88 results on '"Tanner, RJ"'
Search Results
2. T5 Oral dietary nitrate supplementation to enhance pulmonary rehabilitation in chronic obstructive pulmonary disease: a multi-centre, double blind, placebo-controlled, parallel group study
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Pavitt, MJ, primary, Tanner, RJ, additional, Lewis, AP, additional, Buttery, SC, additional, Mehta, B, additional, Jefford, H, additional, Curtis, KJ, additional, Banya, W, additional, Husain, S, additional, Satkunam, K, additional, Shrikrishna, D, additional, D-C Man, W, additional, Polkey, MI, additional, and Hopkinson, NS, additional
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- 2018
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3. A Randomized Controlled Trial of Angiotensin-Converting Enzyme Inhibition for Skeletal Muscle Dysfunction in COPD
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Shrikrishna, D, Tanner, RJ, Lee, JY, Natanek, A, Lewis, A, Murphy, PB, Hart, N, Moxham, J, Montgomery, HE, Kemp, PR, Polkey, MI, and Hopkinson, NS
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Male ,Pulmonary and Respiratory Medicine ,Muscle Weakness ,Blood Pressure ,Angiotensin-Converting Enzyme Inhibitors ,Middle Aged ,Critical Care and Intensive Care Medicine ,Quadriceps Muscle ,Pulmonary Disease, Chronic Obstructive ,Double-Blind Method ,Physical Endurance ,COPD ,Humans ,Female ,Fosinopril ,Cardiology and Cardiovascular Medicine ,Exercise ,Aged ,Original Research - Abstract
BACKGROUND: Skeletal muscle impairment is a recognized complication of COPD, predicting mortality in severe disease. Increasing evidence implicates the renin-angiotensin system in control of muscle phenotype. We hypothesized that angiotensin-converting enzyme (ACE) inhibition would improve quadriceps function and exercise performance in COPD. METHODS: This double-blind, randomized placebo-controlled trial investigated the effect of the ACE inhibitor, fosinopril, on quadriceps function in patients with COPD with quadriceps weakness. Primary outcomes were change in quadriceps endurance and atrophy signaling at 3 months. Quadriceps maximum voluntary contraction (QMVC), mid-thigh CT scan of the cross-sectional area (MTCSA), and incremental shuttle walk distance (ISWD) were secondary outcomes. RESULTS: Eighty patients were enrolled (mean [SD], 65 [8] years, FEV1 43% [21%] predicted, 53% men). Sixty-seven patients (31 fosinopril, 36 placebo) completed the trial. The treatment group demonstrated a significant reduction in systolic BP (Δ−10.5 mm Hg; 95% CI, −19.9 to −1.1; P = .03) and serum ACE activity (Δ−20.4 IU/L; 95% CI, −31.0 to −9.8; P < .001) compared with placebo. No significant between-group differences were observed in the primary end points of quadriceps endurance half-time (Δ0.5 s; 95% CI, −13.3-14.3; P = .94) or atrogin-1 messenger RNA expression (Δ−0.03 arbitrary units; 95% CI, −0.32-0.26; P = .84). QMVC improved in both groups (fosinopril: Δ1.1 kg; 95% CI, 0.03-2.2; P = .045 vs placebo: Δ3.6 kg; 95% CI, 2.1-5.0; P < .0001) with a greater increase in the placebo arm (between-group, P = .009). No change was shown in the MTCSA (P = .09) or ISWD (P = .51). CONCLUSIONS: This randomized controlled trial found that ACE inhibition, using fosinopril for 3 months, did not improve quadriceps function or exercise performance in patients with COPD with quadriceps weakness. TRIAL REGISTRY: Current Controlled Trials; No.: ISRCTN05581879; URL: www.controlled-trials.com
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- 2014
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4. S52 MiR-181 increases in the quadriceps muscle of COPD patients after an acute bout of exercise: Abstract S52 Table 1.
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Donaldson, AVJ, primary, Tanner, RJ, additional, Davey, CA, additional, Hopkinson, N, additional, Man, W D-C, additional, Kemp, PR, additional, and Polkey, MI, additional
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- 2013
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5. P42 Does pulmonary rehabilitation improve exercise capacity and HRQoL in patients with asthma?: Abstract P42 Table 1.
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Tanner, RJ, primary, Boutou, AK, additional, Raste, Y, additional, Lord, VM, additional, Grillo, LJ, additional, Menzies-gow, A, additional, Hull, J, additional, and NS, Hopkinson, additional
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- 2013
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6. S48 The Effect of Angiotensin-Converting Enzyme Inhibition on Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: A Randomised Controlled Trial
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Shrikrishna, D, primary, Tanner, RJ, additional, Lee, JY, additional, Natanek, SA, additional, Lewis, A, additional, Murphy, PB, additional, Hart, N, additional, Moxham, J, additional, Montgomery, H, additional, Kemp, PR, additional, Polkey, MI, additional, and Hopkinson, NS, additional
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- 2012
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7. P78 Physical Inactivity is Associated with Mid-Thigh Intramuscular Fat in Patients with COPD
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Maddocks, M, primary, Shrikrishna, D, additional, Vitoriano, S, additional, Tanner, RJ, additional, Natanek, SA, additional, Hart, N, additional, Kemp, PR, additional, Moxham, J, additional, Polkey, MI, additional, and Hopkinson, NS, additional
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- 2012
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8. Exposure to N,N-Diethyl-Meta-Toluamide Insect Repellent and Human Health Markers: Population Based Estimates from the National Health and Nutrition Examination Survey.
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Haleem ZM, Yadav S, Cushion ML, Tanner RJ, Carek PJ, and Mainous AG
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- Adult, Aged, Biomarkers, DEET metabolism, Female, Humans, Insect Repellents metabolism, Male, Middle Aged, Nutrition Surveys, United States, Alanine Transaminase blood, Aspartate Aminotransferases blood, C-Reactive Protein metabolism, DEET blood, Glomerular Filtration Rate, Insect Repellents blood, Lymphocyte Count, gamma-Glutamyltransferase blood
- Abstract
N,N-diethyl-meta-toluamide (DEET) is one of the most commonly used insect repellants in the United States, yet the existing literature regarding DEET's potential deleterious impact on humans is mixed and is based mostly on case reports. The primary aim of this study was to address this lack of population-based evidence of the effects of DEET exposure on human health in the United States. Our primary outcome measures were biomarkers related to systemic inflammation (high sensitivity C-reactive protein), immune function (lymphocyte), liver function (aspartate aminotransferase, alanine aminotransferase, and γ-glutamyl transferace), and kidney function (estimated glomerular filtration rate). We analyzed data from the population-based National Health and Nutrition Examination Survey, 2015-2016, and identified 1,205 patients (age 20+ years) who had DEET metabolite levels recorded at or above detection limits. A Pearson correlation was used to assess the relationship between DEET metabolite, and each biomarker found there was no significant correlation. Thus, there is no evidence that DEET exposure has any impact on the biomarkers identified.
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- 2020
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9. Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC a multicentre, double-blind, placebo-controlled, randomised parallel group study.
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Pavitt MJ, Tanner RJ, Lewis A, Buttery S, Mehta B, Jefford H, Curtis KJ, Banya WAS, Husain S, Satkunam K, Shrikrishna D, Man W, Polkey MI, and Hopkinson NS
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- Administration, Oral, Aged, Dose-Response Relationship, Drug, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Disease, Chronic Obstructive physiopathology, Treatment Outcome, Dietary Supplements, Exercise physiology, Exercise Therapy methods, Nitrates administration & dosage, Pulmonary Disease, Chronic Obstructive rehabilitation, Quality of Life
- Abstract
Rationale: Dietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with COPD. We aimed to assess whether it could enhance the effect of pulmonary rehabilitation (PR) in COPD., Methods: This double-blind, placebo-controlled, parallel group, randomised controlled study performed at four UK centres, enrolled adults with Global Initiative for Chronic Obstructive Lung Disease grade II-IV COPD and Medical Research Council dyspnoea score 3-5 or functional limitation to undertake a twice weekly 8-week PR programme. They were randomly assigned (1:1) to either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate), or placebo nitrate-deplete BRJ, consumed 3 hours prior to undertaking each PR session. Allocation used computer-generated block randomisation., Measurements: The primary outcome was change in incremental shuttle walk test (ISWT) distance. Secondary outcomes included quality of life, physical activity level, endothelial function via flow-mediated dilatation, fat-free mass index and blood pressure parameters., Results: 165 participants were recruited, 78 randomised to nitrate-rich BRJ and 87 randomised to placebo. Exercise capacity increased more with active treatment (n=57) than placebo (n=65); median (IQR) change in ISWT distance +60 m (10, 85) vs +30 m (0, 70), estimated treatment effect 30 m (95% CI 10 to 40); p=0.027. Active treatment also impacted on systolic blood pressure: treatment group -5.0 mm Hg (-5.0, -3.0) versus control +6.0 mm Hg (-1.0, 15.5), estimated treatment effect -7 mm Hg (95% CI 7 to -20) (p<0.0005). No significant serious adverse events or side effects were reported., Conclusions: Dietary nitrate supplementation appears to be a well-tolerated and effective strategy to augment the benefits of PR in COPD., Trial Registration Number: ISRCTN27860457., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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10. A Practical Risk Measure for Identification of Adults With Oncogenic Oral Human Papillomavirus: Potential Use in Primary Care.
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Mainous AG, Hong YR, Yadav S, Xie Z, and Tanner RJ
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- Adult, Female, Humans, Male, Middle Aged, Nutrition Surveys, Oropharyngeal Neoplasms etiology, Oropharyngeal Neoplasms virology, Sexual Behavior, Sexual Partners, United States, Alphapapillomavirus isolation & purification, Oropharyngeal Neoplasms diagnosis, Papillomavirus Infections diagnosis, Primary Health Care, Risk Assessment
- Abstract
Background and Objectives: Oral human papillomavirus (HPV) infection is the main cause of oropharyngeal cancer. However, there is no assessment tool for early detection and prevention of oropharyngeal cancer in practice. The purpose of the study was to develop and validate a risk assessment tool to predict the presence of HPV associated with oropharyngeal cancer., Methods: Using data from the National Health and Nutrition Examination Survey 2011-2014, 6,978 US adults aged 18 to 59 years who were tested for oral HPV infection were included for this study. We carried out an analysis to test and validate risk predictive models for oral HPV infection. Presence of one of the 20 HPV subtypes associated with oropharyngeal cancer was used for the outcome., Results: Of 6,978 participants aged 18-59, 303 (4.3%; 6.6 million) were found to have oncogenic HPV subtypes. Our final model included sex, income-to-poverty ratio, current smoking, and the lifetime number of oral sex partners. The discriminatory power of the oral HPV risk score to predict the presence of oncogenic HPV was good (C-statistic=0.73). The risk score performed comparably in the validation population (C-statistic=0.72). The comparison between observed and estimated proportions of population with oncogenic oral HPV demonstrated excellent calibration., Conclusions: We developed and validated the oral HPV risk score that predicts the risk of oral HPV requiring only self-reported data and no laboratory testing. The Oral HPV risk score has the potential to provide clinicians with a no-cost, easy way to screen for patients at greater risk for oncogenic HPV infection.
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- 2020
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11. Shared Care for Adults with Sickle Cell Disease: An Analysis of Care from Eight Health Systems.
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Mainous AG 3rd, Rooks B, Tanner RJ, Carek PJ, Black V, and Coates TD
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Adult sickle cell disease (SCD) patients frequently transition from pediatric hematology to adult primary care. We examined healthcare utilization for adult patients with SCD with shared care between hematologists and primary care providers (PCP). We analyzed the OneFlorida Data Trust, a centralized data repository of electronic medical record (EMR) data from eight different health systems in Florida. The number of included adults with SCD was 1147. We examined frequent hospitalizations and emergency department (ED) visits by whether the patient had shared care or single specialty care alone. Most patients were seen by a PCP only (30.4%), followed by both PCP and hematologist (27.5%), neither PCP nor hematologist (23.3%), and hematologist only (18.7%). For patients with shared care versus single specialist care other than hematologist, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.63; 95% CI 0.43-0.90). Similarly, when compared to care from a hematologist only, the shared care group had a lower likelihood of frequent hospitalizations (OR 0.67; 95% CI 0.47-0.95). There was no significant relationship between shared care and ED use. When patients with SCD have both a PCP and hematologist involved in their care there is a benefit in decreased hospitalizations.
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- 2019
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12. Measurements and Monte Carlo Simulations of 241Am Activities in Three Skull Phantoms: EURADOS-USTUR Collaboration.
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López MA, Nogueira P, Vrba T, Tanner RJ, Rühm W, and Tolmachev SY
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- Adult, Algorithms, Europe, Female, Humans, North America, Americium analysis, Monte Carlo Method, Phantoms, Imaging, Skull radiation effects
- Abstract
An international intercomparison was organized by Working Group 7, Internal Dosimetry, of the European Radiation Dosimetry Group in collaboration with Working Group 6, Computational Dosimetry, for measurement and Monte Carlo simulation of Am in three skull phantoms. The main objectives of this combined exercise were (1) comparison of the results of counting efficiency in fixed positions over each head phantom using different germanium detector systems, (2) calculation of the activity of Am in the skulls, (3) comparison of Monte Carlo simulations with measurements (spectrum and counting efficiency), and (4) comparison of phantom performance. This initiative collected knowledge on equipment, detector arrangements, calibration procedures, and phantoms used around the world for in vivo monitoring of Am in exposed persons, as well as on the Monte Carlo skills and tools of participants. Three skull phantoms (BfS, USTUR, and CSR phantoms) were transported from Europe (10 laboratories) to North America (United States and Canada). The BfS skull was fabricated with real human bone artificially labeled with Am. The USTUR skull phantom was made from the US Transuranium and Uranium Registries whole-body donor (case 0102) who was contaminated due to an occupational intake of Am; one-half of the skull corresponds to real contaminated bone, the other half is real human bone from a noncontaminated person. Finally, the CSR phantom was fabricated as a simple hemisphere of equivalent bone and tissue material. The three phantoms differ in weight, size, and shape, which made them suitable for an efficiency study. Based on their own skull calibration, the participants calculated the activity in the three European Radiation Dosimetry Group head phantoms. The Monte Carlo intercomparison was organized in parallel with the measurement exercise using the voxel representations of the three physical phantoms; there were 16 participants. Three tasks were identified with increasing difficulty: (1) Monte Carlo simulation of the simple CSR hemisphere and the Helmholz Zentrum München high-purity germanium detector for calculating the counting efficiency for the 59.54 keV photons of Am, in established measurement geometry; (2) Monte Carlo simulation of particular measurement geometries using the BfS and USTUR voxel phantoms and the Helmholz Zentrum München high-purity germanium detector detector; and (3) application of Monte Carlo methodology to calculate the calibration factor of each participant for the detector system and counting geometry (single or multidetector arrangement) to be used for monitoring a person in each in vivo facility, using complex skull phantoms. The results of both exercises resulted in the conclusion that none of the three available head phantoms is appropriate as a reference phantom for the calibration of germanium detection systems for measuring Am in exposed adult persons. The main reasons for this are: (1) lack of homogeneous activity distribution in the bone material, or (2) inadequate shape/size for simulating an adult skull. Good agreement was found between Monte Carlo results and measurements, which supports Monte Carlo calibration of body counters as an alternative method when appropriate physical phantoms are not available and the detector and source are well known.
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- 2019
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13. The effects of revised operational dose quantities on the response characteristics of a beta/gamma personal dosemeter.
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Eakins JS and Tanner RJ
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- England, Humans, Beta Particles, Gamma Rays, Occupational Exposure analysis, Phantoms, Imaging, Radiation Dosage, Radiation Dosimeters standards, Radiation Monitoring instrumentation
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The International Commission on Radiation Units and Measurements is considering revising the definitions of the operational dose quantities used for personal monitoring. This paper investigates the impacts of the proposed changes on the Public Health England two-element β/γ personal thermoluminescence dosemeter (TLD), in terms of its energy and angle dependences of responses for both skin and whole-body dose assessments. In general, the photon response of the skin element would be unaffected by the proposal, though technical issues may arise during calibration. For body photon doses, the current TLD design still produces acceptable response characteristics in some circumstances, but in general it will need to be redesigned to better match the requirements of the new operational quantity; to that end, a simple adaption is demonstrated that might provide a partial solution. For electron/beta exposures, matching the combined responses of both the body and skin elements to the dose quantities may be more challenging. The performance criteria against which dosemeters are judged may also need to be revised to reflect the proposed change.
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- 2019
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14. Effect of Sedentary Lifestyle on Cardiovascular Disease Risk Among Healthy Adults With Body Mass Indexes 18.5 to 29.9 kg/m 2 .
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Mainous AG 3rd, Tanner RJ, Rahmanian KP, Jo A, and Carek PJ
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- Adult, Aged, Cardiovascular Diseases epidemiology, Cardiovascular Diseases physiopathology, Female, Healthy Volunteers, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Risk Factors, United States epidemiology, Body Mass Index, Cardiovascular Diseases psychology, Exercise physiology, Healthy Lifestyle physiology, Nutrition Surveys, Risk Assessment methods, Sedentary Behavior
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A substantial proportion of adults at healthy body mass index (BMI) are potentially at high risk for cardiovascular disease (CVD). The objective of this study is to determine if sedentary lifestyle characteristics in healthy weight adults increase their likelihood of being at high CVD risk to that of individuals who are overweight. Adults aged 40 to 79 years in the 2011 to 2016 National Health and Nutrition Examination Survey at a healthy BMI (18.5 to 24.9) and overweight BMI (25 to 29.9; unweighted n = 4,572; weighted n = 43,919,354) were analyzed. The American College of Cardiology/American Heart Association atherosclerotic CVD risk score was used to assess CVD risk. For individuals with a BMI 18.5 to 24.9, 29.6% had increased risk of a CVD event. In logistic regressions adjusted for age, race, gender, education, poverty/income ratio, insurance status, and number of visits to a healthcare provider in the past year, individuals with unhealthy sagittal abdominal diameter (odds ratio [OR] 2.44; 95% confidence interval [CI], 0.97 to 6.14), shortness of breath upon exertion (OR 1.35; 95% CI, 0.65 to 2.79), unhealthy waist circumference (OR 0.99; 95% CI, 0.60 to 1.61), and less than recommended levels of physical activity (OR 0.73; 95% CI, 0.43 to 1.23) were not significantly different than overweight adults in being at high risk for CVD events. Individuals with healthy characteristics and a BMI 18.5 to 24.9 were significantly less likely than overweight adults to be at high risk for CVD. In conclusion, the findings suggest that in individuals at a BMI 18.5 to 24.9, characteristics of a sedentary lifestyle increase the likelihood of being at high risk for CVD to that of overweight individuals., (Copyright © 2018. Published by Elsevier Inc.)
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- 2019
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15. Effectiveness of Clinical Decision Support Based Intervention in the Improvement of Care for Adult Sickle Cell Disease Patients in Primary Care.
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Mainous AG 3rd, Carek PJ, Lynch K, Tanner RJ, Hulihan MM, Baskin J, and Coates TD
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- Adolescent, Adult, Blood Transfusion, Female, Humans, Male, Middle Aged, Young Adult, Anemia, Sickle Cell therapy, Decision Support Systems, Clinical, Iron Overload diagnosis
- Abstract
Introduction: Although most patients with rare diseases like sickle cell disease (SCD) are treated in the primary care setting, primary care physicians may find it challenging to keep abreast of medication improvements and complications associated with treatment for rare and complex diseases. The purpose of this study was to evaluate the effectiveness of a clinical decision support (CDS) -based intervention system for transfusional iron overload in adults with SCD to improve management in primary care., Methods: An electronic medical record based clinical decision support system for potential transfusional iron overload in SCD patients in primary care was evaluated. The intervention was implemented in 3 family medicine clinics with a control group of 3 general internal medicine clinics. Data were collected in the 6 months before the intervention and 6 months after the intervention. There were 47 patients in the family medicine group and 24 in the general internal medicine group., Results: There was no management change in the control group while the intervention group improved primary care management from 0% to 44% ( P < .001)., Conclusion: A CDS tool can improve management of SCD patients in primary care., Competing Interests: Conflict of interest: none declared., (© Copyright 2018 by the American Board of Family Medicine.)
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- 2018
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16. Trends in Cardiovascular Disease Risk in the U.S., 1999-2014.
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Mainous AG 3rd, Tanner RJ, Jo A, Park K, and Beau De Rochars VM
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- Cardiovascular Diseases ethnology, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prevalence, Risk Factors, United States epidemiology, Cardiovascular Diseases epidemiology
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Introduction: Cardiovascular disease is the leading cause of death in the U.S. and national prevalence of the proportion of individuals at high risk is unknown. The objective of this study was to investigate the prevalence and trends in high cardiovascular disease risk among adults in the U.S., Methods: In 2017, the authors performed a cross-sectional analysis of data from the National Health and Nutrition Examination Survey, 1999-2014 for adults aged 40-79 years without a diagnosis of cardiovascular disease (unweighted n=18,269, weighted n=96,512,989). The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease risk score was calculated for all participants with complete data. Change in prevalence of individuals at high risk of cardiovascular disease was assessed, defined as ≥7.5% 10-year risk and ≥20% 10-year risk., Results: The prevalence of high risk level did not significantly change over time for the entire sample using the 7.5% 10-year risk level, but did decline significantly at 20% 10-year risk level. Logistic regression results showed that prevalence among non-Hispanic black males increased significantly from 53.5% in 1999-2002 to 65.2% in 2011-2014 using the 7.5% 10-year risk cut off (p-trend=0.003)., Conclusions: A substantial proportion of the population is at high risk of cardiovascular disease. Prevalence of high-risk individuals is prominent for non-Hispanic black males; the reasons for which are unclear. Public health efforts to increase awareness should be considered for this vulnerable population., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2018
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17. THE RESPONSE OF THE PHE NEUTRON PERSONAL DOSEMETER IN TERMS OF THE PROPOSED ICRU PERSONAL DOSE EQUIVALENT.
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Tanner RJ, Hager LG, and Eakins JS
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- Humans, International Agencies, Occupational Exposure, Radiation Dosage, Neutrons, Personal Protective Equipment standards, Radiation Dosimeters standards, Radiation Monitoring instrumentation, Radiation Monitoring standards, Radiation Protection instrumentation, Radiation Protection standards
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The ICRU is considering amending the definition of the operational quantity for personnel monitoring. The present work investigates the impact of the proposed change on the PHE neutron personal dosemeter, which utilizes electrochemically etched PADC and is currently optimized in terms of Hp(10). The energy-dependent dose response characteristics of the dosemeter, and its performance in realistic workplace neutron fields, are calculated and compared for both the current and proposed dose quantities, for both frontal and rotationally isotropic fields. Adoption of the proposed quantity would make the dosemeter more sensitive to normally incident neutrons, but it would require some modification to ensure that it is able to meet the recommendations of the current ISO standard at all energies and its directional dependence of response would be poorer. The implications of this are discussed.
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- 2018
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18. INTERNATIONAL COMPARISON EXERCISE ON NEUTRON SPECTRA UNFOLDING IN BONNER SPHERES SPECTROMETRY: PROBLEM DESCRIPTION AND PRELIMINARY ANALYSIS.
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Gómez-Ros JM, Bedogni R, Domingo C, Eakins JS, Roberts N, and Tanner RJ
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- Computer Simulation, Equipment Design, Radiation Dosage, Neutrons, Radiation Monitoring instrumentation, Radiation Monitoring methods, Radiation Protection instrumentation
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This article describes the purpose, the proposed problems and the reference solutions of an international comparison on neutron spectra unfolding in Bonner spheres spectrometry, organised within the activities of EURADOS working group 6: computational dosimetry. The exercise considered four realistic situations: a medical accelerator, a workplace field, an irradiation room and a skyshine scenario. Although a detailed analysis of the submitted solutions is under preparation, the preliminary discussion of some physical aspects of the problem, e.g. the changes in the unfolding results due to the perturbation of the neutron field by the Bonner spheres, is presented.
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- 2018
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19. Association between race/ethnicity and disability status and receipt of vaccines among older adults in Florida.
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Khan SR, Hall AG, Tanner RJ, and Marlow NM
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- Black or African American, Aged, Aged, 80 and over, Behavioral Risk Factor Surveillance System, Black People, Cross-Sectional Studies, Female, Florida, Hispanic or Latino, Humans, Influenza Vaccines administration & dosage, Logistic Models, Male, Streptococcal Vaccines administration & dosage, White People, Disabled Persons, Ethnicity, Influenza, Human prevention & control, Pneumococcal Infections prevention & control, Racial Groups, Vaccination, Vaccines administration & dosage
- Abstract
Background: Individuals living with a disability or are a member of a certain racial/ethnic group may be at heightened risk for not receiving important vaccinations., Objective: This study examined whether race/ethnicity and disability status are associated with the receipt of two vaccines (influenza and pneumococcal) among older adults living in Florida., Methods: Using the 2011-2015 Florida Behavioral Risk Factor Surveillance System, a cross-sectional survey, we ran bivariate and multivariate analyses to determine the associations for race/ethnicity and disability status with receipt of vaccinations among individuals 65 years and older. Interactions between race/ethnicity and disability status were tested in each model., Results: Among our study sample, 68% received the pneumococcal vaccine in their lifetime and 54% of them received influenza vaccine in the past 12 months. Multivariate logistic regression indicated that Non-Hispanic Blacks and Hispanics were less likely to receive both vaccines compared to Non-Hispanic Whites. Older adults with a disability were more likely to receive influenza and pneumococcal vaccines compared to those without. A significant interaction was observed between race/ethnicity and disability status for predicting pneumococcal vaccination receipt., Conclusions: Large proportions of older adults in Florida continue to go without needed vaccinations. Although race/ethnicity and disability status were shown to have some association with receipt of vaccines, having a regular source of care, employment and income also were shown to be important predictors., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2018
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20. The effects of a revised operational dose quantity on the response characteristics of neutron survey instruments.
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Eakins JS, Tanner RJ, and Hager LG
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- Neutrons, Radiation Dosage, Radiometry instrumentation
- Abstract
The ICRU is considering revising the definition of ambient dose equivalent. This paper investigates the impacts of the proposed change on four designs of neutron survey instrument, the GNU, HSREM, LB6411 and Studsvik 2202D, in terms of their respective energy dependences of response and their performances in realistic workplace fields. In some circumstances the current designs of instrument still produce acceptable characteristics, but in general they may need to be re-optimized to better match the requirements of the new operational quantity; to that end, a simple retrofit solution for the GNU is demonstrated. The performance criteria against which instruments are judged may also need to be revised to reflect the proposed change.
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- 2018
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21. The impact of iodinated contrast media on intravascular and extravascular absorbed doses in X-ray imaging: A microdosimetric analysis.
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Harbron RW, Ainsbury EA, Bouffler SD, Tanner RJ, Pearce MS, and Eakins JS
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- Monte Carlo Method, Radiometry, Arteries diagnostic imaging, Capillaries diagnostic imaging, Contrast Media chemistry, Iodine chemistry, Radiation Dosage, Radiography methods
- Abstract
Studies suggest iodinated contrast media (ICM) may increase organ dose and blood cell DNA damage for a given X-ray exposure. The impact of ICM on dose/damage to extravascular cells and cancer risks is unclear., Methods: We used Monte Carlo modelling to investigate the microscopic distribution of absorbed dose outside the lumen of arteries, capillaries and interstitial fluids containing blood and various concentrations of iodine. Models were irradiated with four X-ray spectra representing clinical procedures., Results: For the artery model, The average dose enhancement factors (DEF) to blood were 1.70, 2.38, 7.38, and 12.34 for mass concentrations of iodine in blood (ρ
i I) of 5, 10, 50 and 100 mg/ml, respectively, compared to 0 mg/ml. Average DEFs were reduced to 1.26, 1.51, 3.48 and 5.56, respectively, in the first micrometre of the vessel wall, falling to 1.01, 1.02, 1.06 and 1.09 at 40-50 μm from the lumen edge. For the capillary models, DEF for extravascular tissues was on average 48% lower than DEF for the whole model, including capillaries. A similar situation was observed for the interstitial model, with DEF to the cell nucleus being 35% lower than DEF for the whole model., Conclusions: While ICM may modify the absorbed doses from diagnostic X-ray examinations, the effect is smaller than suggested by assays of circulating blood cells or blood dose enhancement. Conversely, the potentially large increase in dose to the endothelium of blood vessels means that macroscopic organ doses may underestimate the risk of radiation induced cardiovascular disease for ICM-enhanced exposures., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)- Published
- 2018
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22. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease.
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Smid DE, Franssen FME, Gonik M, Miravitlles M, Casanova C, Cosio BG, de Lucas-Ramos P, Marin JM, Martinez C, Mir I, Soriano JB, de Torres JP, Agusti A, Atalay NB, Billington J, Boutou AK, Brighenti-Zogg S, Chaplin E, Coster S, Dodd JW, Dürr S, Fernandez-Villar A, Groenen MTJ, Guimarães M, Hejduk K, Higgins V, Hopkinson NS, Horita N, Houben-Wilke S, Janssen DJA, Jehn M, Joerres R, Karch A, Kelly JL, Kim YI, Kimura H, Koblizek V, Kocks JH, Kon SSC, Kwon N, Ladeira I, Lee SD, Leuppi JD, Locantore N, Lopez-Campos JL, D-C Man W, Maricic L, Mendoza L, Miedinger D, Mihaltan F, Minami S, van der Molen T, Murrells TJ, Nakken N, Nishijima Y, Norman IJ, Novotna B, O'Donnell DE, Ogata Y, Pereira ED, Piercy J, Price D, Pothirat C, Raghavan N, Ringbaek T, Sajkov D, Sigari N, Singh S, Small M, da Silva GF, Tanner RJ, Tsiligianni IG, Tulek B, Tzanakis N, Vanfleteren LEGW, Watz H, Webb KA, Wouters EFM, Xie GG, Yoshikawa M, and Spruit MA
- Subjects
- Age Factors, Aged, Evidence-Based Medicine, Female, Global Health, Humans, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive diagnosis, Risk Assessment, Severity of Illness Index, Sex Factors, Sickness Impact Profile, Disease Progression, Practice Guidelines as Topic, Pulmonary Disease, Chronic Obstructive classification, Pulmonary Disease, Chronic Obstructive therapy, Symptom Assessment methods
- Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference., Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores., Main Outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points., Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points., Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2017
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23. Enhanced radiation dose and DNA damage associated with iodinated contrast media in diagnostic X-ray imaging.
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Harbron R, Ainsbury EA, Bouffler SD, Tanner RJ, Eakins JS, and Pearce MS
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- Blood Vessels radiation effects, Capillaries radiation effects, Extracellular Fluid radiation effects, Humans, Blood Cells radiation effects, Contrast Media adverse effects, DNA Damage, Diagnostic Imaging adverse effects, Iodine adverse effects, Neoplasms, Radiation-Induced, Radiation Dosage
- Abstract
A review was undertaken of studies reporting increased DNA damage in circulating blood cells and increased organ doses, for X-ray exposures enhanced by iodinated contrast media (ICM), compared to unenhanced imaging. This effect may be due to ICM molecules acting as a source of secondary radiation (Auger/photoelectrons, fluorescence X-rays) following absorption of primary X-ray photons. It is unclear if the reported increase in DNA damage to blood cells necessarily implies an increased risk of developing cancer. Upon ICM-enhancement, the attenuation properties of blood differ substantially from surrounding tissues. Increased energy deposition is likely to occur within very close proximity to ICM molecules (within a few tens of micrometres). Consequently, in many situations, damage and dose enhancement may be restricted to the blood and vessel wall only. Increased cancer risks may be possible, in cases where ICM molecules are given sufficient time to reach the capillary network and interstitial fluid at the time of exposure. In all situations, the extrapolation of blood cell damage to other tissues requires caution where contrast media are involved. Future research is needed to determine the impact of ICM on dose to cells outside the blood itself and vessel walls, and to determine the concentration of ICM in blood vessels and interstitial fluid at the time of exposure.
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- 2017
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24. Physical Activity and Abnormal Blood Glucose Among Healthy Weight Adults.
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Mainous AG 3rd, Tanner RJ, Anton SD, Jo A, and Luetke MC
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- Adult, Age Factors, Body Mass Index, Cross-Sectional Studies, Diabetes Mellitus prevention & control, England, Female, Glycated Hemoglobin analysis, Health Surveys, Humans, Male, Middle Aged, Prediabetic State prevention & control, Sex Factors, Time Factors, Waist-Hip Ratio, Young Adult, Blood Glucose, Diabetes Mellitus blood, Exercise physiology, Ideal Body Weight physiology, Prediabetic State blood
- Abstract
Introduction: Physical activity has been linked to prevention and treatment of prediabetes and diabetes in overweight and obese adults. This study examines the relationship between low physical activity levels and risk of abnormal blood glucose (prediabetes or undiagnosed diabetes) in healthy weight adults., Methods: Data from the 2014 Health Survey for England were analyzed in July 2016, focusing on adults with a BMI ≥18.5 and <25 who had never been diagnosed with diabetes (N=1,153). Abnormal blood glucose was defined as hemoglobin A1c ≥5.7. Physical activity was measured through the International Physical Activity Questionnaire. Bivariate analyses and Poisson models were conducted on the effect of physical activity on abnormal blood glucose, controlling for age, sex, waist to hip ratio, sitting time, age X physical activity interaction, sex X physical activity, and race., Results: Abnormal blood glucose was detected in 23.7% of individuals with low activity levels, 14.8% of those with medium activity levels, and 12.2% of those with high activity levels (p<0.003). Similarly, 25.4% of inactive individuals (physically active for <30 minutes per week) were more likely to have abnormal blood glucose levels than active individuals (13.4%, p<0.0001). Higher physical activity was associated with a lower likelihood of abnormal blood glucose in an adjusted Poisson regression., Conclusions: Among healthy weight adults, low physical activity levels are significantly associated with abnormal blood glucose (prediabetes and undiagnosed diabetes). These findings suggest that healthy weight individuals may benefit from physical exercise., (Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2017
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25. Prevalence and Risk of Penile Human Papillomavirus Infection: Evidence From The National Health and Nutrition Examination Survey 2013-2014.
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Deshmukh AA, Tanner RJ, Luetke MC, Hong YR, Sonawane Deshmukh K, and Mainous AG 3rd
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- Adolescent, Adult, Age Factors, Humans, Male, Middle Aged, National Health Programs, Papillomaviridae classification, Penile Diseases virology, Prevalence, Risk Factors, Sexual Behavior, Sexual Partners, Surveys and Questionnaires, United States epidemiology, Young Adult, Papillomaviridae isolation & purification, Papillomavirus Infections epidemiology, Papillomavirus Infections virology, Penile Diseases epidemiology, Penis virology
- Abstract
Background: The epidemiology of penile human papillomavirus (HPV) infection is not well understood. Our objective was to determine the prevalence of penile HPV infection in the United States., Methods: We analyzed a nationally representative sample of civilian noninstitutionalized US men from the National Health and Nutritional Examination Survey (NHANES) 2013-2014. Penile swab samples were collected from men aged 18-59 years. For detection of HPV types, a Roche Linear Array test was performed. We used NHANES sampling weights to estimate the population prevalence of penile HPV infection., Results: The overall prevalence of any HPV infection was 45.2% (95% confidence interval [CI], 41.3%-49.3%). The prevalence of any high-risk HPV types and low-risk HPV types (mutually exclusive of high-risk HPV) was 30.5% (95% CI, 28.0%-33.0%) and 14.8% (95% CI, 12.7%-17.2%), respectively. Overall HPV prevalence increased with increasing age: the prevalence was lowest among 18- to 24-year-old men (33.8%) and highest among 55- to 59-year-old men (53.4%). HPV types 16 and 18 were detected in 4.3% (95% CI, 3.2%-5.7%) and 1.7% (95% CI, 1.1%-2.6%) of men, respectively. The prevalence of any HPV infection was almost 80% among men who reported having ≥16 lifetime sexual partners and using condoms intermittently., Conclusions: Our findings indicate that penile HPV is common among men in the United States. Almost one-third of all men are infected with high-risk HPV. Prevalence of penile HPV infection increases with increasing age., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2017
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26. Hearing Impairment and Undiagnosed Disease: The Potential Role of Clinical Recommendations.
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Marlow NM, Malaty J, Jo A, Tanner RJ, Beau de Rochars VM, Carek PJ, and Mainous AG 3rd
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- Adult, Aged, Cross-Sectional Studies, Diabetes Mellitus diagnosis, Diagnostic Errors, Female, Humans, Hypercholesterolemia complications, Hypercholesterolemia diagnosis, Hypertension complications, Hypertension diagnosis, Male, Middle Aged, Odds Ratio, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic diagnosis, Self Report, United States epidemiology, Diabetes Mellitus epidemiology, Hearing Loss complications, Hearing Loss epidemiology, Hypercholesterolemia epidemiology, Hypertension epidemiology, Renal Insufficiency, Chronic epidemiology
- Abstract
Purpose: The objective of this study was to use cross-sectional, nationally representative data to examine the relationship between self-reported hearing impairment and undetected diabetes, hypertension, hypercholesterolemia, and chronic kidney disease., Method: We analyzed the National Health and Nutrition Examination Survey for the years 2007-2012 for individuals 40 years of age and older without previously diagnosed cardiovascular disease. Analyses were conducted examining hearing impairment and undiagnosed disease., Results: The unweighted sample size was 9,786, representing 123,444,066 Americans. Hearing impairment was reported in 10.2% of the individuals. In unadjusted analyses, there was no significant difference between adults with hearing impairment and adults with typical hearing for undiagnosed diabetes, hypertension, or hypercholesterolemia. A higher proportion of adults with hearing impairment than adults with typical hearing had undiagnosed chronic kidney disease (20.1% vs. 10.7%; p = .0001). In models adjusting for demographics and health care utilization, hearing impairment was associated with a higher likelihood of having undiagnosed chronic kidney disease (odds ratio = 1.53, 95% CI [1.23, 1.91])., Conclusions: Individuals with hearing impairment are more likely to have undiagnosed chronic kidney disease. Hearing impairment may affect disclosure of important signs and symptoms as well as the comprehension of medical conversations for chronic disease management. General practitioners can play a critical role in improving medical communication by responding with sensitivity to the signs of hearing impairment in their patients.
- Published
- 2017
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27. Prediabetes Screening and Treatment in Diabetes Prevention: The Impact of Physician Attitudes.
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Mainous AG 3rd, Tanner RJ, Scuderi CB, Porter M, and Carek PJ
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- Adult, Blood Glucose analysis, Family Practice methods, Female, Humans, Life Style, Male, Mass Screening standards, Metformin therapeutic use, Middle Aged, Motivation, Patient Education as Topic, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Prediabetic State blood, Surveys and Questionnaires, United States, Young Adult, Attitude of Health Personnel, Diabetes Mellitus prevention & control, Family Practice standards, Hypoglycemic Agents therapeutic use, Physicians, Family psychology, Prediabetic State drug therapy
- Abstract
Purpose: Detection and treatment of prediabetes is an effective strategy in diabetes prevention. However, most patients with prediabetes are not identified. Our objective was to evaluate the relationship between attitudes toward prediabetes as a clinical construct and screening/treatment behaviors for diabetes prevention among US family physicians., Methods: An electronic survey of a national sample of academic family physicians (n 1248) was conducted in 2016. Attitude toward prediabetes was calculated using a summated scale assessing agreement with statements regarding prediabetes as a clinical construct. Perceived barriers to diabetes prevention, current strategies for diabetes prevention, and perceptions of peers were also examined., Results: Physicians who have a positive attitude toward prediabetes as a clinical construct are more likely to follow national guidelines for screening (58.4% vs 44.4; P < .0001) and recommend metformin to their patients for prediabetes (36.4% vs 20.9%; P < .0001). Physicians perceived a number of barriers to treatment, including a patient's economic resources (71.9%), sustaining patient motivation (83.2%), a patient's ability to modify his or her lifestyle (75.3%), and time to educate patient (75.3%) as barriers to diabetes prevention., Conclusions: How physicians view prediabetes varies significantly, and this variation is related to treatment/screening behaviors for diabetes prevention., (© Copyright 2016 by the American Board of Family Medicine.)
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- 2016
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28. THE PHE FORTUITOUS DOSIMETRY CAPABILITY BASED ON OPTICALLY STIMULATED LUMINESCENCE OF MOBILE PHONES.
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Eakins JS, Hager LG, Kouroukla E, Smith RW, and Tanner RJ
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- Algorithms, Calibration, England, Humans, Iridium Radioisotopes, Light, Luminescence, Models, Statistical, Monte Carlo Method, Photons, Radiation Dosimeters, Radioactive Hazard Release, Radiometry standards, Reproducibility of Results, Software, Cell Phone, Environmental Exposure analysis, Radiation Dosage, Radiometry instrumentation, Radiometry methods
- Abstract
The Public Health England fortuitous dosimetry capability is reviewed, with particular attention focussed on the derivation of its energy and fading corrections, the Monte Carlo techniques used to generate the calibration factors between phone and body doses, and the procedures set in place to facilitate a reliable and effective service., (© Crown copyright 2016.)
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- 2016
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29. CALIBRATION OF THERMOLUMINESCENCE AND FILM DOSEMETERS FOR SKIN DOSES FROM HIGH-ACTIVITY MICROPARTICLES.
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Eakins JS, Hager LG, and Tanner RJ
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- Calibration, Humans, Monte Carlo Method, Phantoms, Imaging, Reproducibility of Results, Strontium Radioisotopes analysis, Yttrium Radioisotopes analysis, Film Dosimetry methods, Radiation Dosimeters, Skin radiation effects
- Abstract
The use of EXT-RAD™ extremity TLDs and radiochromic film to measure doses from primarily beta-emitting microparticles is discussed. Specific calibration techniques have been developed, using both Monte Carlo modelling and experiments. Results for a (90)Sr/(90)Y microparticle are presented to illustrate the general techniques and to demonstrate reasonable agreement between the dosimetry methods., (© Crown copyright 2015.)
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- 2016
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30. USE OF A SIMPLE THERMALISED NEUTRON FIELD FOR QUALITY ACCEPTANCE OF WHOLE BODY TLDS.
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Gilvin PJ, Baker ST, Eakins JS, and Tanner RJ
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- Algorithms, Americium analysis, Beryllium analysis, Calibration, England, Equipment Design, Fluorides, Humans, Lithium analysis, Lithium Compounds, Materials Testing, Monte Carlo Method, Neutrons, Phantoms, Imaging, Photons, Radiation Dosage, Radiation Dosimeters, Reproducibility of Results, Thermoluminescent Dosimetry instrumentation, Whole-Body Counting, Thermoluminescent Dosimetry methods
- Abstract
The individual monitoring service of Public Health England (PHE) uses Harshaw™ whole-body and extremity thermoluminescent dosemeters (TLDs) with high-sensitivity lithium fluoride LiF:Mg,Cu,P, together with Harshaw 8800™ automated readers. The neutron-insensitive, (6)Li-depleted variety of TLD material is used by PHE because the service provides separate neutron and photon dosemeters. The neutron dosemeters are not sensitive to photons and vice versa Since insensitivity to neutrons is a supply requirement for TLDs, there is a need to test every new (annual) consignment for this. Because it is thermal neutrons that produce a response in (6)Li TLDs, a thermal field is needed. To this end, PHE has adopted the simple approach of sandwiching the TLDs between two ISO water-filled slab phantoms. In this arrangement, the fast neutrons from an Am-Be source are effectively thermalised. Details of the method are given, together with the results of supporting MCNP calculations and some typical results., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2016
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31. Prevalence of Prediabetes and Abdominal Obesity Among Healthy-Weight Adults: 18-Year Trend.
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Mainous AG 3rd, Tanner RJ, Jo A, and Anton SD
- Subjects
- Adult, Aged, Body Composition, Body Mass Index, Diabetes Mellitus diagnosis, Diabetes Mellitus epidemiology, Female, Humans, Logistic Models, Male, Middle Aged, Nutrition Surveys, Obesity, Abdominal complications, Prediabetic State complications, Prevalence, Sedentary Behavior, Sensitivity and Specificity, United States epidemiology, Waist Circumference, Body Weight, Glycated Hemoglobin analysis, Obesity, Abdominal epidemiology, Prediabetic State epidemiology
- Abstract
Purpose: Trends in sedentary lifestyle may have influenced adult body composition and metabolic health among individuals at presumably healthy weights. This study examines the nationally representative prevalence of prediabetes and abdominal obesity among healthy-weight adults in 1988 through 2012., Methods: We analyzed the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES for the years 1999 to 2012, focusing on adults aged 20 years and older who have a body mass index (BMI) of 18.5 to 24.99 and do not have diabetes, either diagnosed or undiagnosed. We defined prediabetes using glycated hemoglobin (HbA1c) level ranges from 5.7% to 6.4%, as specified by the American Diabetes Association. Abdominal obesity was measured by waist circumference and waist-to-height ratio., Results: The prevalence of prediabetes among healthy-weight adults, aged 20 years and older and without diagnosed or undiagnosed diabetes, increased from 10.2% in 1988-1994 to 18.5% in 2012. Among individuals aged 45 years and older, the prevalence of prediabetes increased from 22.0% to 33.1%. The percentage of adults aged 20 years and older with an unhealthy waist circumference increased from 5.6% in 1988-1994 to 7.6% in 2012. The percentage of individuals with an unhealthy waist-to-height ratio increased from 27.2% in 1988-1994 to 33.7% in 2012. Adjusted models found that measures of abdominal obesity were not independent predictors of prediabetes among adults with a healthy BMI., Conclusions: Among individuals within a healthy BMI range, the prevalence of prediabetes and abdominal obesity has substantially increased. Abdominal obesity does not appear to be the primary cause of the increase., (© 2016 Annals of Family Medicine, Inc.)
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- 2016
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32. Low Grip Strength and Prediabetes in Normal-Weight Adults.
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Mainous AG 3rd, Tanner RJ, Anton SD, and Jo A
- Subjects
- Adult, Age Factors, Body Mass Index, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prediabetic State blood, Risk Factors, Young Adult, Diabetes Mellitus prevention & control, Glycated Hemoglobin analysis, Hand Strength, Prediabetic State diagnosis
- Abstract
Introduction: Detection of prediabetes is an important step in diabetes prevention in primary care. Risk stratification of healthy-weight individuals for detection of prediabetes is necessary to avoid missed opportunities for diabetes prevention., Methods: Using data from the 2011 to 2012 National Health and Nutrition Examination Survey, we studied the relationship between combined handgrip strength, a proxy for lean muscle mass, and prediabetes among adults aged ≥20 years without diagnosed or undiagnosed diabetes who had a healthy body mass index (18.5-24.9 kg/m(2); unweighted n = 1340, weighted n = 58,360,690). Prediabetes was defined as having a glycohemoglobin level between 5.7% and 6.4%., Results: Of the healthy-weight adults, 20.5% had prediabetes. Combined mean grip strength was lower for individuals with prediabetes than those with normoglycemia in the full sample (63.8 vs 70.9 kg; P = .004). Similar results were seen among both men (87.9 vs 82.1 kg; P = .03) and women (51.8 vs 56.5 kg; P = .001) in subgroup analysis., Conclusions: Grip strength is associated with prediabetes among healthy-weight US adults. Grip strength may have utility as an indicator for screening healthy-weight individuals for prediabetes., (© Copyright 2016 by the American Board of Family Medicine.)
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- 2016
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33. Prediabetes Diagnosis and Treatment in Primary Care.
- Author
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Mainous AG 3rd, Tanner RJ, and Baker R
- Subjects
- Aged, Counseling, Female, Glycated Hemoglobin analysis, Humans, Life Style, Male, Middle Aged, Prediabetic State epidemiology, Prediabetic State therapy, Prevalence, Surveys and Questionnaires, Diabetes Mellitus prevention & control, Hypoglycemic Agents therapeutic use, Metformin therapeutic use, Prediabetic State diagnosis, Primary Health Care statistics & numerical data
- Abstract
Background: The increasing prevalence of diabetes is a major health problem. The detection and treatment of prediabetes can delay the onset of diabetes and presents an important diabetes prevention strategy., Methods: Using data from the 2012 National Ambulatory Medical Care Survey, we studied visits by adults aged ≥45 years without diagnosed diabetes who had an HbA1c test within 90 days of the visit (n = 518 unweighted visits; n = 11,167,004 weighted visits). HbA1c results were categorized into normal, prediabetes, and diabetes, and we examined patient characteristics (age, sex, race, payer type, body mass index) and treatment of prediabetes., Results: Among visiting adults, 54.6% had a normal HbA1c value, 33.6% had prediabetes, and 11.9% had diabetes. Of those patient visits with HbA1c consistent with prediabetes, the number of patients diagnosed with prediabetes was too low for a reliable population estimate. Indication of treatment in the medical record (lifestyle modification counseling and/or metformin) was present in 23.0% of those with diagnosed or undiagnosed prediabetes. The most common treatment was lifestyle modification counseling., Conclusions: Our findings show that there are missed opportunities for diabetes prevention in primary care. Providers need to change their approach to prediabetes and play a more effective role in preventing diabetes., (© Copyright 2016 by the American Board of Family Medicine.)
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- 2016
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34. Acute Dietary Nitrate Supplementation and Exercise Performance in COPD: A Double-Blind, Placebo-Controlled, Randomised Controlled Pilot Study.
- Author
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Curtis KJ, O'Brien KA, Tanner RJ, Polkey JI, Minnion M, Feelisch M, Polkey MI, Edwards LM, and Hopkinson NS
- Subjects
- Aged, Cross-Over Studies, Double-Blind Method, Female, Follow-Up Studies, Humans, Magnetic Resonance Spectroscopy, Male, Oxygen Consumption, Pilot Projects, Prognosis, Dietary Supplements, Exercise Therapy, Nitrates administration & dosage, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Background: Dietary nitrate supplementation can enhance exercise performance in healthy people, but it is not clear if it is beneficial in COPD. We investigated the hypotheses that acute nitrate dosing would improve exercise performance and reduce the oxygen cost of submaximal exercise in people with COPD., Methods: We performed a double-blind, placebo-controlled, cross-over single dose study. Subjects were randomised to consume either nitrate-rich beetroot juice (containing 12.9 mmoles nitrate) or placebo (nitrate-depleted beetroot juice) 3 hours prior to endurance cycle ergometry, performed at 70% of maximal workload assessed by a prior incremental exercise test. After a minimum washout period of 7 days the protocol was repeated with the crossover beverage., Results: 21 subjects successfully completed the study (age 68 ± 7 years; BMI 25.2 ± 5.5 kg/m2; FEV1 percentage predicted 50.1 ± 21.6%; peak VO2 18.0 ± 5.9 ml/min/kg). Resting diastolic blood pressure fell significantly with nitrate supplementation compared to placebo (-7 ± 8 mmHg nitrate vs. -1 ± 8 mmHg placebo; p = 0.008). Median endurance time did not differ significantly; nitrate 5.65 (3.90-10.40) minutes vs. placebo 6.40 (4.01-9.67) minutes (p = 0.50). However, isotime oxygen consumption (VO2) was lower following nitrate supplementation (16.6 ± 6.0 ml/min/kg nitrate vs. 17.2 ± 6.0 ml/min/kg placebo; p = 0.043), and consequently nitrate supplementation caused a significant lowering of the amplitude of the VO2-percentage isotime curve., Conclusions: Acute administration of oral nitrate did not enhance endurance exercise performance; however the observation that beetroot juice caused reduced oxygen consumption at isotime suggests that further investigation of this treatment approach is warranted, perhaps targeting a more hypoxic phenotype., Trial Registration: ISRCTN Registry ISRCTN66099139.
- Published
- 2015
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35. Grip Strength as a Marker of Hypertension and Diabetes in Healthy Weight Adults.
- Author
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Mainous AG 3rd, Tanner RJ, Anton SD, and Jo A
- Subjects
- Adult, Aged, Biomarkers, Female, Health Surveys, Humans, Male, Middle Aged, Diabetes Mellitus diagnosis, Hand Strength physiology, Hypertension diagnosis
- Abstract
Introduction: Muscle strength may play a role in cardiometabolic disease. We examined the relationship between hand grip strength and diabetes and hypertension in a sample of healthy weight adults., Methods: In 2015, we analyzed the National Health and Nutrition Examination Survey 2011-2012 for adults aged ≥20 years with healthy BMIs (between 18.5 and <25) and no history of cardiovascular disease (unweighted n=1,467; weighted n=61,587,139). Hand grip strength was assessed with a dynamometer. Diabetes was based on hemoglobin A1c level and reported diabetes diagnosis. Hypertension was based on measured blood pressure and reported hypertension diagnosis., Results: Individuals with undiagnosed diabetes compared with individuals without diabetes had lower grip strength (51.9 vs 69.8, p=0.0001), as did individuals with diagnosed diabetes compared with individuals without diabetes (61.7 vs 69.8, p=0.008). Mean grip strength was lower among individuals with undiagnosed hypertension compared with individuals without hypertension (63.5 vs 71.5, p=0.008) as well as among individuals with diagnosed hypertension compared with those without hypertension (60.8 vs 71.5, p<0.0001). In adjusted analyses controlling for age, sex, race, smoking status, and first-degree relative with disease, mean grip strength was lower for undiagnosed diabetes (β=-10.02, p<0.0001) and diagnosed diabetes (β=-8.21, p=0.03) compared with individuals without diabetes. In adjusted analyses, grip strength was lower among individuals with undiagnosed hypertension (β=-6.6, p=0.004) and diagnosed hypertension (β=-4.27, p=0.04) compared with individuals without hypertension., Conclusions: Among healthy weight adults, combined grip strength is lower in individuals with diagnosed and undiagnosed diabetes and hypertension., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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36. Health Considerations in Regulation and Taxation of Electronic Cigarettes.
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Mainous AG 3rd, Tanner RJ, Mainous RW, and Talbert J
- Subjects
- Humans, Electronic Nicotine Delivery Systems economics, Health Policy, Taxes legislation & jurisprudence
- Abstract
The use of electronic cigarettes (e-cigarettes) is experiencing unprecedented growth. This can be contrasted to the use of conventional cigarettes which showed a decrease among adults with the current smoker prevalence dropping from 20.9% in 2005 to 17.8% in 2013. There is some data that e-cigarettes are attracting both former smokers and never smokers, and in particular, young people as users. Currently most states do not tax e-cigarettes. Taxation and regulation may have a similar overall goal of decreasing smoking but regulation tends to focus reduced availability of products. In terms of tobacco control, taxation focuses on the demand side of the equation. Taxation is a distinct strategy from regulation and has been shown to decrease new adopters of conventional cigarettes. A variety of potential taxation strategies can be considered by policymakers based on different assumptions about e-cigarettes and their utility, ranging from untaxed to taxation at moderate levels compared to conventional cigarettes to taxation equal to conventional cigarettes. Until more evidence for the benefits of e-cigarettes is presented, it seems prudent to view them as a potentially harmful and addictive product that ought to be regulated and taxed in an equivalent manner to conventional cigarettes., (© Copyright 2015 by the American Board of Family Medicine.)
- Published
- 2015
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37. Development of a retrospective/fortuitous accident dosimetry service based on OSL of mobile phones.
- Author
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Smith RW, Eakins JS, Hager LG, Rothkamm K, and Tanner RJ
- Subjects
- Electric Impedance, Equipment Design, Equipment Failure Analysis, Radiation Dosage, Reproducibility of Results, Sensitivity and Specificity, Cell Phone, Radiation Exposure analysis, Radioactive Hazard Release, Terrorism, Thermoluminescent Dosimetry instrumentation
- Abstract
Work is presented on the development of a retrospective/fortuitous accident dosimetry service using optically stimulated luminescence of resistors found in mobile phones to determine the doses of radiation to members of the public following a radiological accident or terrorist incident. The system is described and discussed in terms of its likely accuracy in a real incident., (© Crown copyright 2015.)
- Published
- 2015
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38. Dynamic laryngeal narrowing during exercise: a mechanism for generating intrinsic PEEP in COPD?
- Author
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Baz M, Haji GS, Menzies-Gow A, Tanner RJ, Hopkinson NS, Polkey MI, and Hull JH
- Subjects
- Airway Resistance, Case-Control Studies, Exercise Test, Exercise Tolerance, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Oxygen Consumption, Pulmonary Ventilation, Tidal Volume, Exhalation physiology, Glottis physiopathology, Inhalation physiology, Positive-Pressure Respiration, Intrinsic physiopathology, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
Introduction: Patients with COPD commonly exhibit pursed-lip breathing during exercise, a strategy that, by increasing intrinsic positive end-expiratory pressure, may optimise lung mechanics and exercise tolerance. A similar role for laryngeal narrowing in modulating exercise airways resistance and the respiratory cycle volume-time course is postulated, yet remains unstudied in COPD. The aim of this study was to assess the characteristics of laryngeal narrowing and its role in exercise intolerance and dynamic hyperinflation in COPD., Methods: We studied 19 patients (n=8 mild-moderate; n=11 severe COPD) and healthy age and sex matched controls (n=11). Baseline physiological characteristics and clinical status were assessed prior to an incremental maximal cardiopulmonary exercise test with continuous laryngoscopy. Laryngeal narrowing measures were calculated at the glottic and supra-glottic aperture at rest and peak exercise., Results: At rest, expiratory laryngeal narrowing was pronounced at the glottic level in patients and related to FEV1 in the whole cohort (r=-0.71, p<0.001) and patients alone (r=-0.53, p=0.018). During exercise, glottic narrowing was inversely related to peak ventilation in all subjects (r=-0.55, p=0.0015) and patients (r=-0.71, p<0.001) and peak exercise tidal volume (r=-0.58, p=0.0062 and r=-0.55, p=0.0076, respectively). Exercise glottic narrowing was also inversely related to peak oxygen uptake (% predicted) in all subjects (r=-0.65, p<0.001) and patients considered alone (r=-0.58, p=0.014). Exercise inspiratory duty cycle was related to exercise glottic narrowing for all subjects (r=-0.69, p<0.001) and patients (r=-0.62, p<0.001)., Conclusions: Dynamic laryngeal narrowing during expiration is prevalent in patients with COPD and is related to disease severity, respiratory duty cycle and exercise capacity., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2015
- Full Text
- View/download PDF
39. Attitudes toward Management of Sickle Cell Disease and Its Complications: A National Survey of Academic Family Physicians.
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Mainous AG 3rd, Tanner RJ, Harle CA, Baker R, Shokar NK, and Hulihan MM
- Abstract
Objective. Sickle cell disease (SCD) is a disease that requires a significant degree of medical intervention, and family physicians are one potential provider of care for patients who do not have access to specialists. The extent to which family physicians are comfortable with the treatment of and concerned about potential complications of SCD among their patients is unclear. Our purpose was to examine family physician's attitudes toward SCD management. Methods. Data was collected as part of the Council of Academic Family Medicine Educational Research Alliance (CERA) survey in the United States and Canada that targeted family physicians who were members of CERA-affiliated organizations. We examined attitudes regarding management of SCD. Results. Overall, 20.4% of respondents felt comfortable with treatment of SCD. There were significant differences in comfort level for treatment of SCD patients depending on whether or not physicians had patients who had SCD, as well as physicians who had more than 10% African American patients. Physicians also felt that clinical decision support (CDS) tools would be useful for treatment (69.4%) and avoiding complications (72.6%) in managing SCD patients. Conclusions. Family physicians are generally uncomfortable with managing SCD patients and recognize the utility of CDS tools in managing patients.
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- 2015
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40. Prediabetes, elevated iron and all-cause mortality: a cohort study.
- Author
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Mainous AG 3rd, Tanner RJ, Coates TD, and Baker R
- Subjects
- Adult, Aged, Biomarkers blood, Cohort Studies, Female, Humans, Male, Middle Aged, Nutrition Surveys, Prediabetic State blood, Risk, United States epidemiology, Blood Glucose metabolism, Cause of Death, Ferritins blood, Iron blood, Prediabetic State mortality, Transferrin metabolism
- Abstract
Objectives: Data have indicated low to non-existent increased mortality risk for individuals with prediabetes, but it is unclear if the risk is increased when the patient has elevated iron markers. Our purpose was to examine the mortality risk among adults with prediabetes in the context of coexisting elevated transferrin saturation (TS) or serum ferritin., Setting: Data collected by the third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) in the USA and by the National Center for Health Statistics for the National Death Index from 1988 to 2006., Participants: Individuals age 40 and older who participated in the NHANES and provided a blood sample., Primary Outcome Variable: Mortality was measured as all-cause mortality., Results: Adjusted analyses show that prediabetes has a small increased mortality risk (HR=1.04; 95% CI 1.00 to 1.08). Persons who had prediabetes and elevated serum ferritin had an increased HR for death (HR=1.14; 95% CI 1.04 to 1.24) compared with those who had normal ferritin and normal glucose. Among persons with prediabetes who had elevated TS, they had an increased mortality risk (HR=1.88; 95% CI 1.06 to 3.30) compared with those with normal TS levels and normal glucose., Conclusions: The mortality risk of prediabetes is low. However, among individuals who have coexisting elevated iron markers, particularly TS, the risk rises substantially., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
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- View/download PDF
41. The impact of chelation therapy on survival in transfusional iron overload: a meta-analysis of myelodysplastic syndrome.
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Mainous AG 3rd, Tanner RJ, Hulihan MM, Amaya M, and Coates TD
- Subjects
- Disease-Free Survival, Female, Humans, Male, Survival Rate, Erythrocyte Transfusion, Iron Chelating Agents therapeutic use, Iron Overload drug therapy, Iron Overload etiology, Iron Overload mortality, Myelodysplastic Syndromes mortality, Myelodysplastic Syndromes therapy
- Abstract
Competing Interests: statement The authors declare no potential conflicts of interest.
- Published
- 2014
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42. An evaluation of factors associated with completion and benefit from pulmonary rehabilitation in COPD.
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Boutou AK, Tanner RJ, Lord VM, Hogg L, Nolan J, Jefford H, Corner EJ, Falzon C, Lee C, Garrod R, Polkey MI, and Hopkinson NS
- Abstract
Background: Pulmonary Rehabilitation (PR) is an important treatment for patients with chronic obstructive pulmonary disease (COPD) but it is not established whether any baseline parameter can predict response or compliance., Aim: To identify whether baseline measures can predict who will complete the programme and who will achieve a clinically significant benefit from a Minimum Clinical Important Difference (MCID) in terms of exercise capacity and health-related quality of life (HRQoL)., Methods: Data were collected prospectively from patients with COPD at their baseline assessment for an outpatient PR programme in one of eight centres across London. 'Completion' was defined as attending at least 75% of the designated PR visits and return for the follow-up evaluation. The MCID for outcome measures was based on published data., Results: 787 outpatients with COPD (68.1±10.5 years old; 49.6% males) were included. Patients who completed PR (n=449, 57.1%) were significantly older with less severe airflow obstruction, lower anxiety and depression scores, less dyspnoea and better HRQoL. Only baseline CAT score (OR=0.925; 95% CI 0.879 to 0.974; p=0.003) was retained in multivariate analysis. Patients with the lowest baseline walking distance were most likely to achieve the MCID for exercise capacity. No baseline variable could independently predict achievement of an MCID in HRQoL., Conclusions: Patients with better HRQoL are more likely to complete PR while worse baseline exercise performance makes the achievement of a positive MCID in exercise capacity more likely. However, no baseline parameter could predict who would benefit the most in terms of HRQoL.
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- 2014
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43. Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD.
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Maddocks M, Shrikrishna D, Vitoriano S, Natanek SA, Tanner RJ, Hart N, Kemp PR, Moxham J, Polkey MI, and Hopkinson NS
- Subjects
- Adipose Tissue, Aged, Biomarkers, Carbon Monoxide chemistry, Case-Control Studies, Female, Humans, Male, Middle Aged, Motor Activity, Muscle Strength, Muscle, Skeletal diagnostic imaging, Observer Variation, Phenotype, Pulmonary Disease, Chronic Obstructive diagnostic imaging, Quadriceps Muscle diagnostic imaging, Quadriceps Muscle physiopathology, Reproducibility of Results, Sensitivity and Specificity, Tomography, X-Ray Computed, Adiposity, Exercise physiology, Exercise Tolerance, Muscle, Skeletal physiopathology, Pulmonary Disease, Chronic Obstructive physiopathology
- Abstract
Quadriceps muscle phenotype varies widely between patients with chronic obstructive pulmonary disease (COPD) and cannot be determined without muscle biopsy. We hypothesised that measures of skeletal muscle adiposity could provide noninvasive biomarkers of muscle quality in this population. In 101 patients and 10 age-matched healthy controls, mid-thigh cross-sectional area, percentage intramuscular fat and skeletal muscle attenuation were calculated using computed tomography images and standard tissue attenuation ranges: fat -190- -30 HU; skeletal muscle -29-150 HU. Mean±sd percentage intramuscular fat was higher in the patient group (6.7±3.5% versus 4.3±1.2%, p = 0.03). Both percentage intramuscular fat and skeletal muscle attenuation were associated with physical activity level, exercise capacity and type I fibre proportion, independent of age, mid-thigh cross-sectional area and quadriceps strength. Combined with transfer factor of the lung for carbon monoxide, these variables could identify >80% of patients with fibre type shift with >65% specificity (area under the curve 0.83, 95% CI 0.72-0.95). Skeletal muscle adiposity assessed by computed tomography reflects multiple aspects of COPD related muscle dysfunction and may help to identify patients for trials of interventions targeted at specific muscle phenotypes., (©ERS 2014.)
- Published
- 2014
- Full Text
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44. Measurements with the new PHE neutron survey instrument.
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Eakins JS, Tanner RJ, and Hager LG
- Subjects
- Calibration, Computer Simulation, England, Fast Neutrons, Models, Theoretical, Monte Carlo Method, Neutrons, Radiation Dosage, Workplace, Equipment Design, Radiometry instrumentation, Radiometry methods
- Abstract
A novel design of survey instrument has been developed to accurately estimate ambient dose equivalent from neutrons with energies in the range from thermal to 20 MeV. The device features moderating and attenuating layers to ease measurement of fast and intermediate energy neutrons, combined with guides that channel low-energy neutrons to the single, central detector. A prototype of this device has been constructed and exposed to a set of calibration fields: the resulting measured responses are presented and discussed here, and compared against Monte Carlo data. A simple simulated workplace neutron field has also been developed to test the device., (© Crown copyright 2013.)
- Published
- 2014
- Full Text
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45. Use of aspirin for primary and secondary cardiovascular disease prevention in the United States, 2011-2012.
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Mainous AG, Tanner RJ, Shorr RI, and Limacher MC
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Risk Assessment, Self Report, United States, Aspirin therapeutic use, Cardiovascular Diseases prevention & control, Medication Adherence statistics & numerical data, Platelet Aggregation Inhibitors therapeutic use, Practice Patterns, Physicians' statistics & numerical data, Primary Prevention, Secondary Prevention
- Abstract
Background: Aspirin use has been shown to be an effective tool in cardiovascular disease (CVD) prevention among high-risk patients. The patient-reported physician recommendation for aspirin as preventive therapy among high- and low-risk patients is unknown., Methods and Results: We conducted an analysis of the National Health and Nutrition Examination Survey 2011-2012 to examine the use of aspirin for CVD prevention. Patients without previously diagnosed CVD were classified into high and low risk based on their Framingham Risk Score (10-year coronary heart disease risk). Among patients without previously diagnosed CVD, 22.5% were classified as high risk. Of the high-risk individuals, 40.9% reported being told by their physician to take aspirin, with 79.0% complying. Among those who were at low risk, 26.0% were told by their physician to take aspirin, with 76.5% complying. Logistic regression analysis indicated that age, access to a regular source of care, education, and insurance status were significant predictors of patient-reported physician recommendations for aspirin use for primary prevention. Among high-risk patients, age, race, and insurance status were significant predictors of reported recommendations for aspirin use. Among low-risk patients, age, education, obesity, and insurance status were significant predictors of reported recommendations for aspirin use., Conclusions: Patient reports indicate nonideal rates of being told to take aspirin, for both high- and low-risk patients for primary prevention. Clinical decision support tools that could assist physicians in identifying patients at risk may increase patient reports of physician recommendations for aspirin use., (© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Published
- 2014
- Full Text
- View/download PDF
46. Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study.
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Mainous AG 3rd, Tanner RJ, Baker R, Zayas CE, and Harle CA
- Subjects
- Adolescent, Adult, Cross-Sectional Studies, England epidemiology, Female, Humans, Male, Prevalence, Time Factors, Young Adult, Prediabetic State epidemiology
- Abstract
Objective: Prediabetes is a high-risk state for developing diabetes and associated complications. The purpose of this paper was to report trends in prevalence of prediabetes for individuals aged 16 and older in England without previously diagnosed diabetes., Setting: Data collected by the Health Survey for England (HSE) in England in the years 2003, 2006, 2009 and 2011., Participants: Individuals aged 16 and older who participated in the HSE and provided a blood sample., Primary Outcome Variable: Individuals were classified as having prediabetes if glycated haemoglobin was between 5.7% and 6.4% and were not previously diagnosed with diabetes., Results: The prevalence rate of prediabetes increased from 11.6% to 35.3% from 2003 to 2011. By 2011, 50.6% of the population who were overweight (body mass index (BMI)>25) and ≥40 years of age had prediabetes. In bivariate relationships, individuals with greater socioeconomic deprivation were more likely to have prediabetes in 2003 (p=0.0008) and 2006 (p=0.0246), but the relationship was not significant in 2009 (p=0.213) and 2011 (p=0.3153). In logistic regressions controlling for age, sex, race/ethnicity, BMI and high blood pressure, the second most socioeconomically deprived had a significantly elevated risk of having prediabetes (2011, OR=1.45; 95% CI 1.26 to 1.88)., Conclusions: There has been a marked increase in the proportion of adults in England with prediabetes. The socioeconomically deprived are at substantial risk. In the absence of concerted and effective efforts to reduce risk, the number of people with diabetes is likely to increase steeply in coming years., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
- Full Text
- View/download PDF
47. Monte Carlo modelling of 90Sr/90Y and 85Kr beta fields for Hp(3) measurements.
- Author
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Eakins JS, Baker ST, Gibbens NJ, Gilvin PJ, Hager LG, and Tanner RJ
- Subjects
- Computer Simulation, Electrons, Humans, Phantoms, Imaging, Photons, Radiation Dosage, Radiation Protection, Eye radiation effects, Krypton Radioisotopes analysis, Models, Statistical, Monte Carlo Method, Relative Biological Effectiveness, Strontium Radioisotopes analysis, Yttrium Radioisotopes analysis
- Abstract
In support of research aimed at developing a thermoluminescence dosemeter capable of accurately measuring ionising radiation doses to the lens of the eye, Monte Carlo modelling of a standard beta exposure set-up has been performed. It was found that electrons with an energy distribution corresponding to the beta emission spectrum from (85)Kr deposit negligible doses at a depth of 3 mm in tissue, but doses from (90)Sr/(90)Y are significant; free in air and fluence-to-Hp(3,θ°) and -Hp(0.07,θ°) conversion coefficient data were found for this field for exposures at 0°, 30° and 60° angles of incidence, and the response characteristics of the new eye dosemeter were evaluated. It was shown that the results were not affected greatly by the shape of the calibration phantom. However, it was demonstrated that the presence of intermediating air and beam flattening filters hardens the energy distribution of the field at the point of test, relative to a raw (90)Sr/(90)Y source, and this impacts dose depositions.
- Published
- 2014
- Full Text
- View/download PDF
48. Type testing of a head band dosemeter for measuring eye lens dose in terms of H(P)(3).
- Author
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Gilvin PJ, Baker ST, Gibbens NJ, Roberts GH, Tanner RJ, Eakins JS, Hager LG, and Daniels TJ
- Subjects
- Beta Particles, Humans, Phantoms, Imaging, Protective Devices, Radiation Dosage, Lens, Crystalline radiation effects, Photons, Radiation Monitoring instrumentation, Radiation Monitoring standards, Radiation Protection standards
- Abstract
A new head band dosemeter, for the measurement of eye lens dose in terms of Hp(3), has been type tested by Public Health England's Centre for Radiation, Environmental and Chemical Hazards [formerly part of the UK Health Protection Agency (HPA)]. The type tests were based on the International Standard ISO 12794, drawing also upon earlier work at HPA. The results show that, unlike many existing dosemeters, the new head band dosemeter correctly measures Hp(3) for beta radiations as well as photons.
- Published
- 2013
- Full Text
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49. Lung function indices for predicting mortality in COPD.
- Author
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Boutou AK, Shrikrishna D, Tanner RJ, Smith C, Kelly JL, Ward SP, Polkey MI, and Hopkinson NS
- Subjects
- Aged, Blood Gas Analysis, Cohort Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Multivariate Analysis, Partial Pressure, Plethysmography, Prognosis, Proportional Hazards Models, Prospective Studies, Pulmonary Disease, Chronic Obstructive blood, Pulmonary Disease, Chronic Obstructive physiopathology, Retrospective Studies, Spirometry, Survival Rate, Lung physiopathology, Oxygen metabolism, Pulmonary Disease, Chronic Obstructive mortality, Pulmonary Gas Exchange physiology
- Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by high morbidity and mortality. It remains unknown which aspect of lung function carries the most prognostic information and if simple spirometry is sufficient. Survival was assessed in COPD outpatients whose data had been added prospectively to a clinical audit database from the point of first full lung function testing including spirometry, lung volumes, gas transfer and arterial blood gases. Variables univariately associated with survival were entered into a multivariate Cox proportional hazard model. 604 patients were included (mean ± SD age 61.9 ± 9.7 years; forced expiratory volume in 1 s 37 ± 18.1% predicted; 62.9% males); 229 (37.9%) died during a median follow-up of 83 months. Median survival was 91.9 (95% CI 80.8-103) months with survival rates at 3 and 5 years 0.83 and 0.66, respectively. Carbon monoxide transfer factor % pred quartiles (best quartile (>51%): HR 0.33, 95% CI 0.172-0.639; and second quartile (51-37.3%): HR 0.52, 95% CI 0.322-0.825; versus lowest quartile (<27.9%)), age (HR 1.04, 95% CI 1.02-1.06) and arterial oxygen partial pressure (HR 0.85, 95% CI 0.77-0.94) were the only parameters independently associated with mortality. Measurement of gas transfer provides additional prognostic information compared to spirometry in patients under hospital follow-up and could be considered routinely.
- Published
- 2013
- Full Text
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50. Quadriceps wasting and physical inactivity in patients with COPD.
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Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, Walsh SL, Bloch SA, Sidhu PS, Hart N, Kemp PR, Moxham J, Polkey MI, and Hopkinson NS
- Subjects
- Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Motor Activity, Muscle Weakness diagnostic imaging, Ultrasonography, Muscle Weakness etiology, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive physiopathology, Quadriceps Muscle diagnostic imaging
- Abstract
Quadriceps weakness is an important complication of advanced chronic obstructive pulmonary disease (COPD) but few data exist concerning muscle bulk in early disease. We hypothesised that quadriceps bulk, measured by ultrasound rectus femoris cross-sectional area (USRF(CSA)), would be reduced in mild, as well as advanced, COPD compared with controls, and would correlate with physical activity. 161 patients with stable COPD and 40 healthy subjects had a measurement of USRF(CSA) and wore a multisensor armband to record physical activity. USRF(CSA) was reduced in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I patients compared with healthy subjects (p=0.0002). Stage II-IV patients had reduced USRF(CSA) (p<0.0001) compared with controls but were not significantly different from those with stage I disease. Physical activity level was reduced in stage I (p=0.002) and stage II-IV disease compared with controls. Using regression analysis, physical activity level was independently associated with USRF(CSA) in stage I (p=0.01) but not stage II-IV disease, where residual volume to total lung capacity ratio was the only independent predictor of physical activity level. Quadriceps wasting exists in patients with mild, as well as advanced, COPD, and is independently associated with physical inactivity in GOLD stage I disease. The identification of these patients may guide early lifestyle and therapeutic interventions.
- Published
- 2012
- Full Text
- View/download PDF
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