patients achieving their rehabilitation goals (7DART=94.1%, 5DART=94.5%; P=.967), and 88.6% of patients returning to their homes (7DART=88.1%, 5DART=89.2%; P=.334)., Conclusions: Despite the fact that patients in both groups had similar functional outcomes and discharge destination, the 7DART rehabilitation model reduced length of hospital stay and increased rehabilitation workload, demonstrating increased efficiency and access to care by admitting more patients from acute care, rehabilitating them, and discharging them to the community in less time than the 5DART model., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Published
2012
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23. Raltegravir in the prevention of mother-to-child transmission of HIV-1: effective transplacental transfer and delayed plasma clearance observed in preterm neonates.

Author

Hegazi A, Mc Keown D, Doerholt K, Donaghy S, Sadiq ST, and Hay P

Subjects
Adult, Anti-HIV Agents pharmacology, Female, HIV Infections drug therapy, Humans, Infant, Newborn, Infant, Premature blood, Pregnancy, Pregnancy Complications, Infectious virology, Pyrrolidinones pharmacology, Raltegravir Potassium, Anti-HIV Agents administration & dosage, HIV Infections prevention & control, Infant, Premature metabolism, Infectious Disease Transmission, Vertical prevention & control, Placenta metabolism, Pregnancy Complications, Infectious drug therapy, Prenatal Care methods, Pyrrolidinones administration & dosage
Published
2012
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24. The immunogenicity of a novel A (H1N1) vaccine in HIV-infected children.

Author

Okike IO, Yung C, Ladhani S, Oeser C, Bennett A, Doerholt K, Storey S, Donaghy S, Butter N, Hoschler K, Sheasby L, Heath PT, and Miller E

Subjects
Adjuvants, Immunologic, Adolescent, Antibodies, Viral blood, CD4 Lymphocyte Count, Child, Child, Preschool, Drug Combinations, Female, HIV-1 isolation & purification, Hemagglutination Inhibition Tests, Humans, Immunization, Secondary methods, Influenza Vaccines administration & dosage, Influenza Vaccines adverse effects, Male, Polysorbates administration & dosage, Polysorbates adverse effects, Squalene administration & dosage, Squalene adverse effects, United Kingdom, Vaccination methods, Viral Load, alpha-Tocopherol administration & dosage, alpha-Tocopherol adverse effects, HIV Infections immunology, Influenza Vaccines immunology
Abstract

Background: In October 2009, the United Kingdom Department of Health recommended vaccination of high-risk groups, including children with HIV, with a novel, oil-in-water AS03(B) adjuvanted Influenza A (H1N1) vaccine (Pandemrix). There were no published data available regarding the immunogenicity of this vaccine in such children., Objectives: This study evaluated the immunogenicity of the adjuvanted Influenza A (H1N1) vaccine in HIV-infected children immunised according to national recommendations and assessed the impact of vaccination on individual CD4 counts and HIV viral loads., Methods: HIV-infected children attending outpatient appointments between 01 November and 31 December 2009 were offered two doses of H1N1 vaccine three weeks apart and a blood test before and 3 weeks after the second dose of vaccine. Serum antibody responses were determined by a haemagglutination inhibition (HAI) assay using standard methods., Results: Of the 39 children recruited for vaccination, 31 (median age 11.2, range 3.0-17.9 years) received both doses of vaccine and provided pre- and post-vaccination blood samples. Eight children (26%) had baseline HAI titres ≥ 1:32. After vaccination, 29 children (94%, 95% CI, 78.6-99.2%) had HAI titres ≥ 1:32 (seroprotection), of whom 27 (87.1%, 95% CI, 70.1-96.4%) had also had a four-fold rise in titres (seroconversion). In the univariate analysis, post-vaccination geometric mean titres (GMTs) were higher among the 21 children receiving highly active anti-retroviral therapy compared with the 10 treatment-naïve children (GMT 406 [95% CI 218-757] vs. 128 [49-336]; P=0.035), but this was no longer statistically significant when adjusted for prevaccine GMTs. There was no significant impact of vaccination on CD4+ T cell count or HIV viral load., Conclusion: The AS03(B)-adjuvanted pandemic Influenza A (H1N1) vaccine is highly immunogenic and appears to be safe in HIV-infected children., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Published
2011
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25. High neonatal concentrations of raltegravir following transplacental transfer in HIV-1 positive pregnant women.

Author

McKeown DA, Rosenvinge M, Donaghy S, Sharland M, Holt DW, Cormack I, Hay P, and Sadiq ST

Subjects
Adult, Female, HIV Infections immunology, Humans, Infectious Disease Transmission, Vertical, Placenta blood supply, Pregnancy, Pregnancy Complications, Infectious, Pyrrolidinones blood, Raltegravir Potassium, HIV Infections drug therapy, HIV-1 immunology, Placenta drug effects, Pyrrolidinones pharmacokinetics
Published
2010
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26. Choice of antihypertensives after acute ischemic stroke.

Author

Donaghy S

Subjects
Acute Disease, Antihypertensive Agents administration & dosage, Antihypertensive Agents pharmacokinetics, Brain Ischemia complications, Drug Administration Schedule, Humans, Labetalol administration & dosage, Labetalol pharmacokinetics, Antihypertensive Agents therapeutic use, Brain Ischemia rehabilitation, Labetalol therapeutic use, Stroke Rehabilitation
Published
2005
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27. Spinal malformations in the fetuses of HIV infected women receiving combination antiretroviral therapy and co-trimoxazole.

Author

Richardson MP, Osrin D, Donaghy S, Brown NA, Hay P, and Sharland M

Subjects
Adult, Female, Humans, Pregnancy, Abnormalities, Drug-Induced, Anti-HIV Agents adverse effects, HIV Infections drug therapy, Pregnancy Complications, Infectious drug therapy, Spine abnormalities, Trimethoprim, Sulfamethoxazole Drug Combination adverse effects
Abstract

HIV positive women of reproductive age are increasingly treated with a combination of antiretroviral agents, with effects on the developing human fetus that are largely unknown. We report two cases of severe spinal malformations in the fetuses of women treated with combination antiretroviral therapy and co-trimoxazole.

Published
2000
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28. A new protocol for training severely impaired patients in the usage of memory journals.

Author

Donaghy S and Williams W

Subjects
Adult, Brain Injuries complications, Female, Guidelines as Topic, Humans, Learning, Male, Middle Aged, Patient Education as Topic, Brain Injuries rehabilitation, Memory Disorders etiology, Memory Disorders rehabilitation, Writing
Abstract

Although memory disorders are frequently seen in survivors of brain injuries, remediation of patients with severe memory disorders is still relatively neglected in clinical practice due to pessimism by clinicians regarding the efficacy of such remediation. With respect to memory journal training, a further reason for this neglect is likely the lack of readily accessible protocols that therapists can use to work with these patients. The purpose of the present paper is to describe a new memory journal training protocol that was developed to teach brain injury survivors how to compensate for severe memory impairments by using three strengths of most brain injury survivors: immediate attention, procedural memory, and old learning. A training protocol is described that involves baseline testing and a needs assessment, five levels of training exercises, and discharge probe testing. It is concluded that patients with severely impaired memory abilities can learn the present system when care is taken to individualize journals, conduct proper needs assessments, and provide structured training exercises geared to the strengths of memory impaired persons.

Published
1998
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29. Interrater reliability of the Functional Assessment Measure in a brain injury rehabilitation program.

Author

Donaghy S and Wass PJ

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Observer Variation, Patient Care Team, Psychometrics, Reproducibility of Results, Sensitivity and Specificity, Time Factors, Treatment Outcome, Activities of Daily Living, Brain Injuries physiopathology, Brain Injuries rehabilitation, Self Care, Surveys and Questionnaires standards
Abstract

Objective: To examine the interrater reliability and completion time of the Functional Assessment Measure, which is the Functional Independence Measure (FIM) plus additional items (FIM+FAM)., Design: Interrater reliability study., Setting: Inpatient rehabilitation units of a postacute care brain injury rehabilitation program., Patients: A convenience sample of 53 extremely severely impaired adult survivors of traumatic brain injuries (40 men, 13 women, mean age 38yrs)., Main Outcome Measures: Treatment team members' ratings of the 30 FIM +FAM items, and time taken to complete the FIM+FAM., Results: Intraclass Correlation Coefficients (ICCs) were within the good to excellent range (ICC > .60) for 29 of 30 items and for all subscales except psychosocial adjustment. Higher mean ICC values were obtained for motor domain items than for cognitive/psychosocial domain items. Treatment teams became progressively faster over a 12-week period in completing the FIM+FAM. The generally good to excellent range interrater reliability found in this study helps support the use of the FIM+FAM in rehabilitation settings. Further support was obtained for the finding that motor items are more reliable than cognitive and psychosocial items. Administration of the FIM+FAM can be done in a timely manner in a rehabilitation setting.

Published
1998
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30. Behavioural effects of neocortical and cingulate lesions in the Mongolian gerbil.

Author

Ellard CG, Stewart DJ, Donaghy S, and Vanderwolf CH

Subjects
Animals, Arousal physiology, Brain Mapping, Feeding Behavior physiology, Gerbillinae, Grooming physiology, Hippocampus physiology, Male, Motor Activity physiology, Sexual Behavior, Animal physiology, Social Environment, Behavior, Animal physiology, Cerebral Cortex physiology, Gyrus Cinguli physiology
Abstract

The experiments examine the effects of cortical lesions on a variety of behaviours in the Mongolian gerbil (Meriones unguiculatus). Gerbils with either large anterior or posterior lesions were compared with normal gerbils by administering a battery of tests of rodent behaviours such as grooming, eating, social interaction, ventral marking and foot-stomping. In a second experiment, a more detailed investigation was carried out of the effects of focal cortical lesions on ventral marking. The results of these experiments suggest that anterior cortical lesions in gerbils give rise to a number of different deficits in behaviour. The results further suggest that cingulate cortex is part of the neural substrate for ventral marking behaviour. The implications of these results for contemporary theories of frontal lobe function are discussed.

Published
1990
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