Survival and risk factors for mortality among individuals with congenital heart disease

PhD ThesisWith advances in medical, surgical and intensive care interventions, more individuals with congenital heart disease (CHD) are surviving infancy. However, long-term survival is not well researched. Given that UK paediatric cardiovascular services are undergoing reforms to ensure there are adequate health-care provisions, further information is required on CHD prevalence and survival. An analysis of data from six British Isles Network of Congenital Anomaly Registers (BINOCARs), showed no overall trend in CHD prevalence between 1991 and 2010. However, there was an increasing trend in the prevalence of tetralogy of Fallot, equating to a yearly excess of 16 cases in England and Wales. There was an increased risk of CHD in twins, particularly monochorionic (MC) twins. The prevalence of CHD in MC twins increased over time, equating to a yearly excess of seven cases in England and Wales. Using a systematic review and meta-analysis, pooled five and 10-year survival was 85.4% and 81.4%, respectively. Year of delivery, preterm delivery, extra-cardiac anomalies (ECAs) and birth weight were associated with mortality. In an analysis of data from one BINOCAR linked to death registrations, one-year survival was 89.1%, decreasing to 85.2% at 20 years. Less recent year of delivery, lower gestational age, low birth weight, prenatal diagnosis and the presence of ECAs increased the risk of mortality. The predicted 20-year survival of individuals born with isolated CHD in 2015 was 98.7%. The predicted prevalence of CHD was 74.0 and 68.8 per 10,000 live births in 2015 and 2020, respectively. Using ONS data to extrapolate, this equates to approximately 296,000 cases of CHD being born between 2012-2017 in the UK. Given that infants with CHD require complex surgeries, the predicted prevalence and survival estimates described in this thesis are important for health service planning and for providing accurate information to parents when a CHD is diagnosed prenatally.British Heart Foundatio

Socioeconomic inequalities in mortality in children with congenital heart disease : a systematic review and meta-analysis

Funding Information: Newcastle University Medical Faculty FellowshipPeer reviewedPostprin

Motivational drive and alprazolam misuse : a recipe for aggression?

Benzodiazepine-related aggression has received insufficient research attention, in particular little is known about the motivational factors which may contribute to the development of this paradoxical response. The revised Reinforcement Sensitivity Theory provides a theoretical framework from which to understand the relevant underlying motivational processes. The current study aimed to identify the role of approach and avoidance motivational tendencies in the occurrence of benzodiazepine-related aggression. Data regarding benzodiazepine and other substance use, approach and avoidance motivation, and general and physical aggressive behaviour were collected via self-report questionnaires. Participants were a convenience sample (n=204) who reported using benzodiazepines in the previous year. Participants were primarily male (62.7%), aged 18–51 years old. Hierarchical multiple regressions indicated that general and physical aggression were predicted by alprazolam use and Drive, a facet of approach motivation. Overall, lower diazepam use significantly predicted higher levels of general aggression. However, when diazepam-preferring participants were examined in isolation of the larger sample (23.5% of sample), problematic (dependent) diazepam use was associated with greater aggression scores, as was dependence risk for alprazolam-preferring participants (39.7% of sample). The findings highlight the importance of motivational factors and benzodiazepine use patterns in understanding benzodiazepine-related aggression, with implications for violent offender rehabilitation

Human cloning in film: horror, ambivalence, hope

Fictional filmic representations of human cloning have shifted in relation to the 1997 announcement of the birth of Dolly the cloned sheep, and since therapeutic human cloning became a scientific practice in the early twentieth century. The operation and detail of these shifts can be seen through an analysis of the films The Island (2005) and Aeon Flux (2005). These films provide a site for the examination of how these changes in human cloning from fiction to practice, and from horror to hope, have been represented and imagined, and how these distinctions have operated visually in fiction, and in relation to genre

Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice

Kate Toft - ORCID: 0000-0002-0129-9329 https://orcid.org/0000-0002-0129-9329Background The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians’ perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment. Results Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms ‘swallowing’, ‘eating’ and ‘dysphagia’; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred. Conclusions This study indicates that MDADI's content validity is ‘insufficient’ when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research.https://doi.org/10.1111/1460-6984.13026aheadofprintaheadofprin

Purchasing of tobacco-related and e-cigarette-related products within prisons before and after implementation of smoke-free prison policy: analysis of prisoner spend data across Scotland, UK

Objectives To examine the effect of smoke-free prison policy implementation in November 2018 on purchasing patterns in the prison canteen (shop). Design Interrupted time series. Setting All 12 closed, publicly run prisons in Scotland, UK. Participants People in custody (PiC) between August 2018 and end of March 2019 (n=11 944). Interventions Implementation of smoke-free prisons policy. Outcome measures Total spent on all products, nicotine-related products, and food and beverage products per week. Methods Canteen data were provided for the period July 2018–September 2019 by the Scottish Prison Service. In a series of generalised linear mixed effects models, the amount spent before and after implementation of smoke-free prison policy was compared for all purchases in the time period, and for PiC identified as ‘smokers’ and ‘non-smokers’ from their pre-implementation tobacco purchasing patterns. Results The amount spent on nicotine-related products significantly decreased from pre-implementation to post implementation (incident rate ratio (IRR) 0.40; 99% CI 0.33 to 0.51,

The improved prognosis of hypoplastic left heart:A Population-Based Register Study of 343 Cases in England and Wales

Background: Hypoplastic Left Heart Syndrome (HLHS) is a severe congenital heart defect (CHD) characterised by the underdevelopment of the left side of the heart with varying levels of hypoplasia of the left atrium, mitral valve, left ventricle, aortic valve and aortic arch. In the UK, age 12 survival for cases born between 1991 and 1993 was 21%. UK survival estimates corresponding to cases born between 2000 and 2015 were improved at 56%, but survival was examined up to age five only. Contemporary long-term survival estimates play a crucial role in counselling parents following diagnosis. The aim of this study was to report survival estimates up to age 15 for children born with HLHS or hypoplastic left ventricle with additional CHD in England and Wales between 1998 and 2012. Methods: Cases of HLHS notified to four congenital anomaly registers in England and Wales during 1998–2012, matched to Office for National Statistics mortality information, were included. Kaplan-Meier survival estimates to age 15 were reported. Cox regression models were fitted to examine risk factors for mortality. Results: There were 244 cases of HLHS and 99 cases of hypoplastic left ventricle co-occurring with other CHD, with traced survival status. Kaplan-Meier survival estimates for HLHS were 84.4% at age 1 week, 76.2% at 1 month, 63.5% at age 1 year, 58.6% at age 5 years, 54.6% at age 10 years, and 32.6% to age 15 years. The Kaplan-Meier survival estimates for cases of hypoplastic left ventricle co-occurring with additional CHD were 90.9% at age 1 week, 84.9% at 1 month, 73.7% at age 1 year, 67.7% to age 5 years, 59.2% to age 10 years, and 40.3% to age 15 years. Preterm birth (p = 0.007), low birth weight (p = 0.005), and female sex (p = 0.01) were associated with mortality. Conclusions: We have shown that prognosis associated with HLHS in the twenty first century exceeds that of many previous population-based studies, likely due to improvements in intensive care technologies and advances in surgical techniques over the last few decades

A short-form version of the Australian English Communicative Development Inventory

Published online: 06 Oct 2021.Purpose: The Australian English Communicative Development Inventory (OZI) is a 558-item parent report tool for assessing language development at 12–30 months. Here, we introduce the short form (OZI-SF), a 100-item, picture-supported, online instrument with substantially lower time and literacy demands. Method: In tool development (Study 1), 95 items were drawn from the OZI to match its item distribution by age of acquisition and semantic categories. Five items were added from four other semantic categories, plus 12 gestures and six games/routines. Simulations computed OZI-SF scores from existing long-form OZI norm data, and OZI and projected OZI-SF scores were correlated. In an independent norming sample (Study 2), parents (n¼230) completed the OZI-SF for their children aged 12–30 months. Child scores were analysed by age and sex. Result: OZI-SF and OZI scores correlate highly across age and language development levels. Vocabulary scores (receptive, expressive) correlate with age and the median for girls is higher until 24 months. By 24 months, 50% of the sample combine words “often”. The median time to OZI-SF completion was 12 minutes. Conclusion: Fitted percentiles permit working guidelines for typical (median) performance and lower cut-offs for children who may be behind on age-based expectations and/or at risk for a communication difficulty. The OZI-SF is a short-form of the OZI that has promise for research and clinical/educational use with Australian families.This work was supported by the Australian Research Council Centre of Excellence for the Dynamics of Language (ARC CoEDL, CE140100041)

Validation of an MRI-only planning workflow for definitive pelvic radiotherapy

Purpose: Previous work on Magnetic Resonance Imaging (MRI) only planning has been applied to limited treatment regions with a focus on male anatomy. This research aimed to validate the use of a hybrid multi-atlas synthetic computed tomography (sCT) generation technique from a MRI, using a female and male atlas, for MRI only radiation therapy treatment planning of rectum, anal canal, cervix and endometrial malignancies. Patients and methods: Forty patients receiving radiation treatment for a range of pelvic malignancies, were separated into male (n = 20) and female (n = 20) cohorts for the creation of gender specific atlases. A multi-atlas local weighted voting method was used to generate a sCT from a T1-weighted VIBE DIXON MRI sequence. The original treatment plans were copied from the CT scan to the corresponding sCT for dosimetric validation. Results: The median percentage dose difference between the treatment plan on the CT and sCT at the ICRU reference point for the male cohort was − 0.4% (IQR of 0 to − 0.6), and − 0.3% (IQR of 0 to − 0.6) for the female cohort. The mean gamma agreement for both cohorts was &gt; 99% for criteria of 3%/2 mm and 2%/2 mm. With dose criteria of 1%/1 mm, the pass rate was higher for the male cohort at 96.3% than the female cohort at 93.4%. MRI to sCT anatomical agreement for bone and body delineated contours was assessed, with a resulting Dice score of 0.91 ± 0.2 (mean ± 1 SD) and 0.97 ± 0.0 for the male cohort respectively; and 0.96 ± 0.0 and 0.98 ± 0.0 for the female cohort respectively. The mean absolute error in Hounsfield units (HUs) within the entire body for the male and female cohorts was 59.1 HU ± 7.2 HU and 53.3 HU ± 8.9 HU respectively. Conclusions: A multi-atlas based method for sCT generation can be applied to a standard T1-weighted MRI sequence for male and female pelvic patients. The implications of this study support MRI only planning being applied more broadly for both male and female pelvic sites. Trial registration This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (www.anzctr.org.au) on 04/10/2017. Trial identifier ACTRN12617001406392.</p

Diet, Physical Activity and Gestational Weight Gain Patterns among Pregnant Women Living with Obesity in the North East of England: The GLOWING Pilot Trial

Maternal diet, physical activity (PA) behaviours, and gestational weight gain (GWG) are important for optimum health of women and their babies. This secondary analysis of the GLOWING pilot cluster trial explored these among women living with obesity in high deprivation. Pregnant women completed food frequency, PA and psychosocial questionnaires. Weights were retrieved from medical records and measured during routine appointments with midwives. Descriptive and regression analyses were stratified by obesity class. A total of 163 women were recruited; 54.0% had class 1 obesity, 25.8% class 2, 20.2% class 3, and 76.1% lived in the two most deprived quintiles. Women had suboptimal dietary intake, particularly for oily fish, fruit and vegetables. PA was predominantly light intensity, from household, care and occupational activities. Most women gained weight outside of Institute of Medicine (IOM) guideline recommendations (87.8%); women in class 3 obesity were most likely to have inadequate GWG below IOM recommendations (58.3%, p 0.01) and reduced odds of excessive GWG compared with class 1 (AOR 0.13, 95% 0.04–0.45). Deprived women with obesity have a double inequality as both increase pregnancy risks. This population requires support to meet guideline recommendations for diet, PA and GWG. Further research exploring obesity classes would inform policies and care to achieve the best pregnancy outcomes