279 results on '"John Ly"'
Search Results
2. Phase I trial outcome of amnion cell therapy in patients with ischemic stroke (I-ACT)
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Thanh G. Phan, Rebecca Lim, Siow T. Chan, Hannah McDonald, Poh-Yi Gan, Shenpeng R. Zhang, Liz J. Barreto Arce, Jason Vuong, Tharani Thirugnanachandran, Benjamin Clissold, John Ly, Shaloo Singhal, Marie Veronic Hervet, Hyun Ah Kim, Grant R. Drummond, Euan M. Wallace, Henry Ma, and Christopher G. Sobey
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stem cell ,clinical trial ,ischemic stroke ,phase I ,allogeneic ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
BackgroundWe proposed a Phase I dose escalation trial to assess the safety of allogeneic human amniotic epithelial cells (hAECs) in stroke patients with a view to informing the design for a Phase II trial.MethodsThe design is based on 3 + 3 dose escalation design with additional components for measuring MR signal of efficacy as well as the effect of hAECs (2–8 × 106/kg, i.v.) on preventing immunosuppression after stroke.ResultsEight patients (six males) were recruited within 24 h of ischemic stroke onset and were infused with hAECs. We were able to increase the dose of hAECs to 8 × 106 cells/kg (2 × 106/kg, n = 3; 4 × 106/kg, n = 3; 8 × 106/kg, n = 2). The mean age is 68.0 ± 10.9 (mean ± SD). The frequencies of hypertension and hyperlipidemia were 87.5%, diabetes was 37.5%, atrial fibrillation was 50%, ischemic heart disease was 37.5% and ever-smoker was 25%. Overall, baseline NIHSS was 7.5 ± 3.1, 7.8 ± 7.2 at 24 h, and 4.9 ± 5.4 at 1 week (n = 8). The modified Rankin scale at 90 days was 2.1 ± 1.2. Supplemental oxygen was given in five patients during hAEC infusion. Using pre-defined criteria, two serious adverse events occurred. One patient developed recurrent stroke and another developed pulmonary embolism whilst in rehabilitation. For the last four patients, infusion of hAECs was split across separate infusions on subsequent days to reduce the risk for fluid overload.ConclusionOur Phase I trial demonstrates that a maximal dose of 2 × 106/kg hAECs given intravenously each day over 2 days (a total of 4 × 106/kg) is safe and optimal for use in a Phase II trial.Clinical trial registrationClinicalTrials.gov, identifier ACTRN12618000076279P.
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- 2023
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3. Effect of alteplase, benzodiazepines and beta-blocker on post-stroke pneumonia: Exploration of VISTA-Acute.
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Thanh G Phan, Richard Beare, Philip M Bath, Svitlana Ievlieva, Stella Ho, John Ly, Amanda G Thrift, Velandai K Srikanth, Henry Ma, and VISTA-Acute Collaborators
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Medicine ,Science - Abstract
BackgroundPost-stroke pneumonia is a frequent complication of stroke and is associated with high mortality. Investigators have described its associations with beta-blocker. However, there has been no evaluation of the role of recombinant tissue plasminogen activator (RTPA). We postulate that RTPA may modify the effect of stroke on pneumonia by reducing stroke disability. We explore this using data from neuroprotection trials in Virtual International Stroke Trials Archive (VISTA)-Acute.MethodWe evaluated the impact of RTPA and other medications in random forest model. Random forest is a type of supervised ensemble tree-based machine learning method. We used the standard approach for performing random forest and partitioned the data into training (70%) and validation (30%) sets. This action enabled to the model developed on training data to be evaluated in the validation data. We borrowed idea from Coalition Game Theory on fair distribution of marginal profit (Shapley value) to determine proportional contribution of a covariate to the model. Consistent with other analysis using the VISTA-Acute data, the diagnosis of post-stroke pneumonia was based on reports of serious adverse events.ResultsThe overall frequency of pneumonia was 10.9% (614/5652). It was present in 11.5% of the RTPA (270/2358) and 10.4% (344/3295) of the no RTPA groups. There was significant (pConclusionIn this cohort pneumonia was strongly associated with stroke severity and age whereas RTPA had a much lower effect. An intriguing finding is a possible association between benzodiazepine and pneumonia but this requires further evaluation.
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- 2023
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4. Post-reconstruction enhancement of [18F]FDG PET images with a convolutional neural network
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John Ly, David Minarik, Jonas Jögi, Per Wollmer, and Elin Trägårdh
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Cancer ,Artificial intelligence ,PET ,Image quality ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background The aim of the study was to develop and test an artificial intelligence (AI)-based method to improve the quality of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) images. Methods A convolutional neural network (CNN) was trained by using pairs of excellent (acquisition time of 6 min/bed position) and standard (acquisition time of 1.5 min/bed position) or sub-standard (acquisition time of 1 min/bed position) images from 72 patients. A test group of 25 patients was used to validate the CNN qualitatively and quantitatively with 5 different image sets per patient: 4 min/bed position, 1.5 min/bed position with and without CNN, and 1 min/bed position with and without CNN. Results Difference in hotspot maximum or peak standardized uptake value between the standard 1.5 min and 1.5 min CNN images fell short of significance. Coefficient of variation, the noise level, was lower in the CNN-enhanced images compared with standard 1 min and 1.5 min images. Physicians ranked the 1.5 min CNN and the 4 min images highest regarding image quality (noise and contrast) and the standard 1 min images lowest. Conclusions AI can enhance [18F]FDG-PET images to reduce noise and increase contrast compared with standard images whilst keeping SUVmax/peak stability. There were significant differences in scoring between the 1.5 min and 1.5 min CNN image sets in all comparisons, the latter had higher scores in noise and contrast. Furthermore, difference in SUVmax and SUVpeak fell short of significance for that pair. The improved image quality can potentially be used either to provide better images to the nuclear medicine physicians or to reduce acquisition time/administered activity.
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- 2021
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5. AI-based detection of lung lesions in [18F]FDG PET-CT from lung cancer patients
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Pablo Borrelli, John Ly, Reza Kaboteh, Johannes Ulén, Olof Enqvist, Elin Trägårdh, and Lars Edenbrandt
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AI ,FDG ,PET-CT ,Lung cancer ,Segmentation ,Automatic ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background [18F]-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) is a well-established modality in the work-up of patients with suspected or confirmed diagnosis of lung cancer. Recent research efforts have focused on extracting theragnostic and textural information from manually indicated lung lesions. Both semi-automatic and fully automatic use of artificial intelligence (AI) to localise and classify FDG-avid foci has been demonstrated. To fully harness AI’s usefulness, we have developed a method which both automatically detects abnormal lung lesions and calculates the total lesion glycolysis (TLG) on FDG PET-CT. Methods One hundred twelve patients (59 females and 53 males) who underwent FDG PET-CT due to suspected or for the management of known lung cancer were studied retrospectively. These patients were divided into a training group (59%; n = 66), a validation group (20.5%; n = 23) and a test group (20.5%; n = 23). A nuclear medicine physician manually segmented abnormal lung lesions with increased FDG-uptake in all PET-CT studies. The AI-based method was trained to segment the lesions based on the manual segmentations. TLG was then calculated from manual and AI-based measurements, respectively and analysed with Bland-Altman plots. Results The AI-tool’s performance in detecting lesions had a sensitivity of 90%. One small lesion was missed in two patients, respectively, where both had a larger lesion which was correctly detected. The positive and negative predictive values were 88% and 100%, respectively. The correlation between manual and AI TLG measurements was strong (R 2 = 0.74). Bias was 42 g and 95% limits of agreement ranged from − 736 to 819 g. Agreement was particularly high in smaller lesions. Conclusions The AI-based method is suitable for the detection of lung lesions and automatic calculation of TLG in small- to medium-sized tumours. In a clinical setting, it will have an added value due to its capability to sort out negative examinations resulting in prioritised and focused care on patients with potentially malignant lesions.
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- 2021
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6. The use of a proposed updated EARL harmonization of 18F-FDG PET-CT in patients with lymphoma yields significant differences in Deauville score compared with current EARL recommendations
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John Ly, David Minarik, Lars Edenbrandt, Per Wollmer, and Elin Trägårdh
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Deauville score ,Reconstruction algorithm ,Lymphoma ,EARL ,PET ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background The Deauville score (DS) is a clinical tool, based on the comparison between lesion and reference organ uptake of 18F-fluorodeoxyglucose (FDG), used to stratify patients with lymphoma into categories reflecting their disease status. With a plethora of positron emission tomography with computed tomography (PET-CT) hard- and software algorithms, standard uptake value (SUV) in lesions and reference organs may differ which affects DS classification and therefore medical treatment. The EANM Research Ltd. (EARL) harmonization program from the European Association of Nuclear Medicine (EANM) partly mitigates this issue, but local preferences are common in clinical practice. We have investigated the discordance in DS calculated from patients with lymphoma referred for 18F-FDG PET-CT reconstructed with three different algorithms: the newly introduced block-sequential regularization expectation-maximization algorithm commercially sold as Q. Clear (QC, GE Healthcare, Milwaukee, WI, USA), compliant with the newly proposed updated EARL recommendations, and two settings compliant with the current EARL recommendations (EARLlower and EARLupper, representing the lower and upper limit of the EARL recommendations). Methods Fifty-two patients with non-Hodgkin and Hodgkin lymphoma were included (18 females and 34 males). Segmentation of mediastinal blood pool and liver were semi-automatically performed, whereas segmentation of lesions was done manually. From these segmentations, SUVmax and SUVpeak were obtained and DS calculated. Results There was a significant difference in DS between the QC algorithm and EARLlower/EARLupper (p
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- 2019
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7. Stroke Severity Versus Dysphagia Screen as Driver for Post-stroke Pneumonia
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Thanh G. Phan, Talvika Kooblal, Chelsea Matley, Shaloo Singhal, Benjamin Clissold, John Ly, Amanda G. Thrift, Velandai Srikanth, and Henry Ma
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stroke ,pneumonia ,NIHSS ,dysphagia ,decision tree ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background and Purpose: Post-stroke pneumonia is a feared complication of stroke as it is associated with greater mortality and disability than in those without pneumonia. Patients are often kept “Nil By Mouth” (NBM) after stroke until after receiving a screen for dysphagia and declared safe to resume oral intake. We aimed to assess the proportional contribution of stroke severity and dysphagia screen to pneumonia by borrowing idea from coalition game theory on fair distribution of marginal profit (Shapley value).Method: Retrospective study of admissions to the stroke unit at Monash Medical Center in 2015. Seventy-five percent of data were partitioned into training set and the remainder (25%) into validation set. Variables associated with pneumonia (p < 0.1) were entered into Shapley value regression and conditional decision tree analysis.Results: In 2015, there were 797 admissions and 617 patients with ischemic and hemorrhagic stroke (age 69.9 ± 16.2, male = 55.0%, National Institute of Health Stroke Scale/NIHSS 8.1 ± 7.9). The frequency of pneumonia was 6.6% (41/617). In univariable analyses NIHSS, time to dysphagia screen, Charlson comorbidity index (CCI), and age were significantly associated with pneumonia but not weekend admission. Shapley value regression showed that the largest contributor to the model was stroke severity (72.8%) followed by CCI (16.2%), dysphagia screen (3.8%), and age (7.2%). Decision tree analysis yielded an NIHSS threshold of 14 for classifying people with (27% of 75 patients) and without pneumonia (2.5% of 308 patients). The area under the ROC curve for training data was 0.83 (95% CI 0.75–0.91) with no detectable difference between the training and test data (p = 0.4). Results were similar when dysphagia was exchanged for the variable dysphagia screen.Conclusion: Stroke severity status, and not dysphagia or dysphagia screening contributed to the decision tree model of post stroke pneumonia. We cannot exclude the chance that using dysphagia screen in this cohort had minimized the impact of dysphagia on development of pneumonia.
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- 2019
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8. Exploratory Use of Decision Tree Analysis in Classification of Outcome in Hypoxic–Ischemic Brain Injury
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Thanh G. Phan, Jian Chen, Shaloo Singhal, Henry Ma, Benjamin B. Clissold, John Ly, and Richard Beare
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cardiac arrest ,hypoxic ischemic encephalopathy ,decision tree analysis ,classification ,prediction ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
BackgroundPrognostication following hypoxic ischemic encephalopathy (brain injury) is important for clinical management. The aim of this exploratory study is to use a decision tree model to find clinical and MRI associates of severe disability and death in this condition. We evaluate clinical model and then the added value of MRI data.MethodThe inclusion criteria were as follows: age ≥17 years, cardio-respiratory arrest, and coma on admission (2003–2011). Decision tree analysis was used to find clinical [Glasgow Coma Score (GCS), features about cardiac arrest, therapeutic hypothermia, age, and sex] and MRI (infarct volume) associates of severe disability and death. We used the area under the ROC (auROC) to determine accuracy of model. There were 41 (63.7% males) patients having MRI imaging with the average age 51.5 ± 18.9 years old. The decision trees showed that infarct volume and age were important factors for discrimination between mild to moderate disability and severe disability and death at day 0 and day 2. The auROC for this model was 0.94 (95% CI 0.82–1.00). At day 7, GCS value was the only predictor; the auROC was 0.96 (95% CI 0.86–1.00).ConclusionOur findings provide proof of concept for further exploration of the role of MR imaging and decision tree analysis in the early prognostication of hypoxic ischemic brain injury.
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- 2018
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9. Examining the subcortical infarcts in the era of acute multimodality CT imaging
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Mindy Tan, Shaloo Singhal, Henry Ma, Ronil Vikesh Chandra, Jamie Cheong, BENJAMIN B CLISSOLD, John Ly, Velandai Srikanth, and THANH G PHAN
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Angiography ,Perfusion Imaging ,occlusion ,MR imaging ,Lacunar ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Lacunar infarcts have been characterized as small subcortical infarcts, resulting from in situ microatheroma or lipohyalinosis in small vessels. Based on this hypothesis, such infarcts should not be associated with large areas of perfusion deficits extending beyond subcortical regions to involve cortical regions. By contrast, selected small subcortical infarcts, as defined by MR imaging in the subacute or chronic stage, may initially have large perfusion deficits or related large vessel occlusions. These infarcts with ‘lacunar’ phenotype may also be caused by disease in the parent vessel and may have very different stroke mechanisms from small vessel disease. Our aim was to describe differences in imaging characteristics between patients with small subcortical infarction with ‘lacunar phenotype’ from those with lacunar mechanism. Methods: Patients undergoing acute CT Perfusion/angiography (CTP/CTA) within 6 hours of symptom onset and follow-up magnetic resonance imaging (MRI) for ischaemic stroke were included (2009-2013). A lacunar infarct was defined as a single subcortical infarct (SSI) ≤20 mm on follow-up MRI. Presence of perfusion deficits, vessel occlusion and infarct dimensions were compared between lacunar infarcts and other topographical infarct types. Results: Overall, 182 patients (mean age 66.4±15.3 years, 66% male) were included. SSI occurred in 31 (17%) patients. Of these, 12 (39%) patients had a perfusion deficit compared with those with any cortical infarction (120/142, 67%), and the smallest SSI with a perfusion deficit had a diameter of
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- 2016
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10. Prevalence of brain MRI markers of haemorrhagic risk in patients with stroke and atrial fibrillation
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Christopher Karayiannis, Cathy Soufan, Ronil V Chandra, Thanh G Phan, Kitty Wong, Shaloo Singhal, Lee-Anne Slater, John Ly, Chris Moran, and Velandai Srikanth
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Atrial Fibrillation ,Stroke ,MRI ,microhemorrhage ,microbleeds ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background and Purpose: Cerebral microbleeds, cortical superficial siderosis, white matter lesions and cerebral atrophy may signify greater bleeding risk particularly in patients in whom anticoagulation is to be considered. We investigated their prevalence and associations with stroke type in patients with stroke and atrial fibrillation. Material and Methods: Cross-sectional sample, Monash Medical Centre (Melbourne, Australia) between 2010 and 2013, with brain MRI. MRI abnormalities were rated using standardized methods. Logistic regression was used to study associations adjusting for age and sex.Results: There were 170 patients, mean age 78 years (SD 9.8), 154 (90.6%) with ischemic stroke. Prevalence of MRI markers were: any microbleed 49%, multiple (≥2) microbleeds 30%, confluent white matter lesions 18.8%, siderosis 8.9%, severe cerebral atrophy 37.7%. Combinations of the severe manifestations of these markers were much less prevalent (2.9% to 12.4%). Compared with ischemic stroke, those with hemorrhagic stroke were more likely to have ≥10 microbleeds (OR 5.50 95% CI 1.46-20.77, p=0.012) and siderosis (OR 6.24, 95% CI 1.74-22.40, p=0.005). Siderosis was associated with multiple microbleeds (OR 8.14, 95% CI 2.38 - 27.86, p = 0.001). Patients admitted with hemorrhagic stroke and multiple microbleeds were more frequently anticoagulated prior to stroke (6/7, 85.7%) than in those with single (1/2, 50%) or no microbleeds (4/7, 57%). Conclusion: Multiple CMBs, severe WML, and severe cerebral atrophy were common individually in hospitalized patients with stroke and AF, but less so in combination. A higher burden of CMBs may be associated with ICH in stroke patients with AF.
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- 2016
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11. Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey.
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John Ly, Vidiya Sathananthan, Thomas Griffiths, Zahir Kanjee, Avi Kenny, Nicholas Gordon, Gaurab Basu, Dale Battistoli, Lorenzo Dorr, Breeanna Lorenzen, Dana R Thomson, Ami Waters, Uriah G Moore, Ruth Roberts, Wilmot L Smith, Mark J Siedner, and John D Kraemer
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Medicine - Abstract
BackgroundThe Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data.Methods and findingsWe conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March-April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011-June 14, 2014) or EVD period (June 15, 2014-April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48-0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50-0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50-0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36-0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59-1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias.ConclusionsWe detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies.
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- 2016
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12. Recognition of Handwritten Japanese Characters Using Ensemble of Convolutional Neural Networks.
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Angel I. Solis, Justin Zarkovacki, John Ly, and Adham Atyabi
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- 2023
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13. Meta-Analysis of the Use of Head Impulse Test and Head Impulse Test with Direction Changing Nystagmus and Test of Skew Deviation in the Diagnosis of Peripheral Vertigo and Stroke
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Suyi Ooi, Grace Phillips, Tanya Tang, Luke Chen, Anthony Fok, John Ly, Henry Ma, and Thanh G. Phan
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Neurology ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: The head impulse test (HIT) and HIT combined with direction-changing Nystagmus-Test of Skew deviation (HINTS) have been proposed as bedside tests to differentiate between peripheral and central causes of vertigo in the emergency department (ED). We conducted a meta-analysis of the HIT and HINTS tests to diagnose peripheral vertigo (PV) and central vertigo. Methods: Pubmed, Google Scholar, EmBase, and articles references published in English up to July 2021 were searched for keywords “vertigo” or “acute vestibular syndrome” or “dizziness” and “head impulse” and “stroke.” The bivariate method for meta-analysis was used to calculate positive (PLR) and negative likelihood ratios (NLR) and summary receiver operating characteristics area under the curve (AUC). Results: A total of 11 studies were included analysing both HIT (8 studies, N = 417) and HINTS (6 studies, N = 405). HIT and HINTS were performed within 24 h in 4 of 11 studies. PLR and NLR for HIT in PV was 4.85 (95% CI: 2.83–8.08) and 0.19 (95% CI: 0.12–0.29, I2 63.25%), respectively. The AUC for HIT the diagnosis of PV and stroke was 0.90 and 0.92, respectively. PLR and NLR for a negative HIT in stroke was 5.85 (95% CI: 3.07–10.6) and 0.17 (95% CI: 0.08–0.30), respectively. PLR and NLR for peripheral HINTS pattern for PV was 17.3 (95% CI: 8.38–32.1) and 0.15 (95% CI: 0.07–0.26), respectively. PLR and NLR for central HINTS pattern for stroke: 5.61 (95% CI: 4.19–7.7) and 0.06 (95% CI: 0.03–0.12). In all included studies, HIT and HINTS exams were administered by neurology residents or neurology specialists with additional neuro-otology or neuro-ophthalmology subspeciality experience, and two studies included ED physicians. Raters reported high degree of bias and high concern regarding applicability in most domains of the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Meta-regression did not demonstrate a statistically significant effect of publication year, time to test, and type of assessor on sensitivity or false positive rate. Conclusion: The HIT and HINTS exams appear to be moderately good discriminators of central and PV. However, in most papers, the tests were administered by neurologists and were evaluated beyond 24 h, which may limit utility in the ED setting.
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- 2022
14. Post-reconstruction enhancement of [18F]FDG PET images with a convolutional neural network
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Elin Trägårdh, Jonas Jögi, David Minarik, John Ly, and Per Wollmer
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Artificial intelligence ,Image quality ,Coefficient of variation ,media_common.quotation_subject ,R895-920 ,Standardized uptake value ,Convolutional neural network ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,medicine ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,media_common ,Cancer ,Fluorodeoxyglucose ,medicine.diagnostic_test ,business.industry ,Pattern recognition ,PET ,Positron emission tomography ,030220 oncology & carcinogenesis ,Noise (video) ,business ,medicine.drug - Abstract
Background The aim of the study was to develop and test an artificial intelligence (AI)-based method to improve the quality of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) images. Methods A convolutional neural network (CNN) was trained by using pairs of excellent (acquisition time of 6 min/bed position) and standard (acquisition time of 1.5 min/bed position) or sub-standard (acquisition time of 1 min/bed position) images from 72 patients. A test group of 25 patients was used to validate the CNN qualitatively and quantitatively with 5 different image sets per patient: 4 min/bed position, 1.5 min/bed position with and without CNN, and 1 min/bed position with and without CNN. Results Difference in hotspot maximum or peak standardized uptake value between the standard 1.5 min and 1.5 min CNN images fell short of significance. Coefficient of variation, the noise level, was lower in the CNN-enhanced images compared with standard 1 min and 1.5 min images. Physicians ranked the 1.5 min CNN and the 4 min images highest regarding image quality (noise and contrast) and the standard 1 min images lowest. Conclusions AI can enhance [18F]FDG-PET images to reduce noise and increase contrast compared with standard images whilst keeping SUVmax/peak stability. There were significant differences in scoring between the 1.5 min and 1.5 min CNN image sets in all comparisons, the latter had higher scores in noise and contrast. Furthermore, difference in SUVmax and SUVpeak fell short of significance for that pair. The improved image quality can potentially be used either to provide better images to the nuclear medicine physicians or to reduce acquisition time/administered activity.
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- 2021
15. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
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Henry Ma, Eleni Sakka, Hugues Chabriat, Duncan Wilson, Appu Suman, Peter J. Kelly, SL Ho, Charlotte Zerna, Eric Jouvent, Lawrence K.S. Wong, Anthea Parry, Frances Harrington, Jan Stam, Christopher Patterson, Rustam Al-Shahi Salman, Shigeru Inamura, Krishna A Dani, Henry Houlden, Sebastian Thilemann, Kotaro Iida, Chao Xu, Eunbin Ko, Daniel Guisado-Alonso, Urs Fischer, Caroline E. Lovelock, Man Yu Tse, Wing Chi Fong, Azlisham Mohd Nor, Clare Shakeshaft, Philippe Maeder, Henrik Gensicke, Stefan T. Engelter, James Okwera, Christopher Chen, Dulka Manawadu, John F. Corrigan, Efrat Kliper, Shelagh B. Coutts, Alexander P. Leff, Kam Tat Leung, Chathuri Yatawara, Leopold Hertzberger, M. Eline Kooi, Kazuhisa Yoshifuji, Hing Lung Ip, Keon-Joo Lee, Sanjeevikumar Meenakishundaram, Hiroyuki Irie, Marc Randall, Hatice Ozkan, Hideo Hara, Jill Abrigo, Raquel Delgado-Mederos, Shaloo Singhal, Enrico Flossmann, Beatriz Gómez-Ansón, Paul O'Mahony, Carmen Barbato, Ahamad Hassan, Francesca M Chappell, Harald Proschel, Vincent Mok, Masashi Nishihara, Lakshmanan Sekaran, Derya Selcuk Demirelli, Chu Peng Hoi, Hakan Ay, Joan Martí-Fàbregas, Rebeca Marín, Anne Cristine Guevarra, Martin Cooper, Einor Ben Assayag, Anne-Marie Mendyk, Christine Roffe, Myung Suk Jang, Maarten van Gemert, Hannah Cohen, Jae-Sung Lim, YK Wong, Bonnie Y.K. Lam, Janet Putterill, Wouter Schoonewille, Nick S. Ward, Nikola Sprigg, Kui Kai Lau, Bernard Esisi, Peter M. Rothwell, Henk Verbiest, Kirsty Harkness, Elisa Merino, Gareth Ambler, Arumug Nallasivam, Nigel Smyth, Paul A. Armitage, Heinrich Mattle, Pol Camps-Renom, Martin M. Brown, David Cohen, Min Lou, Pankaj Sharma, Sarah Gunkel, Elles Douven, Andreas Charidimou, Djamil Vahidassr, Cathy Soufan, Alexandros A Polymeris, Michael G. Hennerici, Chris Moran, Rachel Marsh, Mahmud Sajid, Kyohei Fujita, David J. Werring, Joanna M. Wardlaw, Derek Hayden, Joseph Kwan, Timothy J. England, Jaap van der Sande, Luis Prats-Sánchez, Paul Guyler, Ryan Hoi Kit Cheung, Koon-Ho Chan, Frank-Erik de Leeuw, Simone Browning, Jon Scott, Adrian Barry, Alejandro Martínez-Domeño, Luc Bracoub, Dinesh Chadha, Ijaz Anwar, Deborah Kelly, Moon-Ku Han, Anil M. Tuladhar, Thomas Gattringer, Fiona Carty, Abduelbaset Elmarim, Syed Mansoor, Enrico Flossman, Dilek Necioglu Orken, Jane Sword, Velandai Srikanth, Ping Wing Ng, Thomas W. Leung, Richard Shek-kwan Chang, Hans Rolf Jäger, Marwan El-Koussy, Jeroen Hendrikse, Khaled Darawil, Kazunori Toyoda, Mathuri Prabhakaran, Karim Mahawish, Ethem Murat Arsava, Jihoon Kang, Kwok Kui Wong, Michael Power, Felix Fluri, Enas Lawrence, Maam Mamun, Sissi Ispoglou, Mathew Burn, Siu Hung Li, Henry K.F. Mak, Kaori Miwa, Els De Schryver, Franz Fazekas, Jonathan G. Best, Louise Shaw, Hen Hallevi, Keith W. Muir, Ilse Burger, Adrian Wong, Nils Peters, Susana Muñoz-Maniega, Yusuke Yakushiji, David Calvet, Mark White, Michael McCormick, Vinodh Krishnamurthy, David Hargroves, Jan C. Purrucker, Tae Jin Song, Masayuki Shiozawa, Noortje A.M. Maaijwee, Prasanna Aghoram, Nicolas Christ, Lino Ramos, Yannie Soo, Thanh G. Phan, Parashkev Nachev, David J. Seiffge, Kim Wiegertjes, Leo H. Bonati, Chahin Pachai, Oi Ling Chan, Yvo B.W.E.M. Roos, Santiago Medrano-Martorell, Natan M. Bornstein, Elizabeth A. Warburton, Richard Li, Prabel Datta, Pascal P. Gratz, Edmund Ka Ming Wong, Hedley C. A. Emsley, Marie-Yvonne Douste-Blazy, Gunaratam Gunathilagan, Nagaendran Kandiah, Masatoshi Koga, Roland Veltkamp, Lee-Anne Slater, Suk Fung Tsang, Beom Joon Kim, Simon Jung, Zeynep Tanriverdi, Sarah Caine, Peter J. Koudstaal, Laurence Legrand, Kari Saastamoinen, Ale Algra, Jean-Louis Mas, Christine Delmaire, Fidel Nuñez, Robert J. van Oostenbrugge, Sebastian Eppinger, Lillian Choy, Robert Luder, Vincent I.H. Kwa, Aad van der Lugt, Marie Dominique Fratacci, Stephen Makin, Layan Akijian, Régis Bordet, Mi Hwa Yang, Ying Zhou, Elio Giallombardo, Adrian R Parry-Jones, John S. Thornton, Amos D. Korczyn, Narayanaswamy Venketasubramanian, David J. Williams, Aravindakshan Manoj, Julie Staals, Solveig Horstmann, Dianne H.K. van Dam-Nolen, Claire Cullen, Benjamin Wagner, Jun Tanaka, Martin Dennis, Stef Bakker, Gregory Y.H. Lip, L. Jaap Kappelle, Robin Lemmens, Achim Gass, David Mangion, Matthew Smith, Toshio Imaizumi, Wenyan Liu, Jeremy Molad, Christopher Price, Paul J. Nederkoorn, P. J. A. M. Brouwers, Vincent Thijs, Sze Ho Ma, Mark Schembri, Peter Wilkinson, Janice E. O’Connell, Karen Ma, John Ly, Leonidas Panos, Chung Yan Chan, Toshihiro Ide, Christopher Traenka, Joost Jöbsis, Gargi Banerjee, Paul Berntsen, Michael J. Thrippleton, Raymond T.F. Cheung, Christopher Karayiannis, Werner H. Mess, Robert Simister, Jayesh Modi Medanta, Syuhei Ikeda, John Mitchell, Linxin Li, Mauro S.B. Silva, Eric Vicaut, John Coyle, Shoichiro Sato, Michelle Davis, Jonathan Birns, Richard J. Perry, Sean M. Murphy, KC Teo, Maria del C. Valdés Hernández, Bibek Gyanwali, Tarek A. Yousry, Kath Pasco, Sebastian Köhler, Joachim Fladt, Edward S. Hui, Philippe Lyrer, Young Dae Kim, Anna K. Heye, Eric E. Smith, Saima Hilal, Ender Uysal, Ji Hoe Heo, Ysoline Beigneux, Cisca Linn, Hee-Joon Bae, Simon Leach, Winnie C.W. Chu, Ronil V. Chandra, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, MUMC+: HZC Med Staf Spec Klinische Neurofys (9), RS: Carim - B06 Imaging, MUMC+: HZC Klinische Neurofysiologie (5), Klinische Neurowetenschappen, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Neurologie (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Med Staf Spec Neurologie (9), RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, Beeldvorming, and MUMC+: DA BV Klinisch Fysicus (9)
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Adult ,Male ,Risk ,EXTERNAL VALIDATION ,medicine.medical_specialty ,Neurology ,MODELS ,Clinical Neurology ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Recurrence ,Internal medicine ,Antithrombotic ,Humans ,Medicine ,Prospective cohort study ,610 Medicine & health ,Stroke ,METAANALYSIS ,Aged ,Ischemic Stroke ,Science & Technology ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,Magnetic resonance imaging ,Middle Aged ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,medicine.disease ,Magnetic Resonance Imaging ,Ischemic Attack, Transient ,ATRIAL-FIBRILLATION ,Cardiology ,Female ,Neurology (clinical) ,Neurosciences & Neurology ,business ,Intracranial Hemorrhages ,Life Sciences & Biomedicine ,030217 neurology & neurosurgery ,Fibrinolytic agent ,Cohort study - Abstract
Contains fulltext : 235277.pdf (Publisher’s version ) (Closed access) BACKGROUND: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. METHODS: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. FINDINGS: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with a calibration slope of 0·97 (0·87-1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. INTERPRETATION: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. FUNDING: British Heart Foundation and Stroke Association.
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- 2021
16. First reported case in an Irish flock of MCF- like systemic necrotizing vasculitis in sheep associated with ovine herpesvirus 2
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Maresa Sheehan, Patricia A. Pesavento, Francis Campion, John Lynch, Shane McGettrick, Brian Toland, and Aideen Kennedy
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MCF- like systemic necrotizing vasculitis ,Ovine gammaherpesvirus 2 (OvHV-2) ,Sheep ,Ireland ,Veterinary medicine ,SF600-1100 - Abstract
Abstract Background Ovine gammaherpesvirus 2 (OvHV-2) is the causative agent of sheep associated malignant catarrhal fever (MCF). As sheep are the adapted host for OvHV-2, it is generally presumed that infection is not associated with disease in this species. However, a recent case review combined in-situ hybridisation, PCR and histopathology and correlated the viral distribution with systemic necrotizing vasculitis and concluded OvHV-2 was the likely agent responsible for sporadic, MCF-like vascular disease in sheep. Case presentation Using similar methods this case study reports on the findings of the first reported cases in an Irish Flock of MCF- like systemic necrotizing vasculitis in sheep associated with OvHV-2. Sheep A, a 16-month-old Texel-cross hogget displayed signs of ill- thrift, Sheep B, a nine-month-old Belclare-cross lamb, was found dead having displayed no obvious symptoms. Both cases occurred on the same farm, however the animals were not related. Lymphohistiocytic vasculitis of various tissues was the predominant histopathological finding in both animals. Conclusion By combining histopathology, PCR and in-situ hybridisation results, MCF- like systemic necrotizing vasculitis associated with OvHV-2 has been diagnosed for the first time in an Irish flock.
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- 2024
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17. Application of principal component analysis to study topography of hypoxic-ischemic brain injury.
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Shaloo Singhal, Jian Chen 0031, Richard Beare, Henry Ma, John Ly, and Thanh G. Phan
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- 2012
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18. An innovative approach to developing practice informed evidence in the absence of RCTs for a Family-led peer to peer support program
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Alicia Montgomerie, Vita Maiorano, Danielle Abbott, John Lynch, and Rhiannon Pilkington
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Demography. Population. Vital events ,HB848-3697 - Abstract
Objective To illustrate how whole-population linked data can be used to understand a system perspective of client complexity, and build robust evidence of Family by Family program impact. Methods Family by Family program (the program) participant data were linked into the Better Evidence Better Outcomes Linked Data (BEBOLD) Platform. BEBOLD is a whole-of-population linked de-identified administrative data platform for all South Australian children born 1991 onwards (n~500,000), as well as their parents including data spanning health, education, and social services. We descriptively analysed parental child protection history, emergency department presentations, hospitalisations, homelessness and justice system contact in the 24 months prior to and post program commencement. We emulate a trial using the ‘target trial’ causal inference framework to evaluate the program effect on a range of child outcomes using targeted maximum likelihood with a set of over 20 confounders. Results There were 361 families and 841 children in the program included in analysis. Selected results follow: Prior to the program, 35.8% of children were in a family where at least one parent had their own child protection history and 8% had a parent who experienced out-of-home care. Nearly 40% of children had at least one parent with a mental health related emergency department and/or hospitalisation, while 22% of children were in a family with specialist homelessness service contact. Program impact results will be presented at the conference. Conclusion This research-practice partnership illustrates how bringing together program and linked-administrative data generates new evidence about client complexity and program impact.
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- 2024
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19. The scale and timing of child protection system contacts from 0-18 years: a study of 1.9 million Australian children
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Rhiannon Pilkington, Kathleen Falster, Mark Hanly, Alicia Montgomerie, Tasnia Ahmed, BJ Newton, Ben Edwards, Raghu Lingam, Anthony Shakeshaft, Michelle Cretikos, Jessica Stewart, Katherine Hawkins, Kitty McLean, and John Lynch
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Demography. Population. Vital events ,HB848-3697 - Abstract
Introduction To prevent abuse, neglect and poor outcomes for children and families, including child protection intervention, maltreatment, and removals, it is critical to understand the scale and timing of child protection system contacts to identify opportunities for early prevention. Objectives and Approach We quantified the cumulative incidence of child protection contacts during childhood, including initial reports, screened-in reports, investigations, substantiations and removal into out-of-home-care, among all children in two Australian states. We used child protection system data linked for the South Australian (SA) BEBOLD and NSW Child E-Cohort data platforms as the numerator, and census data for the denominator, for 571,497 SA children (birth-years 1991-2019) and 1,362,505 NSW children (birth-years 2005-2018). Results Of children born in 2005 (NSW SA): Two in five children were reported to child protection by age 14; one in ten children were the subject of a child protection investigation in NSW and SA; one in twelve children in NSW and one in 17 in SA, were substantiated at least once; and one in 35 children in NSW and one in 40 in SA were removed into out-of-home care at least once by age 14. Approximately half of all types of child protection contact first occurred by the child’s fourth birthday. Conclusions/implications The scale of lifecourse child protection contact underscores the opportunities for early health and social supports to prevent child maltreatment and escalating child protection intervention. Child protection reports also represent an asset to generate public health intelligence to inform early prevention.
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- 2024
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20. Prenatal and early life maternal substance use prevalence among Australian children born 2007-2018: a data linkage study using health, death, and child protection data
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Madeleine Powell, Rhiannon Pilkington, Tasnia Ahmed, Mark Hanly, BJ Newton, John Lynch, Timothy Dobbins, Jessica Stewart, Michelle Cretikos, Alys Havard, and Falster Kathleen
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Demography. Population. Vital events ,HB848-3697 - Abstract
Objective Quantify the scale and type of maternal substance use from conception to the child’s second birthday (First 1000 days) to inform screening and support services that may reduce associated harm or risk for children. Approach We used mother and child records from whole-population health, death, and child protection datasets to ascertain maternal substance use during the First 1000 days for children born in NSW, Australia, from 2008-2017. The primary outcome - maternal substance use - included use of illicit substances, alcohol, opioid-agonist treatment, organic compounds, solvents, and misuse of prescription medicines. ICD-10 and SNOMED-CT diagnosis codes were used. Results The birth cohort included 970,470 children and 625,856 mothers. 32,000 children (3.4%) had a record of maternal substance use during the First 1000 days of life, including 13,647 (1.4%) with alcohol and 23,485 (2.4%) other drug use. Ascertainment was highest from child protection records (26,045 children), followed by mother’s (12,956 children) then children’s hospital records (3,826 children). 18,672 (1.9%) children had a record of carer substance use only in child protection records. Combining data increased the prevalence estimates; adding child protection records increased the prevalence estimate to 3.4%, compared with 1.2% in health and death records alone. Conclusion More than 3 in every 100 Australian children had a record of maternal substance use in administrative data during the First 1000 days of life in this decade-long study. In addition to health and death data, child protection data offers public health insights into the scale of maternal substance use among whole-population cohorts of children.
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- 2024
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21. Early life child protection contacts and developmental risk at age five: a whole-of-population cohort study of 479,413 children in two Australian states.
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Kathleen Falster, Rhiannon Pilkington, Tasnia Ahmed, Alicia Montgomerie, Mark Hanly, BJ Newton, Marni Brownell, Ben Edwards, Raghu Lingam, Anthony Shakeshaft, Michelle Cretikos, Jessica Stewart, Katherine Hawkins, Kitty McLean, and John Lynch
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Demography. Population. Vital events ,HB848-3697 - Abstract
Introduction Children who experience maltreatment have worse health and development outcomes than other children. Early prevention relies on opportunities to respond to system contacts that reliably indicate the population burden of children’s future developmental risk. Objectives and Approach We quantified the population burden of developmental vulnerability at age five by the type, timing, and frequency of child protection contacts before school, among children in two Australian states. We used linked whole-population births, child protection and Australian Early Development Census (AEDC) data (2009-2018 cycles) in New South Wales (NSW) and South Australia (SA). Results 56,650/398,702 (14%) NSW and 12,617/80,731 (16%) SA children had ≥1 child protection contacts before school. The risk of developmental vulnerability on ≥1 domains was lowest in the no child protection group (NSW, 17-18%; SA, 19%), with higher risks in the child protection report (NSW, 28-29%; SA, 32-35%) through to the OOHC (NSW, 35-38%; SA, 39-50%) groups, with a similar pattern for the risk of medically diagnosed conditions. Children with only one child protection report before school had a higher developmental risk than the no child protection group (NSW, 34% versus 21%; SA, 42% versus 24%). Conclusions/Implications Even a single child protection report in the first 2000 days of children’s lives was a robust indicator of developmental risk at age five, with higher developmental risks among children with more serious child protection contacts before school. Child protection reports represent an under-utilised asset to inform early universal and targeted support from health, human and early education services.
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- 2024
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22. The survival outcomes of localized low‐risk prostate cancer, a population‐based study using NCDB
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Shifeng Mao, Arash Samiei, Yue Yin, Rodney E. Wegner, Angela Sanguino, John Lyne, Ralph Miller, and Jeffrey Cohen
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active surveillance ,external beam radiation ,low‐risk prostate cancer ,prostate seed implantation ,prostatectomy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background The optimal treatment approach for low‐risk prostate cancer (LRPC) remains controversial. While active surveillance is an increasingly popular option, definitive local treatments, including radical prostatectomy (RP), external beam radiotherapy (EBRT), and prostate seed implantation (PSI), are also commonly used. This study aimed to evaluate the survival outcomes of patients with LRPC using a large patient population from the National Cancer Database (NCDB). Methods We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using the NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local treatment (NLT). Only patients with Charlson–Deyo comorbidity scores of 0 or 1 were included to ensure comparability. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups. Results After a median follow‐up of 70.8 months, 24,545 deaths occurred, resulting in an all‐cause mortality rate of 13%. RP demonstrated a survival benefit compared with NLT, particularly in patients younger than 74 years of age. In contrast, radiation treatments (EBRT and PSI) did not improve survival in the younger age groups, except for patients older than 70 years for EBRT and older than 65 years for PSI. Notably, EBRT in patients younger than 65 years was associated with inferior outcomes. Conclusion This study highlights the differences in survival outcomes among LRPC treatment modalities. RP was associated with improved survival compared to NLT, especially in younger patients. In contrast, EBRT and PSI showed survival benefits primarily in the older age groups. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. These findings emphasize the importance of individualized treatment decisions for LRPC management.
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- 2024
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23. Stroke in patients with cancer in the era of hyperacute stroke intervention
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Henry Ma, Ruwan Wijayaratna, John Ly, Amy Davies, Thanh G. Phan, Shaloo Singhal, Benjamin Clissold, Lyndal Van Leer, and Jasmine Chan
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Disease ,Brain Ischemia ,Fibrinolytic Agents ,Internal medicine ,Neoplasms ,Internal Medicine ,medicine ,Humans ,Thrombolytic Therapy ,cardiovascular diseases ,Stage (cooking) ,Stroke ,Survival analysis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Cancer ,Thrombosis ,Thrombolysis ,Middle Aged ,medicine.disease ,Natural history ,Treatment Outcome ,Tissue Plasminogen Activator ,Cohort ,Female ,business - Abstract
OBJECTIVE The natural history of patients with stroke and cancer remains poorly understood in the modern era of hyper-acute stroke therapies (recombinant tissue plasminogen activator (tPA) and endovascular clot retrieval (ECR)). Prior to these advances in stroke treatment, a highly cited study reported median overall survival (mOS) 4.5 months after stroke in a cohort of patients with cancer (2004, n=96). Our aim is to evaluate outcome following stroke for patients with cancer in this modern era. Our hypothesis is that patients with stroke and cancer have better outcome than in earlier studies. DESIGN AND SETTING Retrospective analysis of admission to a tertiary Stroke Unit between January 2015 and September 2017 (N=1910), evaluation of hospital records and cancer treatment records. OUTCOME MEASURES Cancer was categorised as early stage (stage I and II) and advanced stage (stage III or IV, using the RD-Staging system). Survival analysis was performed in R. RESULTS There were 143 stroke patients with cancer (62% male) with mean age 73.2 +/- 12.5 years. Ischemic stroke occurred in 74.1% and 45 of 106 patients (42.5%) received intravenous thrombolysis (34/45) and / or endovascular clot retrieval (11/45). One patient who received ECR died within 30-days of stroke. Those with early-stage disease had mOS of 19.6 months (IQR 3.1, 31.5 months) and in advanced stage cancer mOS was 2.5 months (IQR 0.4, 6.3 months, p
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- 2021
24. AI-based detection of lung lesions in [18F]FDG PET-CT from lung cancer patients
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John Ly, Lars Edenbrandt, Johannes Ulén, Pablo Borrelli, Olof Enqvist, Elin Trägårdh, and Reza Kaboteh
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,FDG ,lcsh:R895-920 ,Automatic ,PET-CT ,Biomedical Engineering ,Total lesion glycolysis ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Segmentation ,Positive predicative value ,medicine ,Radiology, Nuclear Medicine and imaging ,Lung cancer ,Instrumentation ,Original Research ,Radiation ,Lung ,medicine.diagnostic_test ,business.industry ,medicine.disease ,medicine.anatomical_structure ,Positron emission tomography ,AI ,030220 oncology & carcinogenesis ,Fdg pet ct ,medicine.symptom ,Nuclear medicine ,business - Abstract
Background [18F]-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) is a well-established modality in the work-up of patients with suspected or confirmed diagnosis of lung cancer. Recent research efforts have focused on extracting theragnostic and textural information from manually indicated lung lesions. Both semi-automatic and fully automatic use of artificial intelligence (AI) to localise and classify FDG-avid foci has been demonstrated. To fully harness AI’s usefulness, we have developed a method which both automatically detects abnormal lung lesions and calculates the total lesion glycolysis (TLG) on FDG PET-CT. Methods One hundred twelve patients (59 females and 53 males) who underwent FDG PET-CT due to suspected or for the management of known lung cancer were studied retrospectively. These patients were divided into a training group (59%; n = 66), a validation group (20.5%; n = 23) and a test group (20.5%; n = 23). A nuclear medicine physician manually segmented abnormal lung lesions with increased FDG-uptake in all PET-CT studies. The AI-based method was trained to segment the lesions based on the manual segmentations. TLG was then calculated from manual and AI-based measurements, respectively and analysed with Bland-Altman plots. Results The AI-tool’s performance in detecting lesions had a sensitivity of 90%. One small lesion was missed in two patients, respectively, where both had a larger lesion which was correctly detected. The positive and negative predictive values were 88% and 100%, respectively. The correlation between manual and AI TLG measurements was strong (R2 = 0.74). Bias was 42 g and 95% limits of agreement ranged from − 736 to 819 g. Agreement was particularly high in smaller lesions. Conclusions The AI-based method is suitable for the detection of lung lesions and automatic calculation of TLG in small- to medium-sized tumours. In a clinical setting, it will have an added value due to its capability to sort out negative examinations resulting in prioritised and focused care on patients with potentially malignant lesions.
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- 2021
25. Qualitative Evaluation of an Antimicrobial Stewardship Tele-Mentoring Program in US Rural & Critical Access Hospitals
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Elizabeth Moore, Ellen MacLachlan, Natalia Martinez-Paz, Maria Bajenov, Rupali Jain, Jeannie Chan, John Lynch, Paul Pottinger, Zahra Kassamali Escobar, and Chloe Bryson-Cahn
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: The University of Washington (UW) Center for Stewardship in Medicine (CSiM) supports a tele-antimicrobial stewardship (AMS) program (TASP) using the ECHO approach (Extension for Community Healthcare Outcomes) in small, rural, and Critical Access Hospitals (primarily in the western U.S.) with education, mentoring, organizational capacity building, and a community of peers. To evaluate the continuing education (CE) component of UW-TASP ECHO, CSiM surveyed individuals receiving CE credits as part of the program. This survey was designed to track individuals’ satisfaction with the program and to assess the impact of UW-TASP ECHO on AMS in participating facilities. Methods: The CE participants’ survey was completed annually by individuals participating in UW TASP ECHO using online survey software. The survey included closed-ended and open-ended questions. Responses to open-ended questions were entered into Atlas.ti qualitative analysis software and coded iteratively according to themes that emerged. When a new code emerged partway through the coding process, earlier surveys were re-coded for the new code. Final codes were grouped into themes and sub-themes and quotes from each theme identified were summarized and attached to the theme and reported. Results: Data from three administrations of this survey were available: 2018-2019 (n=66); 2020-2021 (n=27); and 2021-2022 (n=30). These surveys were completed by a total of 95 individuals from 53 hospitals. Seven of these individuals completed a survey in each year, 14 completed a survey in two years, and 74 completed only one survey. Themes identified were COVID-19 support (including procedures and policies, being kept up-to-date, research summaries, and peer support), the antibiotic pocket guide developed by UW, strength in community, staff education, role of CSiM in developing/strengthening the AMS program at the facility, change in use of antibiotics, UW imprimatur, learning/growing as a healthcare provider, and importance for small, rural hospitals (see examples in Table 1). Conclusions: This qualitative analysis provides evidence from surveys of individuals participating in CE that UW TASP ECHO has had a meaningful impact in such domains as building a strong community among small, rural and critical access hospitals, educating staff, changing antibiotic use and providing peer support, among others.
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- 2024
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26. Tulio Halperin Donghi, Politics, Economics and Society in Argentina in the Revolutionary Period (Cambridge: Cambridge University Press, 1975).
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John Lynch
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Language and Literature ,Literature (General) ,PN1-6790 - Published
- 2024
27. Detection of traumatic stress in the presence of traumatic experiences: the role of resilience factors in foster care children five years or younger
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Kimberly I. Tumlin, Amanda Crowley, Brian Turner, Elizabeth Riley, and John Lyons
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Traumatic stress ,Detection ,Young children ,Foster care ,Resilience ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Background Children less than five years of age comprised approximately 30% in 2020 of foster care entries in the United States, and they are consistently the largest foster care entry group. Very young children can respond differently to the same adverse life events. Detection of complex interpersonal traumas is core to providing appropriate interventions and prevention of reoccurring negative outcomes in these children. Methods Children who (1) were identified as having experienced complex interpersonal trauma, but (2) who did not have traumatic stress symptoms were identified using Child and Adolescent Needs and Strengths data in a large midwestern state from 2010 to 2021. A logistic model was fit to determine the effect of cumulative traumatic exposures (e.g., adverse childhood experiences such that increased events were hypothesized to predict an increased likelihood of symptomatic detection. We conducted a latent class analysis to understand the relationship between traumatic experiences, asset-based factors, and the detection of traumatic stress in children aged five years and under who had exposure to traumatic events but did not have detectable traumatic stress symptoms. Results We detected three classes within this population of very young children, who were described as “resilient” (demonstrating asset-based resilience when faced with traumatic experiences), “missed” (those who exhibit behavioral and mental health types like those with detected traumatic stress symptoms but who were not detected as such), and “unfolding”. Very young children do demonstrate asset-based resilience when faced with traumatic experiences. Conclusions Detection of traumatic stress may be more difficult in young children. It is important to assess both traumatic stress and strengths to ensure that children who are resilient after exposure to traumatic experiences (i.e., do not demonstrate traumatic stress symptoms) are not referred to unnecessary interventions. Additional educational approaches are needed to help caseworkers identify symptoms of traumatic stress that mirror symptoms of other behavioral and emotional challenges. Precision medicine approaches are required to best match the interventions to specific needs of young children. Recognition of resilience in very young children is critical for designing systems that customize approaches of trauma-informed care.
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- 2023
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28. Publisher Correction: The net electrostatic potential and hydration of ABCG2 affect substrate transport
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Tomoka Gose, Heather M. Aitken, Yao Wang, John Lynch, Evadnie Rampersaud, Yu Fukuda, Medb Wills, Stefanie A. Baril, Robert C. Ford, Anang Shelat, Megan L. O’Mara, and John D. Schuetz
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Science - Published
- 2024
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29. Measuring Knowledge of Community Health Workers at the Last Mile in Liberia: Feasibility and Results of Clinical Vignette Assessments
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Jennifer Bass, Mark J. Siedner, Nathan Uchtmann, Anne H McKenna, Lisa R. Hirschhorn, Lekilay G Tehmeh, Jordan Downey, Anup Agarwal, E John Ly, Emily White, Kuang-Ning Huang, Savior Flomo Mendin, Ami Waters, M Shoaib Khan, Nelson Dunbar, John D. Kraemer, Raj Panjabi, and Avi Kenny
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medicine.medical_specialty ,Referral ,Psychological intervention ,MEDLINE ,Coaching ,Proxy (climate) ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Community health workers ,Humans ,030212 general & internal medicine ,Community Health Services ,Child ,Community Health Workers ,030219 obstetrics & reproductive medicine ,business.industry ,General Medicine ,Liberia ,Checklist ,Vignette ,Family medicine ,Feasibility Studies ,Original Article ,business ,Case Management - Abstract
We integrated clinical vignettes into routine programmatic supervision to assess community health worker knowledge of integrated community case management in rural Liberia. Results included higher rates of correct diagnosis and lifesaving treatment for uncomplicated disease than for more severe cases, with accurate recognition of danger signs posing a challenge., Key Findings Administration of vignettes in a community setting in rural Liberia was feasible and effective for measuring community health worker (CHW) knowledge of case management for the 3 major causes of child mortality addressed by integrated management of childhood illness. Correct diagnosis and lifesaving treatment for uncomplicated malaria were high, but correct diagnosis and treatment rates for complicated conditions including pneumonia with a danger sign were low. Although use of existing digital and paper-based clinical decision support job aids was inconsistent, CHWs who used them had statistically significant higher rates of correct diagnosis and treatment. Key Implications Improving the quality of CHW-delivered care is an important component of achieving universal health coverage, but gaps exist in how to measure knowledge and quality of delivery in remote settings. Clinical vignettes offer a potential approach for program implementers and policy makers to measure CHW knowledge, as a first step to incorporating assessments of the quality of CHW-delivered care into national CHW programs., Introduction: Community health workers (CHWs) can provide lifesaving treatment for children in remote areas, but high-quality care is essential for effective delivery. Measuring the quality of community-based care in remote areas is logistically challenging. Clinical vignettes have been validated in facility settings as a proxy for competency. We assessed feasibility and effectiveness of clinical vignettes to measure CHW knowledge of integrated community case management (iCCM) in Liberia's national CHW program. Methods: We developed 3 vignettes to measure knowledge of iCCM illnesses (malaria, diarrhea, and pneumonia) in 4 main areas: assessment, diagnosis, treatment, and caregiver instructions. Trained nurse supervisors administered the vignettes to CHWs in 3 counties in rural Liberia as part of routine program supervision between January and May 2019, collected data on CHW knowledge using a standardized checklist tool, and provided feedback and coaching to CHWs in real time after vignette administration. Proportions of vignettes correctly managed, including illness classification, treatment, and referral where necessary, were calculated. We assessed feasibility, defined as the ability of clinical supervisors to administer the vignettes integrated into their routine activities once per year for each CHW, and effectiveness, defined as the ability of the vignettes to measure the primary outcomes of CHW knowledge of diagnosis and treatment including referrals. Results: We were able to integrate this assessment into routine supervision, facilitate real-time coaching, and collect data on iCCM knowledge among 155 CHWs through delivery of 465 vignettes. Diagnosis including severity was correct in 65%–82% of vignettes. CHWs correctly identified danger signs in 44%–50% of vignettes, correctly proposed referral to the facility in 63% of vignettes including danger signs, and chose correct lifesaving treatment in 23%–65% of vignettes. Both diagnosis and lifesaving treatment rates were highest for malaria and lowest for severe pneumonia. Conclusion: Administration of vignettes to assess knowledge of correct iCCM case management was feasible and effective in producing results in this setting. Proportions of correct diagnosis and lifesaving treatment varied, with high proportions for uncomplicated disease, but lower for more severe cases, with accurate recognition of danger signs posing a challenge. Future work includes validation of vignettes for use with CHWs through direct observation, strengthening supportive supervision, and program interventions to address identified knowledge gaps.
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- 2020
30. The fraction of life years lost after diagnosis (FLYLAD): a person-centred measure of cancer burden
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David Banham, Jonathan Karnon, Alex Brown, David Roder, and John Lynch
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Indigenous Australians ,Cancer ,Premature mortality ,Mortality to incidence ratio ,Disparity ,Burden of disease ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Cancer control initiatives are informed by quantifying the capacity to reduce cancer burden through effective interventions. Burden measures using health administrative data are a sustainable way to support monitoring and evaluating of outcomes among patients and populations. The Fraction of Life Years Lost After Diagnosis (FLYLAD) is one such burden measure. We use data on Aboriginal and non-Aboriginal South Australians from 1990 to 2010 to show how FLYLAD quantifies disparities in cancer burden: between populations; between sub-population cohorts where stage at diagnosis is available; and when follow-up is constrained to 24-months after diagnosis. Method FLYLADcancer is the fraction of years of life expectancy lost due to cancer (YLLcancer) to life expectancy years at risk at time of cancer diagnosis (LYAR) for each person. The Global Burden of Disease standard life table provides referent life expectancies. FLYLADcancer was estimated for the population of cancer cases diagnosed in South Australia from 1990 to 2010. Cancer stage at diagnosis was also available for cancers diagnosed in Aboriginal people and a cohort of non-Aboriginal people matched by sex, year of birth, primary cancer site and year of diagnosis. Results Cancers diagnoses (N = 144,891) included 777 among Aboriginal people. Cancer burden described by FLYLADcancer was higher among Aboriginal than non-Aboriginal (0.55, 95% CIs 0.52–0.59 versus 0.39, 95% CIs 0.39–0.40). Diagnoses at younger ages among Aboriginal people, 7 year higher LYAR (31.0, 95% CIs 30.0–32.0 versus 24.1, 95% CIs 24.1–24.2) and higher premature cancer mortality (YLLcancer = 16.3, 95% CIs 15.1–17.5 versus YLLcancer = 8.2, 95% CIs 8.2–8.3) influenced this. Disparities in cancer burden between the matched Aboriginal and non-Aboriginal cohorts manifested 24-months after diagnosis with FLYLADcancer 0.44, 95% CIs 0.40–0.47 and 0.28, 95% CIs 0.25–0.31 respectively. Conclusion FLYLAD described disproportionately higher cancer burden among Aboriginal people in comparisons involving: all people diagnosed with cancer; the matched cohorts; and, within groups diagnosed with same staged disease. The extent of disparities were evident 24-months after diagnosis. This is evidence of Aboriginal peoples’ substantial capacity to benefit from cancer control initiatives, particularly those leading to earlier detection and treatment of cancers. FLYLAD’s use of readily available, person-level administrative records can help evaluate health care initiatives addressing this need.
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- 2023
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31. The net electrostatic potential and hydration of ABCG2 affect substrate transport
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Tomoka Gose, Heather M. Aitken, Yao Wang, John Lynch, Evadnie Rampersaud, Yu Fukuda, Medb Wills, Stefanie A. Baril, Robert C. Ford, Anang Shelat, Megan L. O’Mara, and John D. Schuetz
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Science - Abstract
Abstract ABCG2 is a medically important ATP-binding cassette transporter with crucial roles in the absorption and distribution of chemically-diverse toxins and drugs, reducing the cellular accumulation of chemotherapeutic drugs to facilitate multidrug resistance in cancer. ABCG2’s capacity to transport both hydrophilic and hydrophobic compounds is not well understood. Here we assess the molecular basis for substrate discrimination by the binding pocket. Substitution of a phylogenetically-conserved polar residue, N436, to alanine in the binding pocket of human ABCG2 permits only hydrophobic substrate transport, revealing the unique role of N436 as a discriminator. Molecular dynamics simulations show that this alanine substitution alters the electrostatic potential of the binding pocket favoring hydration of the transport pore. This change affects the contact with substrates and inhibitors, abrogating hydrophilic compound transport while retaining the transport of hydrophobic compounds. The N436 residue is also required for optimal transport inhibition of ABCG2, as many inhibitors are functionally impaired by this ABCG2 mutation. Overall, these findings have biomedical implications, broadly extending our understanding of substrate and inhibitor interactions.
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- 2023
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32. Googling Service Boundaries for Endovascular Clot Retrieval Hub Hospitals in a Metropolitan Setting
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Jian Chen, Velandai Srikanth, Thanh G. Phan, Richard Beare, Shaloo Singhal, John Ly, Benjamin Clissold, and Henry Hin Kui Ma
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Service (systems architecture) ,Victoria ,Population ,Statistical difference ,03 medical and health sciences ,0302 clinical medicine ,Catchment Area, Health ,Humans ,Medicine ,030212 general & internal medicine ,Endovascular treatment ,education ,Advanced and Specialized Nursing ,Internet ,Spatial Analysis ,education.field_of_study ,Models, Statistical ,business.industry ,Endovascular Procedures ,Metropolitan area ,Hospitals ,Stroke ,Transportation of Patients ,Proof of concept ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Stroke incidence ,business ,Cartography ,030217 neurology & neurosurgery - Abstract
Background and Purpose— There is great interest in how endovascular clot retrieval hubs provide services to a population. We applied a computational method to objectively generate service boundaries for such endovascular clot retrieval hubs, defined by traveling time to hub. Methods— Stroke incidence data merged with population census to estimate numbers of stroke in metropolitan Melbourne, Australia. Traveling time from randomly generated addresses to 4 endovascular clot retrieval–capable hubs (Royal Melbourne Hospital [RMH], Monash Medical Center [MMC], Alfred Hospital [ALF], and Austin Hospital [AUS]) estimated using Google Map application program interface. Boundary maps generated based on traveling time at various times of day for combinations of hubs. Results— In a 2-hub model, catchment was best distributed when RMH was paired with MMC (model 1a, RMH 1765 km 2 and MMC 1164 km 2 ) or with AUS (model 1c, RMH 1244 km 2 and AUS 1685 km 2 ), with no statistical difference between models ( P =0.20). Catchment was poorly distributed when RMH was paired with ALF (model 1b, RMH 2252 km 2 and ALF 676 km 2 ), significantly different from both models 1a and 1c (both P P Conclusions— We provide proof of concept for a novel computational method to objectively designate service boundaries for endovascular clot retrieval hubs.
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- 2017
33. Implementation research on community health workers’ provision of maternal and child health services in rural Liberia
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Gerald A Sechler, Benjamin Grant, Mark J. Siedner, Lorenzo Dorr, Subarna Mukherjee, E John Ly, Breanna Lorenzen, Alice Johnson, Avi Kenny, Vidiya Sathananthan, Peter W Luckow, John D. Kraemer, Netus Nowine, Emily White, Kirby Erlandson, Abigail McDaniel, Rajesh Panjabi, and Madeleine Ballard
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Adult ,Diarrhea ,Male ,medicine.medical_specialty ,Fever ,Maternal-Child Health Services ,Population ,03 medical and health sciences ,0302 clinical medicine ,Health facility ,Nursing ,Residence Characteristics ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,education ,Respiratory Tract Infections ,2. Zero hunger ,Community Health Workers ,education.field_of_study ,Community engagement ,business.industry ,030503 health policy & services ,Research ,1. No poverty ,Public Health, Environmental and Occupational Health ,Health services research ,Liberia ,3. Good health ,Child mortality ,Cross-Sectional Studies ,Family medicine ,Community health ,Theme Issue ,Female ,Health Services Research ,Rural Health Services ,Rural area ,0305 other medical science ,business - Abstract
To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme.The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation.Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly.We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.Évaluer les changements dans le recours aux services essentiels de santé maternelle et infantile à Konobo, au Libéria, après la mise en œuvre d'un programme de perfectionnement des agents de santé communautaires.Le ministère de la Santé libérien s'est associé avec Last Mile Health, une organisation non gouvernementale, afin de mettre en œuvre un programme pilote destiné à améliorer le recrutement, la formation, l'encadrement et la rémunération des agents de santé communautaires. Pour évaluer les changements au niveau des soins de santé maternelle et infantile, nous avons réalisé plusieurs sondages transversaux par grappes avant (2012) et après (2015) la mise en œuvre du programme.Entre 2012 et 2015, 54 agents de santé communautaires, sept collègues superviseurs et trois superviseurs cliniques ont été formés pour prendre en charge une population de 12 127 personnes dans 44 communautés. Le pourcentage corrigé par régression d'enfants recevant des soins de la part de prestataires de soins officiels a augmenté de 60,1 (intervalle de confiance (IC) de 95%: 51,6 à 68,7) points de pourcentage pour la diarrhée, de 30,6 (IC 95%: 20,5 à 40,7) pour la fièvre et de 51,2 (IC 95%: 37,9 à 64,5) pour les infections aiguës des voies respiratoires. Les accouchements en maternité ont augmenté de 28,2 points (IC 95%: 20,3 à 36,1). Les accouchements en maternité et la prise en charge dans le secteur formel des infections aiguës des voies respiratoires et des cas de diarrhée ont davantage augmenté dans les communautés agricoles que dans celles vivant de l'extraction de l'or. Nous n’avons pas observé de changements significatifs dans le fait de bénéficier d'une ou plusieurs séances de soins prénataux dans une structure de soins ou de soins post-partum dans les 24 heures suivant l'accouchement.Nous avons observé une augmentation significative de la prestation de services de santé maternelle et infantile par des prestataires officiels lors du programme pilote destiné aux agents de santé communautaires dans les régions rurales isolées du Libéria. Des interventions supplémentaires sont nécessaires pour obtenir des résultats optimaux vis-à-vis de la prestation de services cliniques, comme les soins post-partum, et de services dans des zones spécifiques, comme les régions minières.Evaluar los cambios en el uso de servicios de salud materna e infantil básicos en Konobo, Liberia, tras la implementación de un programa mejorado de trabajadores comunitarios de salud (CHW, por sus siglas en inglés).El Ministerio de Salud de Liberia se asoció conEntre 2012 y 2015, 54 CHW, 7 supervisores homólogos y 3 supervisores clínicos recibieron formación para trabajar para una población de 12 127 personas en 44 comunidades. El porcentaje ajustado a la regresión de niños que recibieron atención de profesionales sanitarios formales aumentó un 60,1% (intervalo de confianza (IC) del 95%: 51,6 a 68,7) para la diarrea, un 30,6% (IC del 95%: 20,5 a 40,7) para la fiebre y un 51,2% (IC del 95%: 37,9 a 64,5) para la infección respiratoria aguda. El suministro en centros aumentó un 28,2% (IC del 95%: 20,3 a 36,1). El suministro en centros y la atención del sector formal para la infección respiratoria aguda y la diarrea aumentaron más en comunidades agrícolas que en las de minas de oro. La recepción de una o más sesiones de atención prenatal en un centro sanitario y de atención posparto a las 24 horas del parto no experimentó cambios importantes.Se identificaron aumentos significativos en la aceptación de los servicios de atención sanitaria materna e infantil de profesionales formales durante la versión piloto del programa de CHW en la Liberia rural remota. Los servicios clínicos, como la atención posparto y los servicios en lugares concretos, como zonas mineras, requieren intervenciones adicionales para lograr unos resultados óptimos.تقييم التغييرات التي طرأت على الاستعانة بالخدمات الضرورية لصحة الأمهات والأطفال في كونوبو بليبيريا بعد تنفيذ برنامج محسّن للأخصائيين الصحيين للمجتمع المحلي.دخلت وزارة الصحة الليبيرية في إطار من الشراكة مع منظمة "لاست مايل هيلث" الصحية غير الحكومية لتنفيذ برنامج تجريبي للأخصائيين الصحيين للمجتمع المحلي مع تطوير عمليات التعيين والتدريب والإشراف وتقديم الأجور. ولكي يتم تقييم التغييرات في مجال الاستعانة بالرعاية الصحية للأمهات والأطفال، فقد أجريت مجموعة من الاستبيانات المجمعة القطاعية المتكررة قبل تنفيذ البرنامج (في عام 2012) وبعد تنفيذه (في عام 2015).في الفترة ما بين عاميّ 2012 و2015 تم تدريب 54 من الأخصائيين الصحيين للمجتمع المحلي، وسبعة مشرفين من النظراء، وثلاثة مشرفين سريريين لتقديم الخدمة لشريحة سكانية يبلغ قوامها 12،127 نسمة في 44 مجتمعًا محليًا. وقد زادت النسبة المئوية المعدّلة وفقًا لنموذج الانحدار الإحصائي للأطفال الذين يتلقون الرعاية من مقدمي الرعاية الرسميين بمقدار 60.1 (بمستوى ثقة تبلغ نسبته 95%: 51.6 إلى 68.7) نقطة مئوية بالنسبة للإسهال، وبمقدار 30.6 (بمستوى ثقة تبلغ نسبته 95%: 20.5 إلى 40.7) نقطة مئوية للحمى، وبمقدار 51.2 (بمستوى ثقة تبلغ نسبته 95%: 37.9 إلى 64.5) للعدوى التنفسية الحادة. كما تزايد إجراء عمليات الولادة في المرافق الصحية بمقدار 28.2 نقطة (بمستوى ثقة تبلغ نسبته 95%: 20.3 إلى 36.1). وقد تحققت زيادة أكبر في نسبة عمليات الولادة في المرافق الصحية والرعاية المقدمة من جانب الجهات الرسمية لحالات العدوى الحادة في الجهاز التنفسي والإسهال في المجتمعات المحلية الزراعية بالمقارنة مع المجتمعات المحلية القائمة على تعدين الذهب. ولم تطرأ زيادة ملموسة على تلقي جلسات الرعاية لمرحلة ما قبل الولادة بمعدل جلسة واحدة أو أكثر في المرافق الصحية وخدمات الرعاية بعد الولادة خلال فترة 24 ساعة من الولادة.لقد حددنا زيادات ملموسة في حجم تلقي خدمات الرعاية الصحية للأمهات والأطفال من الجهات الرسمية خلال فترة البرنامج التجريبي للأخصائيين الصحيين للمجتمع المحلي في المناطق الريفية النائية في ليبيريا. وتحتاج الخدمات المعتمدة على العيادات – مثل الرعاية في مرحلة ما بعد الولادة - والخدمات المقدمة في بيئات محددة، مثل مناطق التعدين إلى تدخلات إضافية لتحقيق أفضل النتائج.旨在评估实施加强的社区卫生工作者 (CHW) 计划以后,利比里亚科诺博地区基本妇幼卫生服务使用情况的变化。.利比里亚卫生部联手最后一里医疗 (Last Mile Health),一家非政府组织,实施在招募、培训、监督和报酬方面均有所加强的社区卫生工作者 (CHW) 试点计划。 为了评估妇幼保健使用的变化,我们在该计划实施之前 (2012) 和之后 (2015) 分别开展了重复性横断面群体调查。.2012 至 2015 年间,54 名社区卫生工作者、七名同伴监管员和三名临床监管员接受了培训,以服务 44 个社区内的 12 127 名居民。 从正规护理提供者处接受护理的腹泻儿童的回归调整百分比提高了 60.1【95% 置信区间 (CI): 51.6 至 68.7】个百分点,发热儿童百分比提高了 30.6(95% CI: 20.5 至 40.7),急性呼吸道感染儿童的百分比提高了 51.2 (95% CI: 37.9 至 64.5)。 入院分娩提高了 28.2 个百分点(95% CI: 20.3 至 36.1)。 与采金地区相比,农业地区入院分娩和前往正规科室治疗急性呼吸道感染和腹泻的情况增加得更多。 在医疗机构接受一项或多项产前护理课程和产后 24 小时内护理的情况没有显著变化。.我们发现利比里亚偏远农村地区在社区卫生工作者 (CHW) 计划试点期间从正规医疗机构接受妇幼保健服务的情况显著增加。 腹泻护理等临床服务和采矿地区等特定环境下的服务,需要额外的干预才能达到最理想的效果。.Оценить изменения в использовании основных услуг в сфере охраны здоровья матерей и детей в округе Конобо, Либерия, после внедрения усовершенствованной программы для местных медицинских работников (ММР).Министерство здравоохранения Либерии вступило в партнерские отношения с неправительственной организацией Last Mile Health для внедрения пробной программы ММР, предполагающей усовершенствования в наборе кадров, обучении, надзоре и оплате труда. Чтобы оценить изменения в использовании услуг в сфере охраны здоровья матерей и детей, авторы провели несколько межсекторальных обследований с применением гнездовой выборки до (2012 год) и после (2015 год) внедрения программы.В период между 2012 и 2015 годами было подготовлено 54 ММР, семь инспекторов из партнерских организаций и три инспектора из клиник для обслуживания 12 127 человек в 44 сообществах. Скорректированная, рассчитанная с помощью модели регрессии доля детей, которые получили медицинскую помощь от официальных работников здравоохранения, увеличилась на 60,1 (95% доверительный интервал, ДИ: 51,6–68,7) процентного пункта в случае с диареей, на 30,6 (95% ДИ: 20,5–40,7) при лихорадке и на 51,2 (95% ДИ: 37,9–64,5) при острых респираторных инфекциях. Доля родов, принятых в учреждениях, увеличилась на 28,2 пункта (95% ДИ: 20,3–36,1). Доля родов, принятых в учреждениях, и помощи, оказанной со стороны официального сектора при острых респираторных заболеваниях и диарее, увеличилась больше в сельскохозяйственных общинах, чем в золотодобывающих. Изменения в доле получивших дородовую медицинскую помощь в рамках одного или нескольких сеансов в медицинском учреждении и послеродовой уход в течение 24 часов после родов не были статистически значимы.Авторы выявили существенное увеличение в использовании услуг в сфере охраны здоровья матерей и детей, оказываемых официальными медицинскими работниками, в ходе реализации пробной программы ММР в удаленных сельских регионах Либерии. Клинические услуги, такие как послеродовой уход, и обслуживание в специфических условиях, таких как районы разработки полезных ископаемых, требуют осуществления дополнительных вмешательств для достижения оптимального результата.
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- 2017
34. The use of a proposed updated EARL harmonization of 18F-FDG PET-CT in patients with lymphoma yields significant differences in Deauville score compared with current EARL recommendations
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Lars Edenbrandt, John Ly, Elin Trägårdh, David Minarik, and Per Wollmer
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,Lymphoma ,lcsh:R895-920 ,Standardized uptake value ,Deauville score ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiac imaging ,Original Research ,Reconstruction algorithm ,Medical treatment ,medicine.diagnostic_test ,business.industry ,medicine.disease ,EARL ,PET ,Positron emission tomography ,030220 oncology & carcinogenesis ,Hodgkin lymphoma ,Fdg pet ct ,Nuclear medicine ,business - Abstract
Background The Deauville score (DS) is a clinical tool, based on the comparison between lesion and reference organ uptake of 18F-fluorodeoxyglucose (FDG), used to stratify patients with lymphoma into categories reflecting their disease status. With a plethora of positron emission tomography with computed tomography (PET-CT) hard- and software algorithms, standard uptake value (SUV) in lesions and reference organs may differ which affects DS classification and therefore medical treatment. The EANM Research Ltd. (EARL) harmonization program from the European Association of Nuclear Medicine (EANM) partly mitigates this issue, but local preferences are common in clinical practice. We have investigated the discordance in DS calculated from patients with lymphoma referred for 18F-FDG PET-CT reconstructed with three different algorithms: the newly introduced block-sequential regularization expectation-maximization algorithm commercially sold as Q. Clear (QC, GE Healthcare, Milwaukee, WI, USA), compliant with the newly proposed updated EARL recommendations, and two settings compliant with the current EARL recommendations (EARLlower and EARLupper, representing the lower and upper limit of the EARL recommendations). Methods Fifty-two patients with non-Hodgkin and Hodgkin lymphoma were included (18 females and 34 males). Segmentation of mediastinal blood pool and liver were semi-automatically performed, whereas segmentation of lesions was done manually. From these segmentations, SUVmax and SUVpeak were obtained and DS calculated. Results There was a significant difference in DS between the QC algorithm and EARLlower/EARLupper (p
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- 2019
35. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
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Christopher Price, P. J. A. M. Brouwers, Vincent Thijs, Sze Ho Ma, Mark Schembri, Raymond T.F. Cheung, Christopher Karayiannis, Werner H. Mess, Robert Simister, Peter Wilkinson, Jayesh Modi Medanta, Janice E. O’Connell, Karen Ma, Martin Dennis, Sean C. Murphy, John Ly, Velandai Srikanth, Hing Lung Ip, Mathew Burn, Saima Hilal, Ijaz Anwar, Richard Shek-kwan Chang, Christopher Chen, Carmen Barbato, Hatice Ozkan, Achim Gass, Louise Shaw, Hen Hallevi, Aravindakshan Manoj, Julie Staals, Frances Harrington, Henry Houlden, Hideo Hara, Kam Tat Leung, Christopher Traenka, Jeroen Hendrikse, Keon-Joo Lee, Elio Giallombardo, Ender Uysal, Edmund Ka Ming Wong, Joost Jöbsis, Gargi Banerjee, Dulka Manawadu, Rebeca Marín, John S. Thornton, Nick S. Ward, Vinodh Krishnamurthy, Thomas W. Leung, Ji Hoe Heo, Philippe Maeder, Masatoshi Koga, Michael Power, Marc Randall, Amos D. Korczyn, Narayanaswamy Venketasubramanian, Derya Selcuk Demirelli, Richard Li, Prabel Datta, Christine Guevarra, YK Wong, Ysoline Beigneux, Cisca Linn, Solveig Horstmann, Henk Verbiest, Kirsty Harkness, Eric Vicaut, John Coyle, Shoichiro Sato, Anne Marie Mendyk, Chathuri Yatawara, Alexandros A Polymeris, Lisa Hert, Joan Martí-Fàbregas, Felix Fluri, Cathy Soufan, Djamil Vahidassr, Lakshmanan Sekaran, Chu Peng Hoi, Maarten van Gemert, Andreas Charidimou, Robert Luder, Lillian Choy, Jaap van der Sande, Hannah Cohen, Jae-Sung Lim, Maam Mamun, Vincent I.H. Kwa, Kyohei Fujita, Joseph Kwan, Syuhei Ikeda, John Mitchell, Paul Berntsen, Michael J. Thrippleton, Shelagh B. Coutts, Simone Browning, Paul Guyler, Heinrich Mattle, Elles Douven, Jonathan Birns, M. Eline Kooi, Jan Stam, Hedley C. A. Emsley, David Mangion, David Calvet, Min Lou, Yannie Soo, Santiago Medrano-Martorell, Michael G. Hennerici, Chris Moran, Thomas Gattringer, Bernard Esisi, Kazuhisa Yoshifuji, Hakan Ay, Rustam Al-Shahi Salman, Joanna M. Wardlaw, Derek Hayden, Richard J. Perry, Gunaratam Gunathilagan, Hans Rolf Jäger, Frank-Erik de Leeuw, Luis Prats-Sánchez, Pankaj Sharma, Mi Hwa Yang, Marie Yvonne Douste-Blazy, Enas Lawrence, Nils Peters, Elisa Merino, KC Teo, Ethem Murat Arsava, Luc Bracoub, Dinesh Chadha, Linxin Li, Nikola Sprigg, Adrian R Parry-Jones, Pascal P. Gratz, Siu Hung Li, Stephen Makin, Arumug Nallasivam, Jane Sword, Mauro S.B. Silva, Ping Wing Ng, Layan Akijian, Krishna A Dani, Sebastian Thilemann, Marie Dominique Fratacci, Gareth Ambler, Nagaendran Kandiah, Lee-Anne Slater, Ilse Burger, Kath Pasco, Paul J. Nederkoorn, Suk Fung Tsang, Tae Jin Song, Henry Ma, Kaori Miwa, Keith W. Muir, Susana Muñoz-Maniega, Jihoon Kang, Nicolas Christ, Beom Joon Kim, Noortje A.M. Maaijwee, Kwok Kui Wong, Jon Scott, Leonidas Panos, Oi Ling Chan, Shigeru Inamura, Prasanna Aghoram, David Hargroves, Lino Ramos, Ying Zhou, Chung Yan Chan, Masayuki Shiozawa, Eleni Sakka, Michelle Davis, Matthew Smith, Leo H. Bonati, Dilek Necioglu Orken, Toshihiro Ide, Jaap Kappelle, Ale Algra, Charlotte Zerna, Laurence Legrand, Eric Jouvent, Roland Veltkamp, Simon Jung, Zeynep Tanriverdi, Shahoo Singhal, Sarah Caine, Natan M. Bornstein, Régis Bordet, Anil M. Tuladhar, Maarten Schrooten, John F. Corrigan, Alexander P. Leff, Kazunori Toyoda, Mathuri Prabhakaran, Kim Wiegertjes, Eunbin Ko, Wouter Schoonewille, Sebastian Köhler, Yvo B.W.E.M. Roos, Wing Chi Fong, Jun Tanaka, Abduelbaset Elmarim, Syed Mansoor, Peter J. Koudstaal, Kari Saastamoinen, Eric E. Smith, Paul O'Mahony, Hugues Chabriat, Duncan Wilson, Appu Suman, Dianne H.K. van Dam-Nolen, Parashkev Nachev, Ahamad Hassan, Maria del C. Valdés Hernández, Clare Shakeshaft, Stefan T. Engelter, James Okwera, Aad van der Lugt, Els De Schryver, Stef Bakker, Azlisham Mohd Nor, Yusuke Yakushiji, Robert J. van Oostenbrugge, Claire Cullen, Man Yu Tse, Sebastian Eppinger, Gregory Y.H. Lip, Kotaro Iida, Efrat Kliper, Bibek Gyanwali, Elizabeth A. Warburton, Hee-Joon Bae, Thanh G. Phan, Tarek A. Yousry, Henrik Gensicke, Christine Delmaire, Jean-Louis Mas, Jill Abrigo, Fiona Carty, Jan C. Purrucker, Masashi Nishihara, Leopold Hertzberger, Joachim Fladt, Einor Ben Assayag, Simon Leach, Winnie C.W. Chu, Edward S. Hui, Bonnie Y.K. Lam, Moon Ku Han, Francesca M Chappell, David Williams, Robin Lemmens, Philippe Lyrer, Hiroyuki Irie, Raquel Delgado-Mederos, Ronil V. Chandra, Nigel Smyth, Henry K.F. Mak, Young Dae Kim, Ryan Hoi Kit Cheung, Beatriz Gómez-Ansón, Fidel Nuñez, Anna K. Heye, Adrian Barry, Janet Putterill, Mark White, Alejandro Martínez-Domeño, Vincent Mok, Rachel Marsh, Mahmud Sajid, Timothy J. England, SL Ho, Christopher Patterson, Daniel Guisado-Alonso, Peter J. Kelly, Lawrence K.S. Wong, Anthea Parry, Enrico Flossman, Chao Xu, Marwan El-Koussy, Karim Mahawish, Sissi Ispoglou, Franz Fazekas, Toshio Imaizumi, David J. Seiffge, Wenyan Liu, Chahin Pachai, Adrian Wong, Khaled Darawil, Jeremy Molad, Sanjeevikumar Meenakishundaram, Enrico Flossmann, Harald Proschel, Caroline E. Lovelock, Christine Roffe, Kui Kai Lau, Michael McCormick, Peter M. Rothwell, Paul A. Armitage, Sarah Gunkel, Myung Suk Jang, Martin Cooper, Pol Camps-Renom, Martin M. Brown, David Cohen, David J. Werring, Koon-Ho Chan, Deborah Kelly, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Division 2, Radiology & Nuclear Medicine, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Klinisch Fysicus (9), RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, and MUMC+: MA Med Staf Spec Neurologie (9)
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INTRACEREBRAL HEMORRHAGE ,030204 cardiovascular system & hematology ,AMYLOID ANGIOPATHY ,PREDICT ,Brain Ischemia ,0302 clinical medicine ,SMALL VESSEL DISEASE ,Medicine ,CHINESE PATIENTS ,10. No inequality ,Stroke ,medicine.diagnostic_test ,DEMENTIA ,Hazard ratio ,Absolute risk reduction ,Brain ,Atrial fibrillation ,ASSOCIATION ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,Magnetic Resonance Imaging ,3. Good health ,Ischemic Attack, Transient ,Cardiology ,Life Sciences & Biomedicine ,Intracranial Hemorrhages ,medicine.drug ,Cohort study ,medicine.medical_specialty ,RECURRENT STROKE ,Clinical Neurology ,610 Medicine & health ,Neuroimaging ,Article ,WARFARIN ,03 medical and health sciences ,Internal medicine ,Journal Article ,Humans ,Intracerebral hemorrhage ,Science & Technology ,business.industry ,Warfarin ,Magnetic resonance imaging ,T2-ASTERISK-WEIGHTED MR-IMAGES ,medicine.disease ,ATRIAL-FIBRILLATION ,Neurosciences & Neurology ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Contains fulltext : 208975.pdf (Publisher’s version ) (Open Access) BACKGROUND: Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. METHODS: We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. FINDINGS: Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1.34 years [IQR 0.19-2.44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1.35 (95% CI 1.20-1.50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2.45 (1.82-3.29) for intracranial haemorrhage and 1.23 (1.08-1.40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4.55 [95% CI 3.08-6.72] for intracranial haemorrhage vs 1.47 [1.19-1.80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5.52 [3.36-9.05] vs 1.43 [1.07-1.91]; and for >/=20 cerebral microbleeds, aHR 8.61 [4.69-15.81] vs 1.86 [1.23-1.82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48-84] per 1000 patient-years vs 27 intracranial haemorrhages [17-41] per 1000 patient-years; and for >/=20 cerebral microbleeds, 73 ischaemic strokes [46-108] per 1000 patient-years vs 39 intracranial haemorrhages [21-67] per 1000 patient-years). INTERPRETATION: In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden. FUNDING: British Heart Foundation and UK Stroke Association.
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- 2019
36. Current aspects of TIA management
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Shaloo Singhal, Thanh G. Phan, Benjamin Clissold, Velandai Srikanth, Henry Ma, and John Ly
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Neuroimaging ,Stroke risk ,03 medical and health sciences ,0302 clinical medicine ,Clinical pathway ,Risk indicators ,Physiology (medical) ,Medicine ,Humans ,In patient ,cardiovascular diseases ,Intensive care medicine ,Stroke ,business.industry ,Time critical ,General Medicine ,Thrombolysis ,medicine.disease ,Neurology ,Ischemic Attack, Transient ,030220 oncology & carcinogenesis ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Platelet Aggregation Inhibitors - Abstract
Transient Ischaemic Attack (TIA) if untreated carries a high risk of early stroke and is associated with poorer long-term survival [1]. There is emerging evidence of a reduction in stroke risk following TIA. Time critical investigations and management, as well as service organisation remain key to achieving good outcomes. Patients are diagnosed with TIA if they have transient, sudden-onset focal neurological symptoms which usually completely and rapidly resolve by presentation. The tissue based definition of TIA guides the fact that patients with residual symptoms should be considered as potentially having a stroke, with urgent evaluation regarding eligibility for thrombolysis and/or endovascular clot retrieval (ECR). Essential investigations for all patients with TIA should include early brain imaging, ECG, and carotid imaging in patients with anterior circulation symptoms. After brain imaging, exclusion of high risk indicators and immediate administration of an antiplatelet agent, subsequent attention to other mechanistic factors can be managed safely as part of a structured clinical pathway supervised by stroke specialists. This is in line with the recently revised Stroke Foundation Clinical Guidelines for Stroke Management (2017).
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- 2019
37. Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging. a systematic review and meta-analysis of individual patient data
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Bruce C V Campbell, Henry Ma, Peter A Ringleb, Mark W Parsons, Leonid Churilov, Martin Bendszus, Christopher R Levi, Chung Hsu, Timothy J Kleinig, Marc Fatar, Didier Leys, Carlos Molina, Tissa Wijeratne, Sami Curtze, Helen M Dewey, P Alan Barber, Kenneth S Butcher, Deidre A De Silva, Christopher F Bladin, Nawaf Yassi, Johannes A R Pfaff, Gagan Sharma, Andrew Bivard, Patricia M Desmond, Stefan Schwab, Peter D Schellinger, Bernard Yan, Peter J Mitchell, Joaquín Serena, Danilo Toni, Vincent Thijs, Werner Hacke, Stephen M Davis, Geoffrey A Donnan, Geoffrey A. Donnan, Stephen M. Davis, Bruce C.V. Campbell, Mark W. Parsons, Peter J. Mitchell, Patricia M. Desmond, Thomas Oxley, Teddy Y. Wu, Darshan Shah, Henry Zhao, Edrich Rodrigues, Patrick Salvaris, Fana Alemseged, Felix Ng, Cameron Williams, Jo-Lyn Ng, Hans T-H. Tu, Amy McDonald, David Jackson, Jessica Tsoleridis, Rachael McCoy, Lauren Pesavento, Louise Weir, Timothy J. Kleinig, S. Patel, J. Harvey, J. Mahadevan, E. Cheong, Anna Balabanski, Michael Waters, Roy Drew, Jennifer Cranefield, Elizabeth Mackey, Sherisse Celestino, Essie Low, Helen M. Dewey, Christopher F. Bladin, Poh Sien Loh, Philip M. Choi, Skye Coote, Tanya Frost, K. Hogan, C. Ding, S. McModie, W.W. Zhang, Christopher Kyndt, A. Moore, Z. Ross, J. Liu, Ferdinand Miteff, Christopher R. Levi, Timothy Ang, Neil Spratt, Carlos Garcia-Esperon, Lara Kaauwai, Thanh G. Phan, John Ly, Shaloo Singhal, Benjamin Clissold, Kitty Wong, Martin Krause, Susan Day, Jonathan Sturm, Bill O'Brian, Rohan Grimley, Marion Simpson, Matthew Lee-Archer, Amy Brodtmann, Bronwyn Coulton, Dennis Young, Andrew A. Wong, Claire Muller, Deborah K. Field, W. Vallat, Vanessa Maxwell, Peter Bailey, Arman Sabet, Sachin Mishra, Meng Tan, K. George, P. Alan Barber, L. Zhao, Atte Meretoja, Turgut Tatlisumak, G. Sibolt, M. Tiainen, M. Koivu, K. Aarnio, J. Virta, O. Kasari, S. Eirola, M.C. Sun, T.C. Chen, C.S. Chuang, Y.Y. Chen, C.M. Lin, S.C. Ho, P.M. Hsiao, C.H. Tsai, W.S. Huang, Y.W. Yang, H.Y. Huang, W.C. Wang, C.H. Liu, M.K. Lu, C.H. Lu, W.L. Kung, S.K. Jiang, Y.H. Wu, S.C. Huang, C.H. Tseng, L.T. Tseng, Y.C. Guo, D. Lin, C.T. Hsu, C.W. Kuan, J.P. Hsu, H.T. Tsai, M. Suzuki, Y. Sun, H.F. Chen, C.J. Lu, C.H. Lin, C.C. Huang, H.J. Chu, C.Y. Lee, W.H. Chang, Y.C. Lo, Y.T. Hsu, C.H. Chen, P.S. Sung, C.L. Ysai, J.S. Jeng, S.C. Tang, L.K. Tsai, S.J. Yeh, Y.C. Lee, Y.T. Wang, T.C. Chung, C.J. Hu, L. Chan, Y.W. Chiou, L.M. Lien, H.L. Yeh, J.H. Yeh, W.H. Chen, C.L. Lau, A. Chang, I.Y. Lee, M.Y. Huang, J.T. Lee, G.S. Peng, J.C. Lim, Y.D. Hsu, C.C. Lin, C.A. Cheng, C.H. Yen, F.C. Yang, C.H. Hsu, Y.F. Sung, C.K. Tsai, C.L. Tsai, A. Lee, Graeme Hankey, David Blacker, Richard Gerraty, C-I. Chen, C-S. Hsu, Elise Cowley, Michele Sallaberger, Barry Snow, John Kolbe, Richard Stark, John King, Richard Macdonnell, John Attia, Catherine D'Este, Julie Bernhardt, Leeanne Carey, Dominique Cadilhac, Craig Anderson, David Howells, A. Barber, Alan Connelly, Malcolm Macleod, Victoria O'Collins, W. Wilson, L. Macaulay, Erich Bluhmki, Christoph Eschenfelder, Peter Ringleb, Peter Schellinger, Nils Wahlgren, Joanna Wardlaw, Catherine Oppenheim, Kennedy R. Lees, Markku Kaste, Rüdiger von Kummer, Gilles Chatellier, Rico Laage, Xavier Nuñez, Christina Ehrenkrona, Ann-Sofie Svenson, Lynda Cove, Kurt Niederkorn, Franz Gruber, Peter Kapeller, Robert Mikulik, Jean-Louis Mas, Jörg Berrouschot, Jan Sobesky, Martin Köhrmann, Thorsten Steiner, Christof Kessler, Rainer Dziewas, Sven Poli, Katharina Althaus-Knaurer, Paolo Bovi, Alain L. Rodriguez, Juan F. Arenillas, Keith Muir, Roland Veltkamp, Anand Dixit, Girish Muddegowda, Lalit Kala, Deidre A. De Silva, Kenneth S. Butcher, G. Byrnes, Andre Peeters, J.B. Chalk, John N. Fink, Thomas E. Kimber, David Schultz, Peter J. Hand, Judith Frayne, Brian M. Tress, John McNeil, R. Burns, C. Johnston, and M. Williams
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medicine.medical_specialty ,acute ischemic stroke ,thrombolysis ,Perfusion Imaging ,medicine.medical_treatment ,Perfusion scanning ,030204 cardiovascular system & hematology ,Placebo ,Brain Ischemia ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Modified Rankin Scale ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,rt-pa ,030212 general & internal medicine ,Stroke ,Cerebral Hemorrhage ,business.industry ,General Medicine ,Odds ratio ,Thrombolysis ,medicine.disease ,3. Good health ,meta-analysis ,Diffusion Magnetic Resonance Imaging ,Treatment Outcome ,Tissue Plasminogen Activator ,Meta-analysis ,acute stroke therapy ,Tomography, X-Ray Computed ,business ,Fibrinolytic agent - Abstract
Stroke thrombolysis with alteplase is currently recommended 0-4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis.In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036.We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15-2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23-76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81-2·96, p=0·66).Patients with ischaemic stroke 4·5-9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis.None.
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- 2019
38. Semi-automatic analysis of standard uptake values in serial PET/CT studies in patients with lung cancer and lymphoma.
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John Ly, Sabine Garpered, Peter Höglund, Eskil Jönsson, Sven Valind, Lars Edenbrandt, and Per Wollmer
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- 2012
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39. A PPIX-binding probe facilitates discovery of PPIX-induced cell death modulation by peroxiredoxin
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John Lynch, Yao Wang, Yuxin Li, Kanisha Kavdia, Yu Fukuda, Sabina Ranjit, Camenzind G. Robinson, Christy R. Grace, Youlin Xia, Junmin Peng, and John D. Schuetz
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Biology (General) ,QH301-705.5 - Abstract
Abstract While heme synthesis requires the formation of a potentially lethal intermediate, protoporphyrin IX (PPIX), surprisingly little is known about the mechanism of its toxicity, aside from its phototoxicity. The cellular protein interactions of PPIX might provide insight into modulators of PPIX-induced cell death. Here we report the development of PPB, a biotin-conjugated, PPIX-probe that captures proteins capable of interacting with PPIX. Quantitative proteomics in a diverse panel of mammalian cell lines reveal a high degree of concordance for PPB-interacting proteins identified for each cell line. Most differences are quantitative, despite marked differences in PPIX formation and sensitivity. Pathway and quantitative difference analysis indicate that iron and heme metabolism proteins are prominent among PPB-bound proteins in fibroblasts, which undergo PPIX-mediated death determined to occur through ferroptosis. PPB proteomic data (available at PRIDE ProteomeXchange # PXD042631) reveal that redox proteins from PRDX family of glutathione peroxidases interact with PPIX. Targeted gene knockdown of the mitochondrial PRDX3, but not PRDX1 or 2, enhance PPIX-induced death in fibroblasts, an effect blocked by the radical-trapping antioxidant, ferrostatin-1. Increased PPIX formation and death was also observed in a T-lymphoblastoid ferrochelatase-deficient leukemia cell line, suggesting that PPIX elevation might serve as a potential strategy for killing certain leukemias.
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- 2023
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40. Do poverty and wealth look the same the world over? A comparative study of 12 cities from five high-income countries using street images
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Esra Suel, Emily Muller, James E. Bennett, Tony Blakely, Yvonne Doyle, John Lynch, Joreintje D. Mackenbach, Ariane Middel, Anja Mizdrak, Ricky Nathvani, Michael Brauer, and Majid Ezzati
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Street images ,Visual similarity ,Computer vision ,Urban inequalities ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Urbanization and inequalities are two of the major policy themes of our time, intersecting in large cities where social and economic inequalities are particularly pronounced. Large scale street-level images are a source of city-wide visual information and allow for comparative analyses of multiple cities. Computer vision methods based on deep learning applied to street images have been shown to successfully measure inequalities in socioeconomic and environmental features, yet existing work has been within specific geographies and have not looked at how visual environments compare across different cities and countries. In this study, we aim to apply existing methods to understand whether, and to what extent, poor and wealthy groups live in visually similar neighborhoods across cities and countries. We present novel insights on similarity of neighborhoods using street-level images and deep learning methods. We analyzed 7.2 million images from 12 cities in five high-income countries, home to more than 85 million people: Auckland (New Zealand), Sydney (Australia), Toronto and Vancouver (Canada), Atlanta, Boston, Chicago, Los Angeles, New York, San Francisco, and Washington D.C. (United States of America), and London (United Kingdom). Visual features associated with neighborhood disadvantage are more distinct and unique to each city than those associated with affluence. For example, from what is visible from street images, high density poor neighborhoods located near the city center (e.g., in London) are visually distinct from poor suburban neighborhoods characterized by lower density and lower accessibility (e.g., in Atlanta). This suggests that differences between two cities is also driven by historical factors, policies, and local geography. Our results also have implications for image-based measures of inequality in cities especially when trained on data from cities that are visually distinct from target cities. We showed that these are more prone to errors for disadvantaged areas especially when transferring across cities, suggesting more attention needs to be paid to improving methods for capturing heterogeneity in poor environment across cities around the world.
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- 2023
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41. Effects of environmental impact labels on the sustainability of food purchases: A randomised controlled trial in an experimental online supermarket.
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Christina Potter, Rachel Pechey, Michael Clark, Kerstin Frie, Paul A Bateman, Brian Cook, Cristina Stewart, Carmen Piernas, John Lynch, Mike Rayner, Joseph Poore, and Susan A Jebb
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Medicine ,Science - Abstract
Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. This UK study (N = 1051 participants) investigated the effectiveness of different ecolabels using an experimental online supermarket platform, comparing three labels against control (no label). Significant reductions were found in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.3, -2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5, -1.9]). Providing ecolabels is a promising intervention to promote the selection of more sustainable products.
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- 2024
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42. Retraction: Effects of environmental impact labels on the sustainability of food purchases: Two randomised controlled trials in an experimental online supermarket.
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Christina Potter, Rachel Pechey, Michael Clark, Kerstin Frie, Paul A Bateman, Brian Cook, Cristina Stewart, Carmen Piernas, John Lynch, Mike Rayner, Joseph Poore, Susan A Jebb, and PLOS ONE Editors
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Medicine ,Science - Published
- 2024
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43. 260 Novel CLL-1-directed CAR-T cells mediate potent antigen-specific cytolytic activity in mouse models of acute myeloid leukemia
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Mariana Silva, Brikena Gjeci, Julian Scherer, Reid Williams, Hillary Hoyt, Amanda Halfond, Giacomo Canesin, Julia Etchin, Guy Mundelboim, John Lydeard, and Tirtha Chakraborty
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2023
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44. Multifocal intradural extramedullary anaplastic ependymoma of the spine
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Peter Earls, John Ly, Timothy Steel, Tint T. Shein, Ananya Chakravorty, and Ellen Frydenberg
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Ependymoma ,medicine.medical_specialty ,medicine.diagnostic_test ,Groin ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,Neurological examination ,Case Report ,medicine.disease ,Spinal cord ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,Myelopathy ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Radiology ,business ,030217 neurology & neurosurgery ,Lumbosacral joint - Abstract
Ependymomas are neuroectodermal tumours arising from the ependymal lining of the ventricles and central canal of the spinal cord. Intradural extramedullary (IDEM) ependymomas which are multifocal, and/or anaplastic (WHO grade III) at presentation are exceedingly rare. We present the second case of multifocal anaplastic IDEM ependymoma in the literature. A 47-year old female presented with left gluteal and thigh pain radiating to the groin associated with paraesthesiae. She had a normal neurological examination. Magnetic resonance imaging of the lumbar spine and subsequent magnetic resonance imaging (MRI) of the remaining neuroaxis demonstrated >10 lesions throughout cervical, thoracic and lumbosacral levels. There were no intracranial lesions. The patient initially underwent surgery for removal of three symptomatic lesions at S2. She recovered well. One year later she had further surgery for three progressing lesions at T5. Four of six lesions were WHO grade III. Two smaller nodules at T5 were WHO grade II. The patient had mild sensory disturbance over the right side of the trunk which resolved posteoperatively. There were no long-term sequelae. The patient subsequently underwent full craniospinal irradiation using proton beam therapy. Due to their rarity, there are no guidelines for the management of multifocal IDEM ependymoma. The only previously published case of multifocal anaplastic IDEM ependymoma by Schuurmans et al. involved surgical resection and 20 cycles of whole-spine radiotherapy. Schuurmans patient unfortunately died two years post-diagnosis with progressive cranial metastases and post-radiation myelopathy. In our case, all remaining lesions are stable and she is neurologically intact at 48-month follow up.
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- 2017
45. The effect of interactions between BMI and sustained depressive symptoms on knee osteoarthritis over 4 years: data from the osteoarthritis initiative
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Gabby B. Joseph, Charles E. McCulloch, Michael C. Nevitt, John Lynch, Nancy E. Lane, Valentina Pedoia, Sharmila Majumdar, and Thomas M. Link
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Depression ,Obesity ,MRI ,Cartilage T2 ,JSN ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background To assess the compound effects of BMI and sustained depressive symptoms on changes in knee structure, cartilage composition, and knee pain over 4 years using statistical interaction analyses. Methods One thousand eight hundred forty-four individuals from the Osteoarthritis Initiative Database were analyzed at baseline and 4-year follow-up. Individuals were categorized according to their BMI and presence of depressive symptoms (based on the Center for Epidemiological Studies Depression Scale (threshold≥16)) at baseline and 4-year follow-up. 3 T MRI was used to quantify knee cartilage T2 over 4 years, while radiographs were used to assess joint space narrowing (JSN). Mixed effects models examined the effect of BMI-depressive symptoms interactions on outcomes of cartilage T2, JSN, and knee pain over 4-years. Results The BMI-depressive symptoms interaction was significantly associated with knee pain (p
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- 2023
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46. Exploratory Use of Decision Tree Analysis in Classification of Outcome in Hypoxic-Ischemic Brain Injury
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Thanh G. Phan, Jian Chen, Shaloo Singhal, Henry Ma, Benjamin B. Clissold, John Ly, and Richard Beare
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medicine.medical_specialty ,Mri imaging ,hypoxic ischemic encephalopathy ,Decision tree ,Hypoxic ischemic brain injury ,cardiac arrest ,Hypoxic Ischemic Encephalopathy ,lcsh:RC346-429 ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,lcsh:Neurology. Diseases of the nervous system ,Original Research ,Coma ,business.industry ,decision tree analysis ,Glasgow Coma Scale ,030208 emergency & critical care medicine ,prediction ,Hypothermia ,Neurology ,classification ,Cardiology ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Decision tree model ,Neuroscience - Abstract
Background Prognostication following hypoxic ischemic encephalopathy (brain injury) is important for clinical management. The aim of this exploratory study is to use a decision tree model to find clinical and MRI associates of severe disability and death in this condition. We evaluate clinical model and then the added value of MRI data. Method The inclusion criteria were as follows: age ≥17 years, cardio-respiratory arrest, and coma on admission (2003–2011). Decision tree analysis was used to find clinical [Glasgow Coma Score (GCS), features about cardiac arrest, therapeutic hypothermia, age, and sex] and MRI (infarct volume) associates of severe disability and death. We used the area under the ROC (auROC) to determine accuracy of model. There were 41 (63.7% males) patients having MRI imaging with the average age 51.5 ± 18.9 years old. The decision trees showed that infarct volume and age were important factors for discrimination between mild to moderate disability and severe disability and death at day 0 and day 2. The auROC for this model was 0.94 (95% CI 0.82–1.00). At day 7, GCS value was the only predictor; the auROC was 0.96 (95% CI 0.86–1.00). Conclusion Our findings provide proof of concept for further exploration of the role of MR imaging and decision tree analysis in the early prognostication of hypoxic ischemic brain injury.
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- 2016
47. Antimicrobial Stewardship in a Psychiatric Hospital: Opportunities for Improvement
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Melissa Rozdilsky, Chloe Bryson-Cahn, Jeannie Chan, Rupali Jain, John Lynch, Natalia Martinez-Paz, and Zahra Kassamali Escobar
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Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Western State Hospital (WSH) is an 800-bed, state-owned psychiatric hospital in Washington State which services individuals in 20 counties. WSH provides services and inpatient treatment to patients referred via behavioral health providers and/or the civil court system. Because many patients are admitted with serious, long-term illness, WSH also provides primary care and addresses infectious syndromes encountered in admitted patients. In January 2016, WSH officially began their antimicrobial stewardship program (ASP). In 2017 WSH joined the UW Center for Stewardship in Medicine (UW-CSiM) to grow and optimize their ASP. Methods: The lead pharmacist at WSH participated in weekly hour-long education and tele-mentoring sessions through the UW-CSiM program. Educational materials were adapted from UW-CSiM didactics and delivered to providers during regular meetings and grand rounds. Daily pharmacist led prospective audit with feedback was conducted. Antibiotic use data were collected and measured by days of therapy (DOT) per 1000-patient days from pharmacy dispensing records from 2015 to 2022. Results: From 1/1/15 to 12/31/22, there was a consistent trend of decreasing antibiotic consumption annually. In particular, antibiotic use decreased by over 65% ranging from 35-43 DOT per 1000 patient-days in 2015 to 9-11 DOT per 1000 patient-days in 2022 (Figure 1). This translates to approximately 1000 antibiotic days of therapy in 2015 and 200 days of antibiotic therapy in 2022. As of 2022, the two most common antibiotics used were cephalexin and sulfamethoxazole/trimethoprim Conclusion: Although treating infections is not a principal focus of a psychiatric hospital, patients receiving care in inpatient psychiatric facilities do experience common infections and receive antibiotics during their stay. At WSH, initiation of an antimicrobial stewardship program was associated with sustained decrease in total antibiotic DOT over 7 years. These data highlight the impact of tele-education and tele-mentoring in infectious diseases and antimicrobial stewardship as a path to build a successful antimicrobial stewardship even without formal infectious diseases training. Our single center experience at a large psychiatric hospital demonstrates the use of antimicrobials in these facilities and the opportunity for a large impact of an antimicrobial stewardship program in inpatient psychiatric facilities.
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- 2023
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48. Data on how abundance of resource inflows and punishment types affect resource extraction behavior
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Anna Lou Abatayo and John Lynham
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Resource curse ,Common pool resources ,Social ostracism ,Financial Punishment ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Science (General) ,Q1-390 - Abstract
The data is collected through laboratory experiments on a dynamic common pool resource game, where, in an infinitely repeated number of rounds (i.e., game ended randomly), individuals made decisions about whether to exert a high or a low effort level to extract resources. Experiments were conducted using the student sample (consent provided and ethics approved) at the University of Hawaiʻi at Mānoa. A total of 8 sessions, 2 for each of the 4 treatments, were run with exactly 20 participants within a session. Individuals made decisions in groups of 10. Communication between any participant was not allowed. A session is randomly assigned (1) to vary whether the inflow of resources at the beginning of each round is high or low, and (2) to allow participants to either financially punish or socially punish defectors. A financial punishment resulted to a loss in profit for the punished while a social punishment displayed the words “You have extracted too much! You're being greedy!” on the computer screen of the punished. Individuals were assigned subject ID numbers and interacted using their subject IDs. The data is useful in understanding how resource inflow and type of punishment affects individual resource extraction behavior. The data could also be combined with other publicly available common pool resource datasets for a meta-analysis on individual behavior in the commons.
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- 2023
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49. Increasing electrical reserve provision in districts by exploiting energy flexibility of buildings with robust model predictive control
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Felix Bünning, Philipp Heer, Roy S. Smith, and John Lygeros
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Frequency regulation ,Robust Model Predictive Control ,Demand forecasting ,Building energy ,District heating ,Affine policies ,Energy industries. Energy policy. Fuel trade ,HD9502-9502.5 - Abstract
Due to their thermal inertia, buildings equipped with electric heating and cooling systems can help to stabilize the electricity grid by shifting their load in time, and can thus facilitate energy flexible urban energy systems with the right control system in place. Because of minimum capacity requirements, they can often only participate in demand response schemes, such as secondary frequency reserves through aggregation. Such an aggregation could also take the form of entire district heating and cooling systems with connected buildings that are supplied by large-scale heat pumps and chillers. However, there is a lack of studies investigating the control of such configurations, both in simulation and in application. We present a two-level control scheme based on robust Model Predictive Control with affine policies to offer frequency reserves with a district system, where we exploit the thermal inertia of buffer storage tanks and a subset of the connected buildings. We leverage data-driven model generation methods to overcome the bottleneck of physics-based building modeling. In a numerical case study based on one-year historical data of a real system, we compare the approach to a situation where only the buffer storage is used for flexibility and demonstrate that the reserves offered increase substantially if the inertia of a subset of the connected buildings is also exploited. Furthermore, we validate the control approach in a first-of-its-kind experiment on the actual system, where we show that reserves can be offered by the district system without compromising the comfort in the connected buildings.
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- 2023
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50. Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey
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Mark J. Siedner, Zahir Kanjee, Nicholas Gordon, Wilmot Smith, Breeanna Lorenzen, Gaurab Basu, Vidiya Sathananthan, John Ly, Ruth Roberts, Uriah G. Moore, Dana R. Thomson, Lorenzo Dorr, Ami Waters, John D. Kraemer, Avi Kenny, Thomas Griffiths, and Dale Battistoli
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Gerontology ,Viral Diseases ,Maternal Health ,Surveys ,Global Health ,Geographical Locations ,Labor and Delivery ,0302 clinical medicine ,Health facility ,Pregnancy ,Surveys and Questionnaires ,Health care ,Medicine and Health Sciences ,Global health ,Cluster Analysis ,Medicine ,Public and Occupational Health ,030212 general & internal medicine ,Health Systems Strengthening ,Reproductive health ,Family Characteristics ,education.field_of_study ,1. No poverty ,Obstetrics and Gynecology ,General Medicine ,3. Good health ,Infectious Diseases ,Research Design ,Female ,Research Article ,Neglected Tropical Diseases ,Adult ,medicine.medical_specialty ,030231 tropical medicine ,Population ,Research and Analysis Methods ,Ebola Hemorrhagic Fever ,Odds ,Young Adult ,03 medical and health sciences ,Humans ,Maternal Health Services ,Epidemics ,education ,Demography ,Viral Hemorrhagic Fevers ,Health Care Policy ,Survey Research ,business.industry ,Public health ,Odds ratio ,Hemorrhagic Fever, Ebola ,Liberia ,Tropical Diseases ,Delivery, Obstetric ,Health Care ,People and Places ,Africa ,Birth ,Women's Health ,Rural Health Services ,business - Abstract
Background The Ebola virus disease (EVD) epidemic has threatened access to basic health services through facility closures, resource diversion, and decreased demand due to community fear and distrust. While modeling studies have attempted to estimate the impact of these disruptions, no studies have yet utilized population-based survey data. Methods and Findings We conducted a two-stage, cluster-sample household survey in Rivercess County, Liberia, in March–April 2015, which included a maternal and reproductive health module. We constructed a retrospective cohort of births beginning 4 y before the first day of survey administration (beginning March 24, 2011). We then fit logistic regression models to estimate associations between our primary outcome, facility-based delivery (FBD), and time period, defined as the pre-EVD period (March 24, 2011–June 14, 2014) or EVD period (June 15, 2014–April 13, 2015). We fit both univariable and multivariable models, adjusted for known predictors of facility delivery, accounting for clustering using linearized standard errors. To strengthen causal inference, we also conducted stratified analyses to assess changes in FBD by whether respondents believed that health facility attendance was an EVD risk factor. A total of 1,298 women from 941 households completed the survey. Median age at the time of survey was 29 y, and over 80% had a primary education or less. There were 686 births reported in the pre-EVD period and 212 in the EVD period. The unadjusted odds ratio of facility-based delivery in the EVD period was 0.66 (95% confidence interval [CI] 0.48–0.90, p-value = 0.010). Adjustment for potential confounders did not change the observed association, either in the principal model (adjusted odds ratio [AOR] = 0.70, 95%CI 0.50–0.98, p = 0.037) or a fully adjusted model (AOR = 0.69, 95%CI 0.50–0.97, p = 0.033). The association was robust in sensitivity analyses. The reduction in FBD during the EVD period was observed among those reporting a belief that health facilities are or may be a source of Ebola transmission (AOR = 0.59, 95%CI 0.36–0.97, p = 0.038), but not those without such a belief (AOR = 0.90, 95%CI 0.59–1.37, p = 0.612). Limitations include the possibility of FBD secular trends coincident with the EVD period, recall errors, and social desirability bias. Conclusions We detected a 30% decreased odds of FBD after the start of EVD in a rural Liberian county with relatively few cases. Because health facilities never closed in Rivercess County, this estimate may under-approximate the effect seen in the most heavily affected areas. These are the first population-based survey data to show collateral disruptions to facility-based delivery caused by the West African EVD epidemic, and they reinforce the need to consider the full spectrum of implications caused by public health emergencies., John Kraemer and colleagues estimate changes in facility-based delivery during the Ebola virus disease epidemic in rural Liberia using cross-sectional data from a population-based household survey., Author Summary Why was this study done? The 2014–2015 West African Ebola virus disease (EVD) epidemic killed approximately 11,300 people directly, but its effects are magnified by collateral health consequences. Mathematical models and facility-based data provide evidence of substantial health service interruptions, but little population-based survey data has been published from the three principally affected countries. Maternal health services, which are dependent on functioning health systems, are likely to be particularly susceptible to external shocks, such as the EVD epidemic. What did the researchers do and find? We used a cluster-sample survey to produce a representative sample of births in Rivercess County, Liberia, a part of the country with relatively limited Ebola transmission. Controlling for potential confounders, we compared the odds of facility-based delivery among 686 births in the period before the EVD epidemic with 212 births during the epidemic. We identified a 30% reduction in the odds of facility-based delivery during the EVD epidemic. The odds of facility-based delivery were 41% lower among women who reported a belief that Ebola was or may be transmitted in health facilities, but not significantly lower among women who reported believing that Ebola was not transmitted in health facilities. What do these findings mean? This study provides further evidence that the 2014–2015 West African EVD epidemic caused serious collateral harm to health services. This study also underscores the need to maintain focus on long-term health system reconstruction after the EVD epidemic.
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- 2016
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