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6. Influence of menthol on human temperature regulation and perception

Author

Gillis, D. Jason and House, James Reginald

Subjects
612.01426, Sports and Exercise Sciences
Abstract

When exercise is undertaken in warm, humid conditions, the thermal gradient between the skin and environment, and the capacity for evaporative heat loss, are reduced. These factors, along with an increase in metabolic heat production, lower work capacity and exercise performance. Thermoreceptors located within the skin and deep in the body convey information on this accumulation of thermal energy to higher brain structures and, if mean body temperature rises uncontrollably, the cumulative neuronal input is thought to produce inhibitory signals that lower work capacity, such that metabolic heat production decreases to protect the organism from heat injury. Lessening these inhibitory signals may enhance or help to maintain exercise performance in the heat. The inhibitory signals might be lessened by cooling the skin and deep body temperature prior to or during exercise, or perhaps by applying menthol on the skin, or some combination of these. Menthol is a chemical compound that activates cold receptors (TRPM8) in the skin to elicit cool sensations. These receptors are not otherwise activated unless cooled below 27 °C. Hence, menthol, when applied to the skin of heat stressed humans, may provide a “cool’’ neuronal input to higher brain structures in addition to the neuronal signals arising from warm thermoreceptors located within the body. But menthol may also induce a heat storage (cold defense) response that would then heighten the activity of warm receptors deep in the body. Therefore, it is not clear whether menthol might reduce, enhance or help to maintain exercise performance in heat stressed humans. Moreover, no studies have assessed the perceptual and thermoregulatory response to menthol during rest or exercise, or the consequence of its repeated use. Before it is recommended as a possible ergogenic aid, these studies should be undertaken. The early work presented in this thesis tested the hypotheses that a water-based spray, containing ethanol and/or menthol, would enhance evaporative cooling when sprayed on the skin, thereby lowering heat storage and improving thermal perception compared to an unsprayed Control condition; but menthol would also improve thermal perception independent of temperature by directly stimulating cold receptors, during rest and exercise in warm, humid conditions. The hypothesis that menthol-mediated cool sensations would not undergo any habituation after repeated exposures was also tested. The general approach to testing these hypotheses involved presenting human participants with a thermal challenge that would induce warm sensations and increase thermal discomfort, whilst encouraging a level of heat storage that could be compensated for by increasing heat loss through v sodilation and sweating. This was achieved by manipulating metabolic heat production through a combination of rest and fixed intensity exercise in warm (30 °C) and humid (70 %) conditions. The influence of a menthol solution spray was tested against the backdrop of this thermal challenge. The results supported the general hypothesis that a water-based upper-body spray containing menthol can increase sensations of coolth compared to no spraying or wateronly spraying during rest and exercise in warm, humid conditions, but menthol also influences body temperature regulation. The effect that menthol exerts over perception and thermoregulation differs by dose and fades with time. Specifically, 0.2 % menthol spraying encourages heat storage by enhancing vasoconstriction, and there is no habituation in these responses. 0.05 % menthol spraying did not encourage any additional heat storage compared to a Control spray. Menthol also influenced perception, with a 0.2 % menthol spray promoting cooler sensations and greater irritation than 0.05 % menthol and Control spraying. Compared to a Control spray, 0.2 % menthol reduced thermal comfort during rest and improved it during exercise, while 0.05 % menthol did not alter thermal comfort during rest, and may have improved it during exercise. Neither menthol spray influenced perceived exertion during exercise. Menthol-mediated cool sensations lasted 15 to 30 minutes. Both 0.2 % and 0.05 % menthol sprays underwent an habituation compared to the Control spray, with cool sensations diminishing after repeated daily exposures. It is concluded that a 0.05 % menthol spray, which induces cool sensations without a significant heat storage response, could be considered as a perceptual cooling intervention with some capacity to enhance evaporative heat loss when sprayed on the skin during rest and moderate fixed-intensity exercise in the heat. A 0.2 % menthol spray might be deployed later in exercise, but may increase heat storage and irritation. Further testing is required to identify whether menthol spraying improves maximal exercise performance.

Published
2011

8. Expanding The INSPIRED COPD Outreach ProgramTM to the emergency department: a feasibility assessment

Author

Gillis D, Demmons J, and Rocker G

Subjects
COPD, INSPIRED COPD Outreach ProgramTM, feasibility, emergency department, admission, readmission, Diseases of the respiratory system, RC705-779
Abstract

Darcy Gillis,1 Jillian Demmons,1 Graeme Rocker1,2 1Division of Respirology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Halifax, NS, Canada; 2Division of Respirology, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada Background: The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80%) reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED) we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who avoid hospital admission.Methods: Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency.Results: Referral rates were 0.5/week. Among eligible patients (n=174) 33 (19%) were referred of whom 15 (M=4, F=11) enrolled in INSPIRED-ED. Mean (SD) age was 68 (7) years, post-bronchdilator FEV1 44.2 (15.5) % predicted, and Medical Research Council (MRC) dyspnea score 3.8 (0.41). We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD) Care Transition Measure (CTM-3) improved from 8.6 (2.0) to 11.3 (1.3), P=0.0004, and of 14 patients responding 12 (86%) found the program very helpful. An additional 34 patients were enrolled to our regular program from those referred but ineligible for INSPIRED-ED (n=27) or unwilling to participate (n=7).Conclusions: INSPIRED-ED outcomes were generally positive, however referral and enrollment rates were lower than anticipated. Despite the potential of early self-management education, the ED may not be the ideal recruitment setting for home-based programs. Our findings underline the importance of conducting preliminary work to ascertain best settings for implementing new self-management education initiatives. Keywords: Self-management education, community-based care, holistic COPD care, admission, readmission

Published
2017

10. Symptoms of depression and anxiety increased marginally from before to during the COVID-19 pandemic among young adults in Canada

Author

Marie-Pierre Sylvestre, Gillis D. Tchouangue Dinkou, Alexia Armasu, Annie Pelekanakis, Vickie Plourde, Mathieu Bélanger, Katerina Maximova, Brett D. Thombs, and Jennifer O’Loughlin

Subjects
Adult, Young Adult, Multidisciplinary, Depression, Child, Preschool, COVID-19, Humans, Anxiety, Child, Anxiety Disorders, Pandemics
Abstract

We documented changes in depressive and anxiety symptoms from before to during the COVID-19 pandemic among young adults and investigated whether changes differed across participant characteristics. Data were available in an investigation of 1294 grade 7 students recruited in 1999–2000. For this analysis, we used data collected pre-pandemically in 2017–20 (mean (SD) age = 30.6 (1.0)) and during the pandemic in 2020–21 (mean (SD) age = 33.6 (0.6)). 673 participants with data in both cycles were retained for analysis. Symptoms were measured using the Major Depression Inventory (MDI) and the Generalized Anxiety Disorder-7 (GAD-7) scale. Standardized mean differences (SMD) of changes in MDI and GAD-7 values between cycles were calculated across participant characteristics. On average, MDI scores increased by 2.1 (95%CI 1.4, 2.8) points during the pandemic from mean 10.5; GAD-7 scores increased by 1.2 (0.8, 1.5) points from mean 4.7. The SMD was 0.24 (0.14, 0.33) for MDI, and 0.24 (0.13, 0.34) for GAD-7. No differences in MDI change scores were observed across participant characteristics. Differences in GAD-7 change scores were observed by mood/anxiety disorder (SMD − 0.31 (− 0.58, − 0.05)), household income (0.24 (0.02, 48)), living with young children (− 0.56 (− 1.23,− 0.05)), and adherence to public health recommendations 0.58 (0.19, 1.03)). Increases in depressive and anxiety symptoms were observed 10–16 months into the COVID-19 pandemic among adults age 32–36.

Published
2022

17. Elective cancer surgery in COVID-19–Free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study

Author

James C Glasbey, Dmitri Nepogodiev, Joana Ff Simoes, Omar Omar, Elizabeth Li, Mary L Venn, Mohammad Abou Chaar, Vita Capizzi, Daoud Chaudhry, Anant Desai, Jonathan G Edwards, Jonathan P Evans, Marco Fiore, Jose Flavio Videria, Samuel J Ford, Ian Ganyli, Ewen A Griffiths, Rohan R Gujjuri, Angelos G Kolias, Haytham Ma Kaafarani, Ana Minaya-Bravo, Siobhan C McKay, Helen M Mohan, Keith Roberts, Carlos San Miguel-Méndez, Peter Pockney, Richard Shaw, Neil J Smart, Grant D Stewart, Sudha Sundar, Raghavan Vidya, Aneel A Bhangu, James C Glasbey, Omar Omar, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Daoud Chaudhry, Brett E Dawson, Jonathan P Evans, James C Glasbey, Rohan R Gujjuri, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S Mann, Ella J Marson, Kenneth A McLean, Siobhan C McKay, Emily C Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana Ff Simoes, Isobel M Trout, Mary L Venn, Richard Jw Wilkin, Aneel A Bhangu, James C Glasbey, Neil J Smart, Ana Minaya-Bravo, Jonathan P Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran, Ewen A Griffiths, Sivesh K Kamarajah, Richard Pt Evans, Philip Townend, Keith Roberts, Siobhan McKay, John Isaac, Sohei Satoi, John Edwards, Aman S Coonar, Adrian Marchbank, Edward J Caruana, Georgia R Layton, Akshay Patel, Alessandro Brunelli, Samuel Ford, Anant Desai, Alessandro Gronchi, Marco Fiore, Max Almond, Fabio Tirotta, Sinziana Dumitra, Angelos Kolias, Stephen J Price, Daniel M Fountain, Michael D Jenkinson, Peter Hutchinson, Hani J Marcus, Rory J Piper, Laura Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K Demetriades, Faith Robertson, Alex Alamri, Richard Shaw, Andrew G Schache, Stuart C Winter, Michael Ho, Paul Nankivell, Juan Rey Biel, Martin Batstone, Ian Ganly, Raghavan Vidya, Alex Wilkins, Jagdeep K Singh, Dinesh Thekinkattil, Sudha Sundar, Christina Fotopoulou, Elaine Leung, Tabassum Khan, Luis Chiva, Jalid Sehouli, Anna Fagotti, Paul Cohen, Murat Gutelkin, Rahel Ghebre, Thomas Konney, Rene Pareja, Rob Bristow, Sean Dowdy, T S Shylasree, R Kottayasamy Seenivasagam, Joe Ng, Keiiji Fujiwara, Grant D Stewart, Benjamin Lamb, Krishna Narahari, Alan McNeill, Alexandra Colquhoun, John McGrath, Steve Bromage, Ravi Barod, Veeru Kasivisvanathan, Tobias Klatte, Joana Ff Simoes, Tom Ef Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth A Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F Cunha, Giana H Davidson, Anant Desai, Salomone Di Saverio, Thomas M Drake, John G Edwards, Muhammed Elhadi, Sameh Emile, Shebani Farik, Marco Fiore, J Edward Fitzgerald, Samuel Ford, Tatiana Garmanova, Gaetano Gallo, Dhruv Ghosh, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A Griffiths, Madalegna GrÜndl, Constantine Halkias, Ewen M Harrison, Intisar Hisham, Peter J Hutchinson, Shelley Hwang, Arda Isik, Michael D Jenkinson, Pascal Jonker, Haytham Ma Kaafarani, Debby Keller, Angelos Kolias, Schelto Kruijff, Ismail Lawani, Hans Lederhuber, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Markus W Löffler, Maria Aguilera Lorena, Maria Marta Modolo, Piotr Major, Janet Martin, Hassan N Mashbari, Dennis Mazingi, Symeon Metallidis, Ana Minaya-Bravo, Helen M Mohan, Rachel Moore, David Moszkowicz, Susan Moug, Joshua S Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Francesco Pata, Carlos Jose Perez Rivera, Thomas D Pinkney, Willemijn van der Plas, Peter Pockney, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De la Medina, Keith Roberts, April C Roslani, Martin Rutegård, Juan José Segura-Sampedro, Irène Santos, Sohei Satoi, Raza Sayyed, Andrew Schache, Andreas A Schnitzbauer, Justina O Seyi-Olajide, Neil Sharma, Richard Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Malin Sund, Sudha Sundar, Stephen Tabiri, Philip Townend, Georgios Tsoulfas, Gabrielle H van Ramshorst, Raghavan Vidya, Dale Vimalachandran, Oliver J Warren, Duane Wedderburn, Naomi Wright, C Allemand, L Boccalatte, M Figari, M Lamm, J Larrañaga, C Marchitelli, F Noll, D Odetto, M Perrotta, J Saadi, L Zamora, C Alurralde, E L Caram, D Eskinazi, J P Mendoza, M Usandivaras, R Badra, A Esteban, J S García, P M García, J I Gerchunoff, S M Lucchini, M A NIgra, L Vargas, T Hovhannisyan, A Stepanyan, T Gould, R Gourlay, B Griffiths, S Gananadha, M McLaren, J Cecire, N Joshi, S Salindera, A Sutherland, J H Ahn, G Charlton, S Chen, N Gauri, R Hayhurst, S Jang, F Jia, C Mulligan, W Yang, G Ye, H Zhang, M Ballal, D Gibson, D Hayne, J Moss, T Richards, P Viswambaram, U G Vo, J Bennetts, T Bright, M Brooke-Smith, R Fong, B Gricks, Y H Lam, B S Ong, M Szpytma, D Watson, K Bagraith, S Caird, E Chan, C Dawson, D Ho, E Jeyarajan, S Jordan, A Lim, G J Nolan, A Oar, D Parker, H Puhalla, A Quennell, L Rutherford, P Townend, M Von Papen, M Wullschleger, A Blatt, D Cope, N Egoroff, M Fenton, J Gani, N Lott, P Pockney, N Shugg, M Elliott, D Phung, D Phan, D Townend, C Bong, J Gundara, A Frankel, S Bowman, G R Guerra, J Bolt, K Buddingh, N N Dudi-Venkata, S Jog, H M Kroon, T Sammour, R Smith, C Stranz, M Batstone, K Lah, W McGahan, D Mitchell, A Morton, A Pearce, M Roberts, G Sheahan, B Swinson, N Alam, S Banting, L Chong, P Choong, S Clatworthy, D Foley, A Fox, M W Hii, B Knowles, J Mack, M Read, A Rowcroft, S Ward, G Wright, M Lanner, I Königsrainer, M Bauer, C Freyschlag, M Kafka, F Messner, D Öfner, I Tsibulak, K Emmanuel, M Grechenig, R Gruber, M Harald, L Öhlberger, J Presl, A Wimmer, I Namazov, E Samadov, D Barker, R Boyce, S Corbin, A Doyle, A Eastmond, R Gill, A Haynes, S Millar, M O'Shea, G Padmore, N Paquette, E Phillips, S St John, K Walkes, N Flamey, P Pattyn, W Oosterlinck, J Van den Eynde, R Van den Eynde, A Gatti, C Nardi, R Oliva, R De Cicco, I Cecconello, P Gregorio, L Pontual Lima, U Ribeiro Junior, F Takeda, R M Terra, M Sokolov, B Kidane, S Srinathan, M Boutros, N Caminsky, G Ghitulescu, G Jamjoum, J Moon, J Pelletier, T Vanounou, S Wong, M Boutros, S Dumitra, A Kouyoumdjian, B Johnston, C Russell, M Boutros, S Demyttenaere, R Garfinkle, J Abou-Khalil, C Nessim, J Stevenson, F Heredia, A Almeciga, A Fletcher, A Merchan, L O Puentes, J Mendoza Quevedo, G Bacic, D Karlovic, D Krsul, M Zelic, I Luksic, M Mamic, B Bakmaz, I Coza, E Dijan, Z Katusic, J Mihanovic, I Rakvin, K Frantzeskou, N Gouvas, G Kokkinos, P Papatheodorou, I Pozotou, O Stavrinidou, A Yiallourou, L Martinek, M Skrovina, I Szubota, J Žatecký, V Javurkova, J Klat, T Avlund, P Christensen, J L Harbjerg, L H Iversen, D W Kjaer, Hø Kristensen, M Mekhael, A L Ebbehøj, P Krarup, N Schlesinger, H Smith, A Abdelsamed, A Y Azzam, H Salem, A Seleim, A Abdelmajeed, M Abdou, N E Abosamak, M Al Sayed, F Ashoush, R Atta, E Elazzazy, M Elhoseiny, M Elnemr, M S Elqasabi, M E Elsayed Hewalla, I Elsherbini, E Essam, M Eweda, I Ghallab, E Hassan, M Ibrahim, M Metwalli, M Mourad, M S Qatora, M Ragab, A Sabry, H Saifeldin, M Saleh Mesbah Mohamed Elkaffas, A Samih, A Samir Abdelaal, S Shehata, K Shenit, D Attia, N Kamal, N Osman, A M Abbas, Has Abd Elazeem, M M Abdelkarem, S Alaa, A K Ali, A Ayman, M G Azizeldine, H Elkhayat, S M Elghazaly, F A Monib, M A Nageh, M M Saad, M Salah, M Shahine, E A Yousof, A Youssef, A Eldaly, M ElFiky, A Nabil, G Amira, I Sallam, M Sherief, A Sherif, A Abdelrahman, H Aboulkassem, G Ghaly, R Hamdy, A Morsi, H Salem, G Sherif, H Abdeldayem, I Abdelkader Salama, M Balabel, Y Fayed, A E Sherif, D Bekele, J Kauppila, E Sarjanoja, O Helminen, H Huhta, J H Kauppila, C Beyrne, L Jouffret, L Lugans, L Marie-Macron, E Chouillard, B De Simone, J Bettoni, S Dakpé, B Devauchelle, N Lavagen, S Testelin, S Boucher, R Breheret, A Gueutier, A Kahn, J KÜn-Darbois, A Barrabe, Z Lakkis, A Louvrier, S Manfredelli, P Mathieu, A Chebaro, V Drubay, M El Amrani, C Eveno, K Lecolle, G Legault, L Martin, G Piessen, F R Pruvot, S Truant, P Zerbib, Q Ballouhey, B Barrat, J Laloze, H Salle, A Taibi, J Usseglio, D Bergeat, A Merdrignac, Roy B Le, L O Perotto, A Scalabre, A Aimé, A Ezanno, B Malgras, P Bouche, S Tzedakis, E Cotte, O Glehen, V Kepenekian, J Lifante, G Passot, A D'Urso, E Felli, D Mutter, P Pessaux, B Seeliger, J Bardet, R Berry, G Boddaert, S Bonnet, E Brian, C Denet, D Fuks, D Gossot, M Grigoroiu, A Laforest, Y Levy-Zauberman, C Louis-Sylvestre, A Moumen, G Pourcher, A Seguin-Givelet, E Tribillon, E Duchalais, F Espitalier, C Ferron, O Malard, U Bork, M Distler, J Fritzmann, J Kirchberg, C Praetorius, C Riediger, J Weitz, T Welsch, P Wimberger, K Beyer, C Kamphues, J Lauscher, F N Loch, C Schineis, M Albertsmeier, M Angele, A Kappenberger, H Niess, T Schiergens, J Werner, R Becker, J Jonescheit, I Pergolini, D Reim, C Boeker, I Hakami, J Mall, P Liokatis, W Smolka, K Nowak, T Reinhard, F Hölzle, A Modabber, P Winnand, M Knitschke, P Kauffmann, S Wolfer, J Kleeff, K Lorenz, C Michalski, U Ronellenfitsch, R Schneider, E Bertolani, A Königsrainer, M W Löffler, M Quante, C Steidle, L ÜberrÜck, C Yurttas, C S Betz, J Bewarder, A Böttcher, S Burg, C Busch, M Gosau, A Heuer, J Izbicki, T O Klatte, D Koenig, N Moeckelmann, C Nitschke, M Priemel, R Smeets, U Speth, S Thole, F G Uzunoglu, T Vollkommer, N Zeller, M J Battista, K Gillen, A Hasenburg, S Krajnak, V Linz, R Schwab, K Angelou, D Haidopoulos, A Rodolakis, P Antonakis, K Bramis, L Chardalias, I Contis, N Dafnios, D Dellaportas, G Fragulidis, A Gklavas, M Konstadoulakis, N Memos, I Papaconstantinou, A Polydorou, T Theodosopoulos, A Vezakis, M I Antonopoulou, D K Manatakis, N Tasis, N Arkadopoulos, N Danias, P Economopoulou, P Kokoropoulos, A Larentzakis, N Michalopoulos, J Selmani, T Sidiropoulos, V Tsaousis, P Vassiliu, K Bouchagier, S Klimopoulos, D Paspaliari, G Stylianidis, K Baxevanidou, K Bouliaris, P Chatzikomnitsa, M Efthimiou, A Giaglaras, C Kalfountzos, G Koukoulis, A M Ntziovara, K Petropoulos, K Soulikia, I Tsiamalou, K Zervas, S Zourntou, I Baloyiannis, A Diamantis, E Gkrinia, J Hajiioannou, C Korais, O Koukoura, K Perivoliotis, A Saratziotis, C Skoulakis, D Symeonidis, K Tepetes, G Tzovaras, D Zacharoulis, V Alexoudi, K Antoniades, I Astreidis, P Christidis, D Deligiannidis, T Grivas, O Ioannidis, I Kalaitsidou, L Loutzidou, A Mantevas, D Michailidou, K Paraskevopoulos, S Politis, A Stavroglou, D Tatsis, I Tilaveridis, K Vahtsevanos, G Venetis, I Karaitianos, T Tsirlis, A Charalabopoulos, T Liakakos, E Mpaili, D Schizas, E Spartalis, A Syllaios, C Zografos, C Anthoulakis, C Christou, V Papadopoulos, A Tooulias, D Tsolakidis, G Tsoulfas, D Zouzoulas, E Athanasakis, E Chrysos, J Tsiaoussis, S Xenaki, E Xynos, K Futaba, M F Ho, S F Hon, Twc Mak, Ssm Ng, C C Foo, B Banky, N Suszták, M Aremu, A Canas-Martinez, O Cullivan, C Murphy, P Owens, L Pickett, L Akmenkalne, J Byrne, M Corrigan, C Cullinane, A Daly, C Fleming, P Jordan, S Killeen, N Lynch, A McCarthy, H Mustafa, S O'Brien, P O'Leary, Was Syed, L Vernon, D Callanan, L Huang, A Ionescu, P Sheahan, I Balasubramanian, M Boland, K Conlon, D Evoy, N Fearon, T Gallagher, J Geraghty, H Heneghan, N Kennedy, D Maguire, D McCartan, E W McDermott, R S Prichard, D Winter, D Alazawi, C Barry, T Boyle, W Butt, E M Connolly, N Donlon, C Donohue, B A Fahey, R Farrell, C Fitzgerald, J Kinsella, J O Larkin, P Lennon, P J Maguire, P Mccormick, B J Mehigan, H Mohan, T Nugent, H O'Sullivan, N Ravi, J V Reynolds, A Rogers, P Shokuhi, J Smith, L A Smith, C Timon, Y Bashir, G Bass, T Connelly, B Creavin, H Earley, J A Elliott, A Gillis, D Kavanagh, P Neary, J O'riordan, I S Reynolds, D Rice, P Ridgway, M Umair, M Whelan, P Carroll, C Collins, K Corless, L Finnegan, A Fowler, A Hogan, M Kerin, A Lowery, P McAnena, K McKevitt, K Nizami, É Ryan, A Samy, J C Coffey, R Cunningham, M Devine, D Nally, C Peirce, S Tormey, N Hardy, P Neary, S O'Malley, M Ryan, S Macina, N M Mariani, E Opocher, A Pisani Ceretti, F Ferrari, F Odicino, E Sartori, C Cotsoglou, S Granieri, F Bianco, A Camillo, M Colledan, S Tornese, M F Zambelli, G Bissolotti, S Fusetti, F Lemma, M V Marino, A Mirabella, G Vaccarella, C Agostini, G Alemanno, I Bartolini, C Bergamini, A Bruscino, C Checcucci, R De Vincenti, A Di Bella, M Fambrini, L Fortuna, G Maltinti, P Muiesan, F Petraglia, P Prosperi, M N Ringressi, M Risaliti, F Sorbi, A Taddei, R Tucci, C Bassi, L Bortolasi, T Campagnaro, L Casetti, M De Pastena, A Esposito, M Fontana, A Guglielmi, L Landoni, G Malleo, G Marchegiani, S Nobile, S Paiella, C Pedrazzani, S Rattizzato, A Ruzzenente, R Salvia, G Turri, M Tuveri, P Bellora, G D'Aloisio, M Ferrari, E Francone, S Gentilli, H Nikaj, M Bianchini, M Chiarugi, F Coccolini, G Di Franco, N Furbetta, D Gianardi, S Guadagni, L Morelli, M Palmeri, D Tartaglia, G Anania, P Carcoforo, M Chiozza, A De Troia, M Koleva Radica, M Portinari, M G Sibilla, A Urbani, N Fabbri, C V Feo, S Gennari, S Parini, E Righini, L Ampollini, L Bellanti, M Bergonzani, G Bertoli, G Bocchialini, G D'Angelo, D Lanfranco, L Musini, T Poli, G P Santoro, A Varazzani, L Aguzzoli, G Borgonovo, C Castro Ruiz, S Coiro, G Falco, V D Mandato, V Mastrofilippo, M T Montella, V Annessi, M Zizzo, U Grossi, S Novello, M Romano, S Rossi, G Zanus, G Esposito, F Frongia, A Pisanu, M Podda, C Belluco, A Lauretta, G Montori, L Moras, M Olivieri, F Bussu, A G Carta, M L 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Gupta, J Steinke, S Thrumurthy, E Massie, K McGivern, D Rutherford, M Wilson, J Hardie, S Kazzaz, S Handa, M Kaushal, A Kler, P Patel, J Redfern, S Tezas, Y Aawsaj, S Amonkar, C Barry, L Blackwell, D Blake, J Carter, H Emerson, A Fisher, M Katory, P Korompelis, W McCormick, A Mustafa, L Pearce, N Ratnavelu, R Reehal, L Kretzmer, L Lalou, B Manku, I Parwaiz, J Stafford, M Abdelkarim, A Asqalan, T Gala, S Ibrahim, A Maw, R Mithany, R Morgan, G Sundaram Venkatesan, K Ang, E J Caruana, M F Chowdhry, A Mohammad, A Nakas, S Rathinam, M Boal, O Brown, S Dwerryhouse, S Higgs, A Vallance, E Boyd, V Irvine, A Kirk, G Bakolas, A Boulton, A Chandock, T Khan, M Kumar, P Agoston, A Bille, B Challacombe, S Fraser, K Harrison-Phipps, J King, G Mehra, L Mills, M Najdy, R Nath, L Okiror, J Pilling, V Rizzo, T Routledge, A Sayasneh, L Stroman, A Wali, M Fehervari, C Fotopoulou, N Habib, S Hamrang-Yousefi, Z Jawad, L Jiao, M Pai, J Ploski, P Rajagopal, S Saso, M Sodergren, D Spalding, S Laws, C Hardie, C McNaught, R Alam, A Budacan, J Cahill, M Kalkat, S Karandikar, L Kenyon, D Naumann, A Patel, J Ayorinde, T Chase, T Cuming, A Ghanbari, L Humphreys, S Tayeh, A Aboelkassem Ibrahim, R Bichoo, H Cao, Akw Chai, J Choudhury, C Evans, H Fitzjohn, H Ikram, M Langstroth, M Loubani, A McMillan, S Nazir, Ssa Qadri, A Robinson, E Ross, T Sehgal, A Wilkins, J Dixon, J Dunning, K Freystaetter, M Jha, S Lester, A Madhavan, S V Thulasiraman, Y Viswanath, T Curl-Roper, C Delimpalta, Ccl Liao, V Velchuru, E Westwood, E Belcher, G Bond-Smith, S Chidambaram, F Di Chiara, K Fasanmade, L Fraser, H Fu, M Ganau, S Gore, J Graystone, D Jeyaretna, H Khatkar, M Lami, M Maher, S Mastoridis, R Mihai, R Piper, S Prabhu, Obf Risk, U Selbong, K Shah, R Smillie, H Soleymani Majd, S Sravanam, D Stavroulias, G D Tebala, M Vatish, C Verberne, K Wallwork, S Winter, M I Bhatti, H Boyd-Carson, E Elsey, E Gemmill, P Herrod, M Jibreel, E Lenzi, T Saafan, D Sapre, T Sian, N Watson, A Athanasiou, G Bourke, L Bradshaw, A Brunelli, J Burke, P Coe, F Costigan, H Elkadi, M Ho, J Johnstone, A Kanatas, V Kantola, A Kaufmann, A Laios, S Lam, E MacInnes, S Munot, C Nahm, M Otify, C Pompili, I Smith, G Theophilou, G Toogood, R Wade, D Ward, C West, S Annamalai, C Ashmore, A Boddy, T Hossain, A Kourdouli, A Gvaramadze, A Jibril, L Prusty, D Thekkinkattil, A Harky, M Shackcloth, A Askari, C Chan, N Cirocchi, S Kudchadkar, K Patel, J Sagar, S Shaw, R Talwar, M Abdalla, R Edmondson, O Ismail, D Jones, K Newton, N Stylianides, A Aderombi, U Andaleeb, O Bajomo, K Beatson, W Garrett, M Mehmood, V Ng, R Al-Habsi, G S Divya, B Keeler, B Al-Sarireh, R Egan, R Harries, A Henry, M Kittur, Z Li, K Parkins, F Soliman, N Spencer, D Thompson, C Burgess, C Gemmell, C Grieco, M Hollyman, L Hunt, J Morrison, S Ojha, N Ryan, F Abbadessa, S Barnard, C Chan, N Dawe, J Hammond, Ali F Mahmoud, I McPherson, C Mellor, J Moir, S Pandanaboyana, J Powell, B Rai, A Rogers, C Roy, A Sachdeva, C Saleh, S Tingle, T Williams, J Manickavasagam, C McDonald, N McGrath, N McSorley, K Ragupathy, L Ramsay, A Solth, O Kakisi, K Seebah, I Shaikh, L Sreedharan, M Youssef, J Shah, P Ameerally, N McLarty, S Mills, A Shenfine, K Sahnan, J Abu, E Addae-Boateng, D Bratt, L Brock, N Burnside, S Cadwell-Sneath, K Gajjar, C Gan, C Grundy, K Hallam, K Hassell, M Hawari, A Joshi, H Khout, K Konstantinidi, Rxn Lee, D Nunns, R Schiemer, T Walton, H Weaver, L Whisker, K Williamson, J McVeigh, R Myatt, M A Williams, R Kaur, E Leung, S Sundar, M Michel, S Patil, S Ravindran, J Sarveswaran, L Scott, M Edmond, E King, M Almond, A Bhangu, O Breik, L D Cato, A Desai, S Ford, E Griffiths, M Idle, M Kamal, A Kisiel, R Kulkarni, Jkc Mak, T Martin, P Nankivell, A Parente, S Parmar, A M Pathanki, L Phelan, P Praveen, S Saeed, N Sharma, J Singh, F Tirotta, D Vijayan, A Geddes, J McCaul, J McMahon, A H Khan, F Khan, A Mansuri, S Mukherjee, M Patel, M Sarigul, S Singh, K L Tan, A Woodham, A Adiamah, H Brewer, A Chowdhury, J Evans, D Humes, J Jackman, A Koh, C Lewis-Lloyd, O Oyende, J Reilly, D Worku, P Cool, G Cribb, K Shepherd, C Bisset, S Moug, N Elson, G Faulkner, P Saleh, C Underwood, G Brixton, L Findlay, T Klatte, A Majkowska, J Manson, R Potter, A Bhalla, Z Chia, P Daliya, A Goyal, E Grimley, A Hamad, A Kumar, F L Malcolm, E Theophilidou, J Bowden, N Campain, I Daniels, C Evans, G Fowler, J John, L Massey, F McDermott, J McGrath, A McLennan, M Ng, J Pascoe, N Rajaretnam, S Bulathsinhala, B Davidson, G Fusai, C Hidalgo Salinas, N Machairas, T Pissanou, J M Pollok, D A Raptis, F Soggiu, H Tzerbinis, S E Xyda, A Beamish, E Davies, R Foulkes, D Magowan, H Nassa, R Ooi, C Price, L Smith, F Solari, A Tang, G Williams, Y Al-Tamimi, A Bacon, N Beasley, D Chew, M Crank, N Ilenkovan, M Macdonald, B Narice, O Rominiyi, A Thompson, I Varley, T Drake, E Harrison, G Linder, J Mayes, R McGregor, R Skipworth, V Zamvar, E Davies, P Hawkin, T Raymond, O Ryska, R Baron, D Dunne, S Gahunia, C Halloran, N Howes, R McKinney, F McNicol, J Russ, P Szatmary, J R Tan, A Thomas, P Whelan, A Anzak, A Banerjee, O Fuwa, F Hughes, J D Jayasinghe, C Knowles, H Kocher, I Leal Silva, F S Ledesma, A Minicozzi, L Navaratne, R Rahman, R Ramamoorthy, C Sohrabi, M Thaha, B Thakur, M Venn, V Yip, R Baumber, J Parry, S Evans, L Jeys, G Morris, M Parry, J Stevenson, N Ahmadi, G Aresu, Z M Barrett-Brown, A S Coonar, H Durio Yates, D Gearon, J Hogan, M King, A Peryt, I S Pradeep, C Smith, M Adishesh, R Atherton, K Baxter, M Brocklehurst, M Chaudhury, N Krishnamohan, J McAleer, G Owens, E Parkin, P Patkar, I Phang, A Aladeojebi, M Ali, B Barmayehvar, A Gaunt, M Gowda, E Halliday, M Kitchen, F Mansour, M Thomas, D Zakai, N Abbassi-Ghadi, H Assalaarachchi, A Currie, M Flavin, A Frampton, M Hague, C Hammer, J Hopper, J Horsnell, S Humphries, A Kamocka, T K Madhuri, S Preston, P Singh, J Stebbing, A Tailor, D Walker, F Aljanadi, M Jones, P Mhandu, C O'Donnell, R Turkington, Z Al-Ishaq, S Bhasin, A S Bodla, A Burahee, A Crichton, R Fossett, N Pigadas, S Pickford, E Rahman, D Snee, R Vidya, N Yassin, F Colombo, D Fountain, M T Hasan, K Karabatsou, R Laurente, O Pathmanaban, A Al-Mukhtar, S Brown, J Edwards, A Giblin, C Kelty, M Lee, G Lye, T Newman, A Sharkey, C Steele, N Sureshkumar Shah, E Whitehall, R Athwal, A Baker, L Jones, C Konstantinou, S Ramcharan, S Singh, J Vatish, R Wilkin, M Ethunandan, G K Sekhon, H Shields, R Singh, F Wensley, S Lawday, A Lyons, T Abbott, S Anwar, K Ghufoor, C Sohrabi, E Chung, R Hagger, A Hainsworth, A Karim, H Owen, A Ramwell, K Williams, C Baker, A Davies, J Gossage, M Kelly, W Knight, J Hall, G Harris, G James, C Kang, D J Lin, A D Rajgor, T Royle, R Scurrah, B Steel, L J Watson, D Choi, R Hutchison, A Jain, V Luoma, H Marcus, R May, A Menon, B Pramodana, L Webber, I A Aneke, P Asaad, B Brown, J Collis, S Duff, A Khan, F Moura, B Wadham, H Warburton, T Elmoslemany, M Jenkinson, C Millward, R Zakaria, S Mccluney, C Parmar, S Shah, J Allison, M S Babar, B Collard, S Goodrum, K Lau, A Patel, R Scott, E Thomas, H Whitmore, D Balasubramaniam, B Jayasankar, S Kapoor, A Ramachandran, A Elhamshary, Smb Imam, K Kapriniotis, V Kasivisvanathan, J Lindsay, S Rakhshani-Moghadam, N Beech, M Chand, L Green, N Kalavrezos, H Kiconco, R McEwen, C Schilling, D Sinha, J Pereca, J Singh, S Chopra, D Egbeare, R Thomas, T Combellack, Sef Jones, M Kornaszewska, M Mohammed, A Sharma, G Tahhan, V Valtzoglou, J Williams, P Eskander, K Gash, L Gourbault, M Hanna, T Maccabe, C Newton, J Olivier, S Rozwadowski, E Teh, D West, H Al-Omishy, M Baig, H Bates, G Di Taranto, K Dickson, N Dunne, C Gill, D Howe, D Jeevan, A Khajuria, K Martin-Ucar AMcEvoy, P Naredla, V Ng, S Robertson, M Sait, D R Sarma, S Shanbhag, T Shortland, S Simmonds, J Skillman, N Tewari, G Walton, M A Akhtar, A Brunt, J McIntyre, K Milne, M M Rashid, A Sgro, K E Stewart, A Turnbull, M Aguilar Gonzalez, S Talukder, C Boyle, D Fernando, K Gallagher, A Laird, D Tham, M Bath, P Patki, C Sohrabi, C Tanabalan, T Arif, C Magee, T Nambirajan, S Powell, R Vinayagam, I Flindall, A Hanson, V Mahendran, S Green, M Lim, L MacDonald, V Miu, L Onos, K Sheridan, R Young, F Alam, O Griffiths, C Houlden, R Jones, V S Kolli, A K Lala, S Leeson, R Peevor, Z Seymour, L Chen, E Henderson, A Loehrer, K Brown, D Fleming, A Haynes, C Heron, C Hill, H Kay, E Leede, K McElhinney, K Olson, E C Osterberg, C Riley, P Srikanth, M Thornhill, D Blazer, G DiLalla, E S Hwang, W Lee, M Lidsky, J Plichta, L Rosenberger, R Scheri, K Shah, K Turnage, J Visgauss, S Zani, J Farma, J Clark, D Kwon, E Etchill, H E Gabre-Kidan AJenny, A Kent, M Ladd, C Long, H Malapati, A Margalit, S Rapaport, J Rose, K Stevens, L Tsai, D Vervoort, P Yesantharao, A Dehal, D Klaristenfeld, K Huynh, L Brown, I Ganly, J Mullinax, N Gusani, J Hazelton, J Maines, J S Oh, A Ssentongo, P Ssentongo, M Azam, A Choudhry, W Marx, J Fleming, A Fuson, J Gigliotti, A Ovaitt, Y Ying, M K Abel, V Andaya, K Bigay, M A Boeck, L Chen, H Chern, C Corvera, I El-Sayed, A Glencer, P Ha, Bcs Hamilton, C Heaton, K Hirose, D M Jablons, K Kirkwood, L Z Kornblith, J R Kratz, R Lee, P N Miller, E Nakakura, B Nunez-Garcia, R O'Donnell, D Ozgediz, P Park, B Robinson, A Sarin, B Sheu, M Varma, K Wai, R Wustrack, M J Xu, D Beswick, J Goddard, J Manor, J Song, T Fullmer, C Gaskill, N Gross, K Kiong, C L Roland, S N Zafar, M Abdallah, A Abouassi, M Almasri, G Kulkarni, H Marwan, M Mehdi, S Aoun, V S Ban, H H Batjer, J Caruso, D Abbott, A Acher, T Aiken, J Barrett, E Foley, P Schwartz, S N Zafar, A Hawkins, A Maiga, J Laufer, S Scasso

Subjects
Aged, 80 and over, Male, Critical Care, SARS-CoV-2, International Cooperation, COVID-19, Middle Aged, Cohort Studies, Logistic Models, Postoperative Complications, Elective Surgical Procedures, Neoplasms, Outcome Assessment, Health Care, Humans, Female, Epidemics, Aged
Abstract

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

Published
2021

18. NMOSD and MS prevalence in the Indigenous populations of Australia and New Zealand

Author

Bukhari, W., Khalilidehkordi, E., Mason, D.F., Barnett, M.H., Taylor, B.V., Fabis-Pedrini, M., Kermode, A.G., Subramanian, S., Waters, P., Broadley, S.A., Abernethy, D., Bhuta, S., Blum, S., Boggild, M., Boundy, K., Brew, B.J., Brilot, F., Brownlee, W.J., Bundell, C.S., Butzkueven, H., Carroll, W.M., Chen, C., Clarke, L., Coulthard, A., Dale, R.C., Das, C., Dear, K., Fulcher, D., Gillis, D., Hawke, S., Heard, R., Henderson, A.P.D., Heshmat, S., Hodgkinson, S., Jimenez Sanchez, S., Kilpatrick, T.J., King, J., Kneebone, C., Kornberg, A.J., Lechner-Scott, J., Lin, M-W, Lynch, C., Macdonell, R.A.L., Marriott, M.P., McCombe, P.A., O’Gorman, C., Parratt, J.D.E., Pender, M.P., Pereira, J., Pollard, J.D., Prain, K.M., Ramanathan, S., Reddell, S.W., Shaw, C., Silvestrini, R.A., Slee, M., Spies, J., Stankovich, J., Sutton, I., Vincent, A., Vucic, S., Walsh, M., Willoughby, E., Wong, R.C., Woodhall, M., Yiu, E.M., Bukhari, W., Khalilidehkordi, E., Mason, D.F., Barnett, M.H., Taylor, B.V., Fabis-Pedrini, M., Kermode, A.G., Subramanian, S., Waters, P., Broadley, S.A., Abernethy, D., Bhuta, S., Blum, S., Boggild, M., Boundy, K., Brew, B.J., Brilot, F., Brownlee, W.J., Bundell, C.S., Butzkueven, H., Carroll, W.M., Chen, C., Clarke, L., Coulthard, A., Dale, R.C., Das, C., Dear, K., Fulcher, D., Gillis, D., Hawke, S., Heard, R., Henderson, A.P.D., Heshmat, S., Hodgkinson, S., Jimenez Sanchez, S., Kilpatrick, T.J., King, J., Kneebone, C., Kornberg, A.J., Lechner-Scott, J., Lin, M-W, Lynch, C., Macdonell, R.A.L., Marriott, M.P., McCombe, P.A., O’Gorman, C., Parratt, J.D.E., Pender, M.P., Pereira, J., Pollard, J.D., Prain, K.M., Ramanathan, S., Reddell, S.W., Shaw, C., Silvestrini, R.A., Slee, M., Spies, J., Stankovich, J., Sutton, I., Vincent, A., Vucic, S., Walsh, M., Willoughby, E., Wong, R.C., Woodhall, M., and Yiu, E.M.

Abstract

Background We studied the prevalence of neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in Indigenous populations of Australia and New Zealand with the aim of assessing potential differences. Methods Cases of possible NMOSD and MS were collected from Australia and New Zealand. Clinical details, MR imaging, and serologic results were used to apply 2015 IPND diagnostic criteria for NMOSD and 2010 McDonald criteria for MS. Frequencies of self-determined ethnic ancestry were calculated for confirmed NMOSD, suspected NMOSD, and MS. Prevalence rates for NMOSD and MS according to ancestry were compared. Results There were 75 cases with NMOSD, 89 with suspected NMSOD, and 101 with MS. NMOSD cases were more likely to have Asian, Indigenous, or Other ancestry compared to suspected NMOSD or MS. There were no differences in the clinical phenotype of NMOSD seen in Indigenous compared to European ancestry populations. Per 100,000, the prevalence estimate for NMOSD in people with Māori ancestry was 1.50 (95% CI 0.52–2.49) which was similar to those with Asian ancestry 1.57 (95% CI 1.15–1.98). NMOSD prevalence in Australian Aboriginal and Torres Strait Islander populations was 0.38 (95% CI 0.00–0.80) per 100,000. Conclusion The prevalence of NMOSD in the Māori population is similar to South East Asian countries, reflecting their historical origins. The prevalence of MS in this group is intermediate between those with South East Asian and European ancestry living in New Zealand. Both NMOSD and particularly MS appear to be uncommon in the Indigenous populations of Australia.

Published
2021

19. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis

Author

Clarke, L, Arnett, S, Bukhari, W, Khalilidehkordi, E, Jimenez Sanchez, S, O'Gorman, C, Sun, J, Prain, KM, Woodhall, M, Silvestrini, R, Bundell, CS, Abernethy, DA, Bhuta, S, Blum, S, Boggild, M, Boundy, K, Brew, BJ, Brownlee, W, Butzkueven, H, Carroll, WM, Chen, C, Coulthard, A, Dale, RC, Das, C, Fabis-Pedrini, MJ, Gillis, D, Hawke, S, Heard, R, Henderson, APD, Heshmat, S, Hodgkinson, S, Kilpatrick, TJ, King, J, Kneebone, C, Kornberg, AJ, Lechner-Scott, J, Lin, MW, Lynch, C, Macdonell, RAL, Mason, DF, McCombe, PA, Pereira, J, Pollard, JD, Ramanathan, S, Reddel, SW, Shaw, Cameron, Spies, JM, Stankovich, J, Sutton, I, Vucic, S, Walsh, M, Wong, RC, Yiu, EM, Barnett, MH, Kermode, AGK, Marriott, MP, Parratt, JDE, Slee, M, Taylor, BV, Willoughby, E, Brilot, F, Vincent, A, Waters, P, Broadley, SA, Clarke, L, Arnett, S, Bukhari, W, Khalilidehkordi, E, Jimenez Sanchez, S, O'Gorman, C, Sun, J, Prain, KM, Woodhall, M, Silvestrini, R, Bundell, CS, Abernethy, DA, Bhuta, S, Blum, S, Boggild, M, Boundy, K, Brew, BJ, Brownlee, W, Butzkueven, H, Carroll, WM, Chen, C, Coulthard, A, Dale, RC, Das, C, Fabis-Pedrini, MJ, Gillis, D, Hawke, S, Heard, R, Henderson, APD, Heshmat, S, Hodgkinson, S, Kilpatrick, TJ, King, J, Kneebone, C, Kornberg, AJ, Lechner-Scott, J, Lin, MW, Lynch, C, Macdonell, RAL, Mason, DF, McCombe, PA, Pereira, J, Pollard, JD, Ramanathan, S, Reddel, SW, Shaw, Cameron, Spies, JM, Stankovich, J, Sutton, I, Vucic, S, Walsh, M, Wong, RC, Yiu, EM, Barnett, MH, Kermode, AGK, Marriott, MP, Parratt, JDE, Slee, M, Taylor, BV, Willoughby, E, Brilot, F, Vincent, A, Waters, P, and Broadley, SA

Abstract

Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), “bright spotty” (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS

Published
2021

21. Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation

Author

Khalilidehkordi, E, Clarke, L, Arnett, S, Bukhari, W, Jimenez Sanchez, S, O'Gorman, C, Sun, J, Prain, KM, Woodhall, M, Silvestrini, R, Bundell, CS, Abernethy, D, Bhuta, S, Blum, S, Boggild, M, Boundy, K, Brew, BJ, Brown, M, Brownlee, W, Butzkueven, H, Carroll, WM, Chen, C, Coulthard, A, Dale, RC, Das, C, Fabis-Pedrini, MJ, Fulcher, D, Gillis, D, Hawke, S, Heard, R, Henderson, APD, Heshmat, S, Hodgkinson, S, Kilpatrick, TJ, King, J, Kneebone, C, Kornberg, AJ, Lechner-Scott, J, Lin, MW, Lynch, C, Macdonell, RAL, Mason, DF, McCombe, PA, Pereira, J, Pollard, JD, Ramanathan, S, Reddel, SW, Shaw, C, Spies, J, Stankovich, J, Sutton, I, Vucic, S, Walsh, M, Wong, RC, Yiu, EM, Barnett, MH, Kermode, AG, Marriott, MP, Parratt, J, Slee, M, Taylor, BV, Willoughby, E, Brilot, F, Vincent, A, Waters, P, Broadley, SA, Khalilidehkordi, E, Clarke, L, Arnett, S, Bukhari, W, Jimenez Sanchez, S, O'Gorman, C, Sun, J, Prain, KM, Woodhall, M, Silvestrini, R, Bundell, CS, Abernethy, D, Bhuta, S, Blum, S, Boggild, M, Boundy, K, Brew, BJ, Brown, M, Brownlee, W, Butzkueven, H, Carroll, WM, Chen, C, Coulthard, A, Dale, RC, Das, C, Fabis-Pedrini, MJ, Fulcher, D, Gillis, D, Hawke, S, Heard, R, Henderson, APD, Heshmat, S, Hodgkinson, S, Kilpatrick, TJ, King, J, Kneebone, C, Kornberg, AJ, Lechner-Scott, J, Lin, MW, Lynch, C, Macdonell, RAL, Mason, DF, McCombe, PA, Pereira, J, Pollard, JD, Ramanathan, S, Reddel, SW, Shaw, C, Spies, J, Stankovich, J, Sutton, I, Vucic, S, Walsh, M, Wong, RC, Yiu, EM, Barnett, MH, Kermode, AG, Marriott, MP, Parratt, J, Slee, M, Taylor, BV, Willoughby, E, Brilot, F, Vincent, A, Waters, P, and Broadley, SA

Abstract

Neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) show overlap in their clinical features. We performed an analysis of relapses with the aim of determining differences between the two conditions. Cases of NMOSD and age- and sex-matched MS controls were collected from across Australia and New Zealand. Demographic and clinical information, including relapse histories, were recorded using a standard questionnaire. There were 75 cases of NMOSD and 101 MS controls. There were 328 relapses in the NMOSD cases and 375 in MS controls. Spinal cord and optic neuritis attacks were the most common relapses in both NMOSD and MS. Optic neuritis (p < 0.001) and area postrema relapses (P = 0.002) were more common in NMOSD and other brainstem attacks were more common in MS (p < 0.001). Prior to age 30 years, attacks of optic neuritis were more common in NMOSD than transverse myelitis. After 30 this pattern was reversed. Relapses in NMOSD were more likely to be treated with acute immunotherapies and were less likely to recover completely. Analysis by month of relapse in NMOSD showed a trend toward reduced risk of relapse in February to April compared to a peak in November to January (P = 0.065). Optic neuritis and transverse myelitis are the most common types of relapse in NMOSD and MS. Optic neuritis tends to occur more frequently in NMOSD prior to the age of 30, with transverse myelitis being more common thereafter. Relapses in NMOSD were more severe. A seasonal bias for relapses in spring-summer may exist in NMOSD.

Published
2020

22. Cycling exposure and infrastructural correlates in a Flemish adolescent population

Author

UCL - SSH/IACS - Institute of Analysis of Change in Contemporary and Historical Societies, Vanparijs, J., Van Cauwenberg, J., Int Panis, L., Van Hecke, E., Gillis, D., Gautama, S., Meeusen, R., de Geus, Sebastiaan, UCL - SSH/IACS - Institute of Analysis of Change in Contemporary and Historical Societies, Vanparijs, J., Van Cauwenberg, J., Int Panis, L., Van Hecke, E., Gillis, D., Gautama, S., Meeusen, R., and de Geus, Sebastiaan

Published
2020

23. Menthol as an ergogenic aid for the Tokyo 2021 Olympic Games:An expert-led Consensus Statement using the Modified Delphi Method

Author

Barwood, M J, Gibson, O R, Gillis, D J, Jeffries, O, Morris, Nathan Bradley, Pearce, J, Ross, M L, Stevens, C, Rinaldi, K, Kounalakis, S N, Riera, F, Mündel, T, Waldron, M, Best, R, Barwood, M J, Gibson, O R, Gillis, D J, Jeffries, O, Morris, Nathan Bradley, Pearce, J, Ross, M L, Stevens, C, Rinaldi, K, Kounalakis, S N, Riera, F, Mündel, T, Waldron, M, and Best, R

Abstract

Introduction: Menthol topical application and mouth rinsing are ergogenic in hot environments, improving performance and perception, with differing effects on body temperature regulation. Consequently, athletes and federations are beginning to explore the possible benefits to elite sport performance for the Tokyo 2021 Olympics, which will take place in hot (~ 31 °C), humid (70% RH) conditions. There is no clear consensus on safe and effective menthol use for athletes, practitioners, or researchers. The present study addressed this shortfall by producing expert-led consensus recommendations. Method: Fourteen contributors were recruited following ethical approval. A three-step modified Delphi method was used for voting on 96 statements generated following literature consultation; 192 statements total (96/96 topical application/mouth rinsing). Round 1 contributors voted to “agree” or “disagree” with statements; 80% agreement was required to accept statements. In round 2, contributors voted to “support” or “change” their round 1 unaccepted statements, with knowledge of the extant voting from round 1. Round 3 contributors met to discuss voting against key remaining statements. Results: Forty-seven statements reached consensus in round 1 (30/17 topical application/rinsing); 14 proved redundant. Six statements reached consensus in round 2 (2/4 topical application/rinsing); 116 statements proved redundant. Nine further statements were agreed in round 3 (6/3 topical application/rinsing) with caveats. Discussion: Consensus was reached on 62 statements in total (38/24 topical application/rinsing), enabling the development of guidance on safe menthol administration, with a view to enhancing performance and perception in the heat without impairing body temperature regulation.

Published
2020

25. Load/unload systems with multiple flying height states

Author

Suk, M., Ruiz, O., and Gillis, D.

Subjects
Tribology -- Research, Science and technology
Abstract

In hard disk drives that utilize load/unload technology, the slider loads onto the disk from hundreds of microns away before the slider settles into the designed flying height. Due to the forces acting on the slider after the transition from the unloaded state to the fully loaded state, the resulting flying height of the slider may be about two orders of magnitude higher than the intended nominal flying height. Under certain circumstances, the slider may never reach the nominal flying height required for proper operation of the magnetic recording process. In this paper, the existence of multiple flying heights is demonstrated and verified both by experimentation and simulation. The effect of some of the critical parameters is also identified by both methods. We show that necessary care must be taken to avoid unwanted loading sequences where the system may be unable to store or retrieve data. [DOI: 10.1115/1.1576426]

Published
2004

30. Apollo Medical Operations Project: Recommendations for EVA and Lunar Surface Operations

Author

Scheuring, R. A, Davis, J. R, Duncan, J. M, Polk, J. D, Jones, J. A, Gillis, D. B, and Novak, J

Subjects
Aerospace Medicine, Man/System Technology And Life Support
Abstract

The potential risk of injury to crewmembers is inherent in aggressive surface activities, whether they be Moon-, Mars-, or asteroid-based. In December 2005, the Space Medicine Division at JSC requested a study to identify Apollo mission issues that had an impact to crew health or performance or both. This talk focused on the Apollo EVA suit and lunar surface operations concerning crew health and performance. There were roughly 20 recommendations from this study of Apollo for improving these two areas for future exploration missions, a few of which were incorporated into the Human Systems Integration Requirements (HSIR). Dr. Richard Scheuring covered these topics along with some of the analog work that has been done regarding surface operations and medical contingencies.

Published
2013

38. A Method for Determining the Nominal Occular Hazard Zone for Gaussian Beam Laser Rangers with a Firmware Controlled Variable Focal Length

Author

Picco, C. E, Shavers, M. R, Victor, J. M, Duron, J. L, Bowers, W. h, Gillis, D. B, and VanBaalen, M

Subjects
Communications And Radar
Abstract

LIDAR systems that maintain a constant beam spot size on a retroreflector in order to increase the accuracy of bearing and ranging data must use a software controlled variable position lens. These systems periodically update the estimated range and set the position of the focusing lens accordingly. In order to precisely calculate the r NOHD for such a system, the software method for setting the variable position lens and gaussian laser propagation can be used to calculate the irradiance at any point given the range estimation. NASA s Space Shuttle LIDAR, called the Trajectory Control Sensor (TCS), uses this configuration. Analytical tools were developed using Excel and VBA to determine the radiant energy to the International Space Station (ISS) crewmembers eyes while viewing the shuttle on approach and departure. Various viewing scenarios are considered including the use of through-the-lens imaging optics and the window transmissivity at the TCS wavelength. The methodology incorporates the TCS system control logic, gaussian laser propagation, potential failure mode end states, and guidance from American National Standard for the Safe Use of Lasers (ANSI Z136.1-2007). This approach can be adapted for laser safety analyses of similar LIDAR systems.

Published
2009

40. Effect of slider burnish on disk damage during dynamic load/unload

Author

Suk, M. and Gillis, D.

Subjects
Disk drives -- Research, Load factor design -- Analysis, Surfaces (Technology) -- Research, Science and technology
Abstract

Two of the most difficult issues to resolve in current design of head/disk interface in magnetic recording devices are stiction and durability problems. One method of overcoming these problems is by implementing a technology known as load/unload, where the system is designed so that the slider never touches the disk surface. One potential problem with this type of system is slider/disk contact induced disk defects. The objective of this paper is to show that the likelihood of disk scratches caused by head/disk contacts during the load/unload process can be significantly decreased by rounding the edges of the air-bearing surface. Using the resistance method, we observe that head/disk contacts burnish the corners of the slider and thereby decrease exponentially with load/unload cycles. A well burnished slider rarely causes any disk damage thus resulting in an interface with significantly higher reliability. A simple Hertzian contact stress analysis indicates that the contact stress at the head/disk interface can be greatly decreased by increasing the radius of curvature of the air-bearing surface edges.

Published
1998

43. Recommendations for Exploration Space Medicine from the Apollo Medical Operations Project

Author

Scheuring, R. a, Davis, J. R, Duncan, J. M, Polk, J. D, Jones, J. A, and Gillis, D. B

Subjects
Lunar And Planetary Science And Exploration
Abstract

Introduction: A study was requested in December, 2005 by the Space Medicine Division at the NASA-Johnson Space Center (JSC) to identify Apollo mission issues relevant to medical operations that had impact to crew health and/or performance. The objective was to use this new information to develop medical requirements for the future Crew Exploration Vehicle (CEV), Lunar Surface Access Module (LSAM), Lunar Habitat, and Advanced Extravehicular Activity (EVA) suits that are currently being developed within the exploration architecture. Methods: Available resources pertaining to medical operations on the Apollo 7 through 17 missions were reviewed. Ten categories of hardware, systems, or crew factors were identified in the background research, generating 655 data records in a database. A review of the records resulted in 280 questions that were then posed to surviving Apollo crewmembers by mail, face-to-face meetings, or online interaction. Response analysis to these questions formed the basis of recommendations to items in each of the categories. Results: Thirteen of 22 surviving Apollo astronauts (59%) participated in the project. Approximately 236 pages of responses to the questions were captured, resulting in 107 recommendations offered for medical consideration in the design of future vehicles and EVA suits based on the Apollo experience. Discussion: The goals of this project included: 1) Develop or modify medical requirements for new vehicles; 2) create a centralized database for future access; and 3) take this new knowledge and educate the various directorates at NASA-JSC who are participating in the exploration effort. To date, the Apollo Medical Operations recommendations are being incorporated into the exploration mission architecture at various levels and a centralized database has been developed. The Apollo crewmembers input has proved to be an invaluable resource, prompting ongoing collaboration as the requirements for the future exploration missions continue to evolve and be refined.

Published
2007

44. Biomedical Support of U.S. Extravehicular Activity

Author

Gernhardt, Michael L, Dervay, J. P, Gillis, D, McMann, H. J, and Thomas, K. S

Subjects
Man/System Technology And Life Support
Abstract

The world's first extravehicular activity (EVA) was performed by A. A. Leonov on March 18, 1965 during the Russian Voskhod-2 mission. The first US EVA was executed by Gemini IV astronaut Ed White on June 3, 1965, with an umbilical tether that included communications and an oxygen supply. A hand-held maneuvering unit (HHMU) also was used to test maneuverability during the brief EVA; however the somewhat stiff umbilical limited controlled movement. That constraint, plus difficulty returning through the vehicle hatch, highlighted the need for increased thermal control and improved EVA ergonomics. Clearly, requirements for a useful EVA were interrelated with the vehicle design. The early Gemini EVAs generated requirements for suits providing micro-meteor protection, adequate visual field and eye protection from solar visual and infrared radiation, gloves optimized for dexterity while pressurized, and thermal systems capable of protecting the astronaut while rejecting metabolic heat during high workloads. Subsequent Gemini EVAs built upon this early experience and included development of a portable environmental control and life support systems (ECLSS) and an astronaut maneuvering unit. The ECLSS provided a pressure vessel and controller with functional control over suit pressure, oxygen flow, carbon dioxide removal, humidity, and temperature control. Gemini EVA experience also identified the usefulness of underwater neutral buoyancy and altitude chamber task training, and the importance of developing reliable task timelines. Improved thermal management and carbon dioxide control also were required for high workload tasks. With the Apollo project, EVA activity was primarily on the lunar surface; and suit durability, integrated liquid cooling garments, and low suit operating pressures (3.75 pounds per square inch absolute [psia] or 25.8 kilopascal [kPa],) were required to facilitate longer EVAs with ambulation and significant physical workloads with average metabolic rates of 1000 BTU/hr and peaks of up to 2200 BTU/hr. Mobility was further augmented with the Lunar Roving Vehicle. The Apollo extravehicular mobility unit (EMU) was made up of over 15 components, ranging from a biomedical belt for capturing and transmitting biomedical data, urine and fecal containment systems, a liquid cooling garment, communications cap, a modular portable life support system (PLSS), a boot system, thermal overgloves, and a bubble helmet with eye protection. Apollo lunar astronauts performed successful EVAs on the lunar surface from a 5 psia (34.4 kPa) 100% oxygen environment in the Lunar Lander. A maximum of three EVAs were performed on any mission. For Skylab a modified A7LB suit, used for Apollo 15, was selected. The Skylab astronaut life support assembly (ALSA) provided umbilical support through the life support umbilical (LSU) and used open loop oxygen flow, rather than closed-loop as in Apollo missions. Thermal control was provided by liquid water circulated by spacecraft pumps and electrical power also was provided from the spacecraft via the umbilical. The cabin atmosphere of 5 psia (34.4 kPa), 70% oxygen, provided a normoxic atmosphere and because of the very low nitrogen partial pressures, no special protocols were required to protect against decompression sickness (DCS) as was the case with the Apollo spacecraft with a 5 psi, 100% oxygen environment.

Published
2007

47. A WOUND CARE AND INTRAVENOUS ACCESS SUMMIT FOR ON-ORBIT CARE

Author

Scheuring, R, Paul, B, Gillis, D, Bacal, K, McCulley, P, Polk, J, and Johnson-Throop, K

Subjects
Aerospace Medicine
Abstract

Wound care issues and the ability to establish intravenous (IV) access among injured or ill crew members are a source of concern for NASA flight surgeons. Indeed, the microgravity environment and the remote nature of the International Space Station (ISS) pose unique challenges in diagnosing and treating an injured astronaut. Therefore, it is necessary to identify and adapt the best evidence based terrestrial practices regarding wound care, hemostasis, and IV access for use on the ISS. Methods: A panel of consultants was convened to evaluate the adequacy of the current ISS in-flight medical system for diagnosis and treatment of wounds and establishing IV access by a nonclinician crew medical officer. Participants were acknowledged experts in terrestrial wound care and/or operational medicine. Prior to the meeting, each panelist was encouraged to participate in a pre-summit online forum. Results: Eight external experts participated in a face-to-face meeting held at NASA-Johnson Space Center. Recommendations were made to augment the space station pharmacopoeia, as well as current wound care diagnostic, therapeutic, and deorbit criteria protocols. Additionally, suggestions were offered regarding IV access techniques and devices for use in the microgravity environment. Discussion: The results of the expert panel provide an evidence-based approach to the diagnosis and care of wounds in an injured astronaut on aboard the ISS. The results of the panel underscored the need for further research in wound therapy and IV access devices.

Published
2005

48. Space Shuttle Hot Cabin Emergency Responses

Author

Stepaniak, P, Effenhauser, R. K, McCluskey, R, Gillis, D. B, Hamilton, D, and Kuznetz, L. H

Subjects
Space Transportation And Safety
Abstract

Methods: Human thermal tolerance, countermeasures, and thermal model data were reviewed and compared to existing shuttle ECS failure temperature and humidity profiles for each failure mode. Increases in core temperature associated with cognitive impairment was identified, as was metabolic heat generation of crewmembers, temperature monitoring, and communication capabilities after partial power-down and other limiting factors. Orbiter landing strategies and a hydration and salt replacement protocol were developed to put wheels on deck in each failure mode prior to development of significant cognitive impairment or collapse of crewmembers. Thermal tradeoffs for use of the Advanced Crew Escape Suit (ACES), Liquid Cooling Garment, integrated G-suit and Quick Don Mask were examined. candidate solutions involved trade-offs or conflicts with cabin oxygen partial pressure limits, system power-downs to limit heat generation, risks of alternate and emergency landing sites or compromise of Mode V-VIII scenarios. Results: Rehydration and minimized cabin workloads are required in all failure modes. Temperature/humidity profiles increase rapidly in two failure modes, and deorbit is recommended without the ACES, ICU and g-suit. This latter configuration limits several shuttle approach and landing escape modes and requires communication modifications. Additional data requirements were identified and engineering simulations were recommended to develop more current shuttle temperature and humidity profiles. Discussion: After failure of the shuttle ECS, there is insufficient cooling capacity of the ACES to protect crewmembers from rising cabin temperature and humidity. The LCG is inadequate for cabin temperatures above 76 F. Current shuttle future life policy makes it unlikely that major engineering upgrades necessary to address this problem will occur.

Published
2005

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