27 results on '"Manning RM"'
Search Results
2. Assessing the effect of health system resources on HIV and tuberculosis programmes in Malawi: a modelling study.
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Mangal TD, Mohan S, Colbourn T, Collins JH, Graham M, Jahn A, Janoušková E, Lin IL, Smith RM, Mnjowe E, Molaro M, Mwenyenkulu TE, Nkhoma D, She B, Tamuri A, Revill P, Phillips AN, Mfutso-Bengo J, and Hallett TB
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- Humans, Malawi epidemiology, Models, Theoretical, Health Resources, Delivery of Health Care organization & administration, Female, HIV Infections epidemiology, HIV Infections prevention & control, Tuberculosis epidemiology, Tuberculosis prevention & control
- Abstract
Background: Malawi is progressing towards UNAIDS and WHO End TB Strategy targets to eliminate HIV/AIDS and tuberculosis. We aimed to assess the prospective effect of achieving these goals on the health and health system of the country and the influence of consumable constraints., Methods: In this modelling study, we used the Thanzi la Onse (Health for All) model, which is an individual-based multi-disease simulation model that simulates HIV and tuberculosis transmission, alongside other diseases (eg, malaria, non-communicable diseases, and maternal diseases), and gates access to essential medicines according to empirical estimates of availability. The model integrates dynamic disease modelling with health system engagement behaviour, health system use, and capabilities (ie, personnel and consumables). We used 2018 data on the availability of HIV and tuberculosis consumables (for testing, treatment, and prevention) across all facility levels of the country to model three scenarios of HIV and tuberculosis programme scale-up from Jan 1, 2023, to Dec 31, 2033: a baseline scenario, when coverage remains static using existing consumable constraints; a constrained scenario, in which prioritised interventions are scaled up with fixed consumable constraints; and an unconstrained scenario, in which prioritised interventions are scaled up with maximum availability of all consumables related to HIV and tuberculosis care., Findings: With uninterrupted medical supplies, in Malawi, we projected HIV and tuberculosis incidence to decrease to 26 (95% uncertainty interval [UI] 19-35) cases and 55 (23-74) cases per 100 000 person-years by 2033 (from 152 [98-195] cases and 123 [99-160] cases per 100 000 person-years in 2023), respectively, with programme scale-up, averting a total of 12·21 million (95% UI 11·39-14·16) disability-adjusted life-years. However, the effect was compromised by restricted access to key medicines, resulting in approximately 58 700 additional deaths (33 400 [95% UI 22 000-41 000] due to AIDS and 25 300 [19 300-30 400] due to tuberculosis) compared with the unconstrained scenario. Between 2023 and 2033, eliminating HIV treatment stockouts could avert an estimated 12 100 deaths compared with the baseline scenario, and improved access to tuberculosis prevention medications could prevent 5600 deaths in addition to those achieved through programme scale-up alone. With programme scale-up under the constrained scenario, consumable stockouts are projected to require an estimated 14·3 million extra patient-facing hours between 2023 and 2033, mostly from clinical or nursing staff, compared with the unconstrained scenario. In 2033, with enhanced screening, 188 000 (81%) of 232 900 individuals projected to present with active tuberculosis could start tuberculosis treatment within 2 weeks of initial presentation if all required consumables were available, but only 8600 (57%) of 15 100 presenting under the baseline scenario., Interpretation: Ignoring frailties in the health-care system, in particular the potential non-availability of consumables, in projections of HIV and tuberculosis programme scale-up might risk overestimating potential health impacts and underestimating required health system resources. Simultaneous health system strengthening alongside programme scale-up is crucial, and should yield greater benefits to population health while mitigating the strain on a heavily constrained health-care system., Funding: Wellcome and UK Research and Innovation as part of the Global Challenges Research Fund., Competing Interests: Declaration of interests TC has received consulting fees from the UN Economic Commission for Africa and has participated on the Trial Steering Committee for adolescent mental health in Nepal. SM has received consultancy fees from The Global Fund to Fight AIDS, Tuberculosis and Malaria. ANP has received consultancy fees from the Bill & Melinda Gates Foundation. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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3. Health workforce needs in Malawi: analysis of the Thanzi La Onse integrated epidemiological model of care.
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She B, Mangal TD, Prust ML, Heung S, Chalkley M, Colbourn T, Collins JH, Graham MM, Jewell B, Joshi P, Li Lin I, Mnjowe E, Mohan S, Molaro M, Phillips AN, Revill P, Smith RM, Tamuri AU, Twea PD, Manthalu G, Mfutso-Bengo J, and Hallett TB
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- Humans, Malawi, Delivery of Health Care organization & administration, Female, Models, Theoretical, Male, Adult, Patient Acceptance of Health Care statistics & numerical data, Health Personnel, Nurses supply & distribution, Health Services Needs and Demand, Health Workforce
- Abstract
Background: To make the best use of health resources, it is crucial to understand the healthcare needs of a population-including how needs will evolve and respond to changing epidemiological context and patient behaviour-and how this compares to the capabilities to deliver healthcare with the existing workforce. Existing approaches to planning either rely on using observed healthcare demand from a fixed historical period or using models to estimate healthcare needs within a narrow domain (e.g., a specific disease area or health programme). A new data-grounded modelling method is proposed by which healthcare needs and the capabilities of the healthcare workforce can be compared and analysed under a range of scenarios: in particular, when there is much greater propensity for healthcare seeking., Methods: A model representation of the healthcare workforce, one that formalises how the time of the different cadres is drawn into the provision of units of healthcare, was integrated with an individual-based epidemiological model-the Thanzi La Onse model-that represents mechanistically the development of disease and ill-health and patients' healthcare seeking behaviour. The model was applied in Malawi using routinely available data and the estimates of the volume of health service delivered were tested against officially recorded data. Model estimates of the "time needed" and "time available" for each cadre were compared under different assumptions for whether vacant (or established) posts are filled and healthcare seeking behaviour., Results: The model estimates of volume of each type of service delivered were in good agreement with the available data. The "time needed" for the healthcare workforce greatly exceeded the "time available" (overall by 1.82-fold), especially for pharmacists (6.37-fold) and clinicians (2.83-fold). This discrepancy would be largely mitigated if all vacant posts were filled, but the large discrepancy would remain for pharmacists (2.49-fold). However, if all of those becoming ill did seek care immediately, the "time needed" would increase dramatically and exceed "time supply" (2.11-fold for nurses and midwives, 5.60-fold for clinicians, 9.98-fold for pharmacists) even when there were no vacant positions., Conclusions: The results suggest that services are being delivered in less time on average than they should be, or that healthcare workers are working more time than contracted, or a combination of the two. Moreover, the analysis shows that the healthcare system could become overwhelmed if patients were more likely to seek care. It is not yet known what the health consequences of such changes would be but this new model provides-for the first time-a means to examine such questions., (© 2024. The Author(s).)
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- 2024
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4. Distal supports, capabilities, and growth-focused recovery: A comparison of Housing First and the staircase continuum of care.
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Greenwood RM, O'Shaughnessy BR, Manning RM, Hogan N, Vargas-Moniz MJ, and Ornelas J
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- Humans, Male, Female, Adult, Middle Aged, Community Integration, Housing, Europe, Continuity of Patient Care, Ill-Housed Persons psychology, Social Support
- Abstract
Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods., (© 2024 The Authors. American Journal of Community Psychology published by Wiley Periodicals LLC on behalf of Society for Community Research and Action.)
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- 2024
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5. The changes in health service utilisation in Malawi during the COVID-19 pandemic.
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She B, Mangal TD, Adjabeng AY, Colbourn T, Collins JH, Janoušková E, Li Lin I, Mnjowe E, Mohan S, Molaro M, Phillips AN, Revill P, Smith RM, Twea PD, Nkhoma D, Manthalu G, and Hallett TB
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- Adult, Humans, Child, Pandemics, Malawi epidemiology, Health Services, COVID-19 epidemiology, HIV Infections drug therapy, HIV Infections epidemiology, Malnutrition
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Introduction: The COVID-19 pandemic and the restriction policies implemented by the Government of Malawi may have disrupted routine health service utilisation. We aimed to find evidence for such disruptions and quantify any changes by service type and level of health care., Methods: We extracted nationwide routine health service usage data for 2015-2021 from the electronic health information management systems in Malawi. Two datasets were prepared: unadjusted and adjusted; for the latter, unreported monthly data entries for a facility were filled in through systematic rules based on reported mean values of that facility or facility type and considering both reporting rates and comparability with published data. Using statistical descriptive methods, we first described the patterns of service utilisation in pre-pandemic years (2015-2019). We then tested for evidence of departures from this routine pattern, i.e., service volume delivered being below recent average by more than two standard deviations was viewed as a substantial reduction, and calculated the cumulative net differences of service volume during the pandemic period (2020-2021), in aggregate and within each specific facility., Results: Evidence of disruptions were found: from April 2020 to December 2021, services delivered of several types were reduced across primary and secondary levels of care-including inpatient care (-20.03% less total interactions in that period compared to the recent average), immunisation (-17.61%), malnutrition treatment (-34.5%), accidents and emergency services (-16.03%), HIV (human immunodeficiency viruses) tests (-27.34%), antiretroviral therapy (ART) initiations for adults (-33.52%), and ART treatment for paediatrics (-41.32%). Reductions of service volume were greatest in the first wave of the pandemic during April-August 2020, and whereas some service types rebounded quickly (e.g., outpatient visits from -17.7% to +3.23%), many others persisted at lower level through 2021 (e.g., under-five malnutrition treatment from -15.24% to -42.23%). The total reduced service volume between April 2020 and December 2021 was 8 066 956 (-10.23%), equating to 444 units per 1000 persons., Conclusion: We have found substantial evidence for reductions in health service delivered in Malawi during the COVID-19 pandemic which may have potential health consequences, the effect of which should inform how decisions are taken in the future to maximise the resilience of healthcare system during similar events., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 She et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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6. Psychometric properties of the measure of achieved capabilities in homeless services.
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Greenwood RM, O'Shaughnessy BR, Manning RM, Vargas Moniz MJ, Sacchetto B, and Ornelas J
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- Adult, Humans, Psychometrics, Europe, Social Problems, Housing, Ill-Housed Persons
- Abstract
Background: Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one's potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity., Methods: We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320)., Results: Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure's concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities., Conclusions: Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed., (© 2023. The Author(s).)
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- 2023
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7. Homeless Adults' Recovery Experiences in Housing First and Traditional Services Programs in Seven European Countries.
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Greenwood RM, Manning RM, O'Shaughnessy BR, Vargas-Moniz MJ, Loubière S, Spinnewijn F, Lenzi M, Wolf JR, Bokszczanin A, Bernad R, Källmén H, and Ornelas J
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- Adult, Aged, Aged, 80 and over, Choice Behavior, Cross-Sectional Studies, Europe, Female, Humans, Male, Mental Disorders psychology, Middle Aged, Young Adult, Community Mental Health Services methods, Ill-Housed Persons psychology, Housing
- Abstract
Across Europe, as governments turn to housing-led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment-first approach to addressing long-term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment-first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross-sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed., (© 2019 Society for Community Research and Action.)
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- 2020
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8. Comparison of Housing First and Traditional Homeless Service Users in Eight European Countries: Protocol for a Mixed Methods, Multi-Site Study.
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Greenwood RM, Manning RM, O'Shaughnessy BR, Cross O, Vargas-Moniz MJ, Auquier P, Santinello M, Wolf JR, Bokszczanin A, Bernad R, Källmén H, Spinnewijn F, and Ornelas J
- Abstract
Background: Homeless services expend considerable resources to provide for service users' most basic needs, such as food and shelter, but their track record for ending homelessness is disappointing. An alternative model, Housing First, reversed the order of services so that homeless individuals are offered immediate access to independent housing, with wraparound supports but no treatment or abstinence requirements. Although the evidence base for Housing First's effectiveness in ending homelessness is robust, less is known about its effectiveness in promoting recovery., Objective: The objective of this research is to compare rehabilitation- and recovery-related outcomes of homeless services users who are engaged in either Housing First or traditional staircase services in eight European countries: France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, and Sweden., Methods: A mixed methods, multi-site investigation of Housing First and traditional services will compare quantitative outcomes at two time points. Key rehabilitation outcomes include stable housing and psychiatric symptoms. Key growth outcomes include community integration and acquired capabilities. Semistructured interviews will be used to examine service users' experiences of environmental constraints and affordances on acquired capabilities to identify features of homeless services that enhance service users' capabilities sets. Multi-level modelling will be used to test for group differences-Housing First versus traditional services-on key outcome variables. Thematic analysis will be used to understand the ways in which service users make sense of internal and external affordances and constraints on capabilities., Results: The study is registered with the European Commission (registration number: H2020-SC6-REVINEQUAL-2016/ GA726997). Two press releases, a research report to the funding body, two peer-reviewed articles, and an e-book chapter are planned for dissemination of the final results. The project was funded from September 2016 through September 2019. Expected results will be disseminated in 2019 and 2020., Conclusions: We will use the findings from this research to formulate recommendations for European social policy on the configuration of homeless services and the scaling up and scaling out of Housing First programs. From our findings, we will draw conclusions about the setting features that promote individuals' exits from homelessness, rehabilitation, and recovery., International Registered Report Identifier (irrid): RR1-10.2196/14584., (©Ronni Michelle Greenwood, Rachel M Manning, Branagh R O'Shaughnessy, Oisin Cross, Maria J Vargas-Moniz, Pascal Auquier, Massimo Santinello, Judith R Wolf, Anna Bokszczanin, Roberto Bernad, Håkan Källmén, Frederik Spinnewijn, José Ornelas, HOME_EU Consortium. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 05.02.2020.)
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- 2020
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9. Understanding Innovation in Homeless Service Provision: A Study of Frontline Providers' Values-Readiness for Change.
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Manning RM and Greenwood RM
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- Case Management organization & administration, Empowerment, Health Status, Humans, Interviews as Topic, Ireland, Negotiating, Personal Autonomy, Qualitative Research, Substance-Related Disorders epidemiology, Time Factors, Ill-Housed Persons statistics & numerical data, Mental Disorders epidemiology, Social Work organization & administration
- Abstract
Service innovation for adults experiencing mental illness and homelessness typically involves shifting from treatment-led, staircase models toward recovery-oriented, Housing-First models. Aligning frontline service providers' values to those embedded within newer models is an important, but under-investigated, influence on the innovation process. To assess values alignment in this context, we conducted semi-structured qualitative interviews with frontline providers in staircase services in Ireland (n = 50). Data showed that, while their values mostly aligned to the treatment-led model, there was meaningful evidence of more recovery-oriented values, too. Strategies to enhance innovation through values-alignment are discussed.
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- 2019
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10. Recovery in homelessness: The influence of choice and mastery on physical health, psychiatric symptoms, alcohol and drug use, and community integration.
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Manning RM and Greenwood RM
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- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Ireland, Male, Middle Aged, Substance-Related Disorders rehabilitation, Young Adult, Choice Behavior, Health Status, Ill-Housed Persons psychology, Mental Disorders rehabilitation, Personal Autonomy, Self Efficacy, Social Participation
- Abstract
Objective: Recovery is the process through which one learns to overcome, manage, or live with the negative consequences of physical illness, mental illness, alcohol or drug misuse, or trauma. Homeless individuals endure many, or all, of these experiences. Previous research has shown that characteristics of homeless services, particularly the amount of choice they afford to service users, can influence recovery experiences, potentially by increasing a sense of mastery. The purpose of this study was to test the hypothesis that choice in housing and services would predict recovery in a number of domains, and that these relationships would be mediated by mastery., Method: Using survey data collected from a sample of homeless services users (n = 160) in Ireland, we conducted a series of cross-sectional mediation analyses to predict recovery in domains of physical health, psychiatric symptoms, alcohol and drug use, and community integration., Results: We observed the hypothesized mediational relationship for each recovery domain except alcohol use. That is, personal mastery mediated the relationship of perceived choice to self-appraised physical health, psychiatric symptoms, drug use, and physical and psychological aspects of community integration, but not alcohol use., Conclusions and Implications for Practice: Findings add further support to the growing body of evidence that suggests choice is centrally important to recovery experiences among individuals in homelessness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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- 2019
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11. The influence of matrix stiffness on the behavior of brain metastatic breast cancer cells in a biomimetic hyaluronic acid hydrogel platform.
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Narkhede AA, Crenshaw JH, Manning RM, and Rao SS
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- Cell Adhesion, Cell Line, Tumor, Cell Movement, Cell Proliferation, Elastic Modulus, Female, Focal Adhesion Protein-Tyrosine Kinases metabolism, Humans, Phosphatidylinositol 3-Kinases metabolism, Biomimetic Materials chemistry, Brain Neoplasms secondary, Breast Neoplasms pathology, Extracellular Matrix metabolism, Hyaluronic Acid chemistry, Hydrogels chemistry
- Abstract
Breast cancer brain metastasis marks the most advanced stage of breast cancer no longer considered curable with a median survival period of ∼4-16 months. Apart from the genetic susceptibility (subtype) of breast tumors, brain metastasis is also dictated by the biophysical/chemical interactions of tumor cells with native brain microenvironment, which remain obscure, primarily due to the lack of tunable biomimetic in vitro models. To address this need, we utilized a biomimetic hyaluronic acid (HA) hydrogel platform to elucidate the impact of matrix stiffness on the behavior of MDA-MB-231Br cells, a brain metastasizing variant of the triple negative breast cancer line MDA-MB-231. We prepared HA hydrogels of varying stiffness (0.2-4.5 kPa) bracketing the brain relevant stiffness range to recapitulate the biophysical cues provided by brain extracellular matrix. In this system, we observed that the MDA-MB-231Br cell adhesion, spreading, proliferation, and migration significantly increased with the hydrogel stiffness. We also demonstrated that the stiffness based responses of these cells were mediated, in part, through the focal adhesion kinase-phosphoinositide-3 kinase pathway. This biomimetic material system with tunable stiffness provides an ideal platform to further the understanding of mechanoregulation associated with brain metastatic breast cancer cells. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1832-1841, 2018., (© 2018 Wiley Periodicals, Inc.)
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- 2018
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12. Microsystems of Recovery in Homeless Services: The Influence of Service Provider Values on Service Users' Recovery Experiences.
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Manning RM and Greenwood RM
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- Adolescent, Adult, Aged, Female, Health Status, Humans, Interviews as Topic, Male, Mental Health, Middle Aged, Qualitative Research, Surveys and Questionnaires, Young Adult, Attitude of Health Personnel, Ill-Housed Persons psychology, Patient Satisfaction, Social Values
- Abstract
There is still much to learn about how aspects of the ecology of homelessness shape homeless adults' recovery experiences. In the present mixed-methods study, the relationship of service providers' work-related values to their service users' recovery experiences in the microsystem of homelessness were examined. Service providers completed semi-structured qualitative interviews about their service users, daily work activities, and work-related goals. At three time points, their service users completed quantitative measures of choice, mastery, and recovery in four life domains: physical health, psychiatric symptoms, substance use, and community integration. Service providers' interview transcripts were coded for three indicators of values: assumptions, actions, and end-states. Summative Content Analysis was used to transform qualitative codes into numeric data so they could be used to predict service users' recovery. In a series of growth curve models, the extent to which service providers' end-state values, as an indicator of consumer-led values, was shown to indirectly predict service users' recovery experiences, through their perceived choice and mastery. Findings confirm that providers' values are an important influence on service users' recovery. Results are discussed in terms of their implications for recovery-oriented theory and practice., (© Society for Community Research and Action 2018.)
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- 2018
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13. Mastery matters: consumer choice, psychiatric symptoms and problematic substance use among adults with histories of homelessness.
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Greenwood RM and Manning RM
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- Adult, Aged, Aged, 80 and over, Choice Behavior, Female, Ill-Housed Persons psychology, Humans, Ireland, Male, Middle Aged, Substance-Related Disorders diagnosis, Surveys and Questionnaires, Young Adult, Mental Disorders physiopathology, Substance-Related Disorders psychology
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Previous research demonstrated the importance of consumer choice and mastery to residential stability and psychiatric functioning for adults with histories of homelessness. In the present study, we investigated whether these relationships hold, even in the context of problem-related substance misuse. Questionnaire data were collected in Ireland from 101 residents of long-term homeless accommodation in 2010. Hayes' PROCESS macro for mediation and moderation analysis in SPSS was employed to test our hypotheses. Findings demonstrated that the indirect effect of choice through mastery on psychiatric functioning was stronger for individuals with more recent problem-related substance use than for those with no or distant histories of problem-related substance use. Our findings confirm that consumer choice in housing and services is important to homeless services users' recovery experiences. Because of its relationship with mastery, consumer choice in housing and services protects homeless services users' psychiatric functioning, especially when substance use-related choices have had negative consequences. Our findings suggest that if homeless services take away consumer choice when substance use causes problems, they may actually undermine, rather than foster, service users' psychiatric functioning., (© 2016 John Wiley & Sons Ltd.)
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- 2017
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14. The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: four-year follow-up.
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Manning RM, Jung RT, Leese GP, and Newton RW
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- Appetite Depressants therapeutic use, Diabetes Mellitus diet therapy, Female, Fenfluramine therapeutic use, Follow-Up Studies, Glycated Hemoglobin metabolism, Humans, Male, Middle Aged, Ambulatory Care, Diabetes Mellitus therapy, Dietetics, Home Care Services, Obesity, Psychotherapy, Group, Weight Loss
- Abstract
Weight change and glycaemic control in 132 diabetic patients previously treated for 1 year by four different methods aimed at weight loss were reanalysed 4 years after the outset. The four treatment groups comprised clinic visits, home visits, behavioural group therapy, and dexfenfluramine given for the initial 3 months followed by clinic visits. When analysed on an intention to treat basis only the dexfenfluramine group maintained a significant weight loss at year 4 (mean -2.46 kg) with 43% of patients losing 3 kg or more; HBA1c was not decreased. The other treatment groups showed overall weight regain from year 1 to year 4. Within the home visit group however, the number of patients losing at least 3 kg doubled between years 1 (21%) and 4 (38%). When analysed on a completion basis, weight loss in the dexfenfluramine group was significant in females but not in males at year 4. During the 4 years of observation a cohort of 54 patients reflecting our routine clinic practice gained on average 0.35 kg. Although now withdrawn, the use of an appetite suppressant dexfenfluramine for just 3 months would appear to have a long-term advantage on weight loss in this diabetic population, although the weight lost was not associated with improvement in glycaemic control.
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- 1998
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15. Overview of the Mars Pathfinder mission and assessment of landing site predictions.
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Golombek MP, Cook RA, Economou T, Folkner WM, Haldemann AF, Kallemeyn PH, Knudsen JM, Manning RM, Moore HJ, Parker TJ, Rieder R, Schofield JT, Smith PH, and Vaughan RM
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- Atmosphere, Geologic Sediments, Magnetics, Water, Extraterrestrial Environment, Mars
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Chemical analyses returned by Mars Pathfinder indicate that some rocks may be high in silica, implying differentiated parent materials. Rounded pebbles and cobbles and a possible conglomerate suggest fluvial processes that imply liquid water in equilibrium with the atmosphere and thus a warmer and wetter past. The moment of inertia indicates a central metallic core of 1300 to 2000 kilometers in radius. Composite airborne dust particles appear magnetized by freeze-dried maghemite stain or cement that may have been leached from crustal materials by an active hydrologic cycle. Remote-sensing data at a scale of generally greater than approximately 1 kilometer and an Earth analog correctly predicted a rocky plain safe for landing and roving with a variety of rocks deposited by catastrophic floods that are relatively dust-free.
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- 1997
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16. The comparison of four weight reduction strategies aimed at overweight diabetic patients.
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Manning RM, Jung RT, Leese GP, and Newton RW
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- Adolescent, Adult, Aged, Behavior Therapy, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Diet, Reducing, Female, Fenfluramine adverse effects, Fenfluramine therapeutic use, Home Care Services, Humans, Male, Middle Aged, Motivation, Weight Loss physiology, Diabetes Mellitus therapy, Diabetes Mellitus, Type 1 therapy, Diabetes Mellitus, Type 2 therapy, Obesity, Weight Loss drug effects
- Abstract
Four weight reduction strategies were investigated in a diabetic population who previously had shown little motivation to lose weight. Some 409 patients, body mass index 28-45 were invited to participate. Only 51% replied, although 22 patients (5.4%) lost > 3 kg by invitation alone. The study comprised 159 patients, randomly allotted to either regular clinic visits, behavioural group therapy, dexfenfluramine (30 mg d-1 for initial 3 months) or combined home and clinic visits. A further 58 patients were monitored as controls. At 3 months the best weight loss (intention to treat) was achieved using dexfenfluramine with mean weight losses of 1.6, 1.2, 3.4, and 1.7 kg, respectively, in each group. At 1 year weight losses were similar (1.2, 1.8, 2.8, 1.2 kg, respectively) but contrasted with a mean 1.2 kg weight gain in the controls. Some 38% lost > 3 kg on dexfenfluramine compared to 19-23% for the others. In those who completed the study, weight loss was similar with behavioural therapy (3 kg) or dexfenfluramine (3.2 kg). We conclude that intensive dietetic efforts can reverse the weight increase in the diabetic population although weight loss is minimal. Dexfenfluramine was most effective in the short term, behavioural therapy useful long term but only in those who remained within the group; home visits offered no advantage.
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- 1995
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17. Studies of circulating parathyroid hormone in man using a homologous amino-terminal specific immunoradiometric assay.
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Papapoulos SE, Manning RM, Hendy GN, Lewin IG, and O'Riordan JL
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- Female, Humans, Hyperparathyroidism blood, Hypoparathyroidism blood, Male, Metabolic Clearance Rate, Pseudohypoparathyroidism blood, Radioimmunoassay methods, Parathyroid Hormone blood
- Abstract
Circulating immunoreactive parathyroid hormone (PTH) was measured by a homologous, amino-terminal, specific, immunoradiometric assay in man. In forty-two healthy subjects the concentrations ranged between < 40 pg/ml and 120 pg/ml. No hormone could be detected in the sera of eleven patients with hypoparathyroidism, but the concentrations were clearly elevated in six patients with pseudohypoparathyroidism (range 190-1120 pg/ml). In thirty-five patients with primary hyperparathyroidism the mean (+/- SEM) concentration was 283.4 +/- 42.4 pg/ml (range 100-1350 pg/ml). A significant positive correlation was demonstrated between immunoassayable hormone and serum calcium concentrations in these patients. In nine patients PTH concentrations were measured before and after parathyroidectomy. In all of them they were elevated pre-operatively but fell to the normal range after parathyroidectomy. The disappearance of exogenously administered synthetic human PTH (1-34) from the circulation of two normal subjects was rapid with an apparent plasma half-disappearance time (t1/2) between 2 and 3 min; the metabolic clearance rate was 12.9 and 9.0 ml. kg-1 . min-1 respectively. Similarly, the disappearance of endogenous, amino-terminal, immunoreactive PTH from the circulation of two patients with primary hyperparathyroidism after parathyroidectomy was rapid; the apparent t1/2 was approximately 3 min. Homologous amino-terminal specific immunoassays for PTH can thus be useful for the study of both the acute, and chronic, changes of circulating hormone in man and represent an improvement over heterologous unselected assay systems.
- Published
- 1980
- Full Text
- View/download PDF
18. Control of secretion of parathyroid hormone in secondary hyperparathyroidism.
- Author
-
Adami S, Muirhead N, Manning RM, Gleed JH, Papapoulos SE, Sandler LM, Catto GR, and O'Riordan JL
- Subjects
- Calcium blood, Humans, Hyperparathyroidism, Secondary blood, Kidney Failure, Chronic blood, Osteomalacia blood, Parathyroid Hormone blood, Radioimmunoassay, Hyperparathyroidism, Secondary physiopathology, Parathyroid Hormone metabolism
- Published
- 1982
- Full Text
- View/download PDF
19. Characterization of antibodies against intact human parathyroid hormone [proceedings].
- Author
-
Manning RM, Hendy GN, and O'Riordan JL
- Subjects
- Humans, Antibodies analysis, Parathyroid Hormone immunology
- Published
- 1977
20. A carboxy-terminal specific assay for human parathyroid hormone.
- Author
-
Manning RM, Adami S, Papapoulos SE, Gleed JH, Hendy GN, Rosenblatt M, and O'Riordan JL
- Subjects
- Adolescent, Adult, Aged, Animals, Child, Child, Preschool, Female, Goats, Humans, Hyperparathyroidism blood, Hyperparathyroidism, Secondary blood, Hypoparathyroidism blood, Male, Middle Aged, Parathyroid Glands surgery, Pseudohypoparathyroidism blood, Radioimmunoassay, Parathyroid Hormone blood
- Published
- 1981
- Full Text
- View/download PDF
21. Calcium homeostasis in the fetal pig.
- Author
-
Care AD, Ross R, Pickard DW, Weatherley AJ, Garel JM, Manning RM, Allgrove J, Papapoulos S, and O'Riordan JL
- Subjects
- Animals, Calcitonin blood, Calcium blood, Calcium metabolism, Female, Gestational Age, Hypercalcemia chemically induced, Maternal-Fetal Exchange, Parathyroid Hormone blood, Parathyroid Hormone immunology, Parathyroid Hormone pharmacology, Placenta metabolism, Pregnancy, Calcium physiology, Fetus physiology, Homeostasis, Swine embryology
- Abstract
Acute studies have been carried out with pregnant sows and their fetuses during the last 2 weeks of gestation. In blood samples obtained simultaneously it was shown that the concentrations of ionized calcium, calcitonin and parathyroid hormone (PTH) in fetal plasma were all greater than the corresponding values in maternal plasma. In contrast, the fetal concentrations of 24,25-dihydroxy vitamin D3 were lower than maternal and those of 1,25-dihydroxy vitamin D3 were not significantly different. In one experiment the circulatory level of fetal PTH was shown to be higher than in the sow by both an immunoradiometric assay and a very sensitive cytochemical assay. The latter showed the fetal: maternal ratio to be approximately three. This inappropriately high level of fetal PTH was unaffected by short term hypocalcaemic and hypercalcaemic changes in the fetal circulation. Although part of this fetal PTH may have been secreted in response to the action of beta-catecholamines released as a result of the experimental conditions, the transplacental gradient of PTH was also demonstrated in the chronically catheterized fetus. A short term period of either hypercalcaemia or hypocalcaemia induced in the mother was without consistent effect upon plasma calcium concentration in the fetus. However, an increase in ionized calcium concentration in the fetal plasma was found to follow the cessation of a period of maternal hypocalcaemia. It can be seen that the porcine fetus possesses the important elements of a calcium homeostatic mechanism, namely parathyroid hormone, calcitonin and the biologically active metabolites of vitamin D. Although the degree of independence from the mother is somewhat less than in the sheep, it is concluded that the porcine fetus is largely autonomous with respect to calcium homeostasis.
- Published
- 1982
22. Development of homologous immunological assays for human parathyroid hormone.
- Author
-
Manning RM, Hendy GN, Papapoulos SE, and O'Riordan JL
- Subjects
- Animals, Antibody Specificity, Cattle, Goats immunology, Humans, Parathyroid Hormone immunology, Peptides immunology, Radioimmunoassay methods, Swine, Parathyroid Hormone analysis
- Abstract
Antisera to a trichloroacetic-acid precipitate of human parathyroid hormone (PTH) were produced in goats. Two of these antisera (G36 and G31) were of high affinity, and the bovine and porcine hormones were less reactive. Synthetic peptides containing the amino-terminal region of human PTH reacted with both antisera; the 1--34 peptide (PTH-(1--34)), with the sequence proposed by Niall, Sauer, Jacobs, Keutmann, Segre, O'Riordan, Aurbach & Potts in 1974, was more reactive than that having the sequence proposed by Brewer, Fairwell, Ronan, Sizemore & Arnaud in 1972. The antisera were further characterized with a number of other native and synthetic fragments of human PTH and reacted poorly with fragments from the carboxy-terminal region of the molecule. Since the amino-terminal fragments did not account for all the immunoreactivity, it is assumed that the antisera had some recognition sites for the central part of the molecule. Highly purified human PTH-(1==84) was labelled with 125I and radioimmunoassays were developed using this tracer and antiserum G36. To avoid the problems associated with labelling human PTH with 125I, a labelled antibody assay was developed with G36 and an immunoadsorbent consisting of human PTH-(1--34) (sequence of Niall et al.) coupled to cellulose. A sensitive homologous amino-terminal specific assay was developed in this way.
- Published
- 1980
- Full Text
- View/download PDF
23. Amino-terminal labelled antibody assay for human parathyroid hormone [proceedings].
- Author
-
Papapoulos SE, Hendy GN, Manning RM, Lewin IG, and O'Riordan JL
- Subjects
- Humans, Parathyroid Hormone blood, Radioimmunoassay methods, Parathyroid Hormone analysis
- Published
- 1978
24. Suppression of secondary hyperparathyroidism in uraemia: acute and chronic studies.
- Author
-
Muirhead N, Catto GR, Edward N, Adami S, Manning RM, and O'Riordan JL
- Subjects
- Adult, Calcitriol therapeutic use, Calcium blood, Humans, Hyperparathyroidism, Secondary complications, Hyperparathyroidism, Secondary surgery, Hyperparathyroidism, Secondary therapy, Middle Aged, Peptide Fragments blood, Renal Dialysis, Uremia complications, Uremia therapy, Calcium Gluconate, Gluconates, Hyperparathyroidism, Secondary blood, Parathyroid Hormone blood, Uremia blood
- Abstract
A study was conducted evaluating the response of serum parathyroid hormone to acute hypercalcaemia and long term administration of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in patients receiving maintenance haemodialysis. During infusion of elemental calcium 4 mg/kg/h over four hours in 12 patients not receiving vitamin D the concentration of serum amino terminal parathyroid hormone fell by 31-96% (mean 74.8 (SD 17.6)%) while that of carboxy terminal parathyroid hormone changed little. There was a strong inverse correlation between baseline serum calcium concentration and percentage fall in amino terminal parathyroid hormone during infusion (r = 0.88; p less than 0.001). In seven patients who received prolonged treatment with 1,25(OH)2D3 after calcium infusion there was a positive correlation between maximum percentage fall in amino terminal parathyroid hormone during infusion and the percentage fall in amino terminal parathyroid hormone after 1,25(OH)2D3 treatment (r = 0.79; p less than 0.05). The responsiveness of the parathyroid glands to changes in calcium in acute studies may be used to predict the efficacy of long term treatment with 1,25(OH)2D3. Patients in whom calcium infusion does not suppress parathyroid hormone may have true parathyroid autonomy and require early parathyroidectomy.
- Published
- 1984
- Full Text
- View/download PDF
25. Immunological properties of synthetic human parathyroid hormone 53--84 fragment.
- Author
-
Hendy GN, Manning RM, Rosenblatt M, Tregear GW, Keutmann HT, and O'Riordan JL
- Subjects
- Humans, Peptide Fragments immunology, Radioimmunoassay, Hormones immunology, Parathyroid Hormone immunology
- Abstract
The immunological properties of a synthetic peptide comprising the carboxyl-terminal 53--84 region of human parathyroid hormone (PTH) have been studied. The immunoreactivity of the synthetic human PTH-(53--84) peptide paralleled that of a 53--84 fragment of the native human hormone prepared by enzymic digestion, in both a standard radioimmunoassay, which was not region-specific, and also a radioimmunoassay specific for the carboxyl-terminal region of PTH. However, in both types of radioimmunoassay the synthetic human PTH-(53--84) peptide was four to five times more reactive than the native human PTH-(53--84) fragment.
- Published
- 1979
- Full Text
- View/download PDF
26. Cytochemical bioassay of parathyroid hormone in maternal and cord blood.
- Author
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Allgrove J, Adami S, Manning RM, and O'Riordan JL
- Subjects
- Biological Assay methods, Female, Histocytochemistry, Humans, Peptide Fragments blood, Radioimmunoassay, Calcium blood, Fetal Blood analysis, Parathyroid Hormone blood, Pregnancy
- Abstract
Parathyroid hormone and calcium were measured in plasma taken from pregnant women at term and from the umbilical veins of their infants at birth. Three assays were used to measure parathyroid hormone, a cytochemical bioassay of bioactivity and two immunoradiometric assays, one specific for the amino terminus, the other specific for the carboxy terminus of the parathyroid hormone molecule. Plasma calcium was significantly higher in the infants than in the mothers. Maternal parathyroid hormone bioactivity and the amino terminus were both slightly raised, but the carboxy terminus value was normal; these findings supported the view that late pregnancy is a time of mild physiological hyperparathyroidism. In the infants, the amino terminus was undetectable and the carboxy terminus was either undetectable or towards the lower end of the normal range: bioactivity of parathyroid hormone was considerably raised and was related to the gradient of calcium across the placenta. This suggests that the parathyroid glands are not suppressed during fetal life and that they may play an important part in the maintenance of high fetal plasma calcium concentrations.
- Published
- 1985
- Full Text
- View/download PDF
27. Long-term experience of alfacalcidol in renal osteodystrophy.
- Author
-
Sharman VL, Brownjohn AM, Goodwin FJ, Hately W, Manning RM, O'Riordan JH, Papapoulos SE, and Marsh FP
- Subjects
- Adult, Alkaline Phosphatase blood, Calcium blood, Chronic Kidney Disease-Mineral and Bone Disorder blood, Chronic Kidney Disease-Mineral and Bone Disorder enzymology, Humans, Middle Aged, Parathyroid Hormone blood, Phosphorus blood, Renal Dialysis, Time Factors, Chronic Kidney Disease-Mineral and Bone Disorder drug therapy, Hydroxycholecalciferols therapeutic use
- Abstract
Thirteen patients receiving regular haemodialysis, with biochemical or radiological evidence of renal osteodystrophy, were treated with alfacalcidol (1 alpha hydroxy vitamin D3) for four years. During the first eighteen months of treatment plasma alkaline phosphatase and serum parathyroid hormone concentrations fell and subperiosteal phalangeal erosions improved. Thereafter plasma alkaline phosphatase and serum parathyroid hormone concentrations rose and after four years' treatment only four patients had a normal plasma alkaline phosphatase, only five a normal serum parathyroid hormone level and in only six had the erosions healed completely. Hypercalcaemia occurred in twelve patients, plasma calcium exceeding 3.0 mmol/l in ten. Plasma calcium rose abruptly close to the time when plasma alkaline phosphatase became normal and often remained raised despite reduction in dosage of alfacalcidol. We have reservations about the ultimate value of long-term treatment with alfacalcidol in haemodialysed patients with renal osteodystrophy and urge caution in its use.
- Published
- 1982
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