• Tiagabine add-on therapy for drug-resistant focal epilepsy

      Bresnahan, Rebecca; Martin-McGill, Kirsty J.; Hutton, Jane L.; Marson, Anthony G. (Wiley, 2019-10-14)
    • Time to take responsibility for collections

      Burek, Cynthia V.; University College Chester (English Nature, 2003)
      This journal article discusses how geological collections can be preserved.
    • To Infinity and Beyond: The Use of GPS Devices within the Football Codes

      Malone, James; Barrett, Stephen; Barnes, Chris; Twist, Craig; Drust, Barry; Liverpool Hope University; Hull City FC; CB Sports Performance; University of Chester; Liverpool John Moores University (Taylor and Francis, 2019-10-17)
      The quantification of external load through global positioning systems (GPS) is now commonplace across the different football codes. Despite this acceptance amongst sports science practitioners, confusion still remains around which are the most appropriate metrics to use when monitoring their athletes. In addition, the translation of the message between the data gathered and the athletes and coaches can often be lost. The aim of this commentary is to provide discussion and recommendations when using GPS for athlete monitoring.
    • Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

      Hughes, Stephen F.; Hendricks, Beverly D.; Edwards, David R.; Maclean, Kirsty M.; Bastawrous, Salah S.; Middleton, Jim F.; University of Chester; North Wales (Central) NHS Trust; Keele University (BioMed Central, 2010-01-19)
      BACKGROUND: It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR) and total knee replacement (TKR) orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. METHODS: During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1) and CD62L cell surface expression, intracellular production of H(2)O(2 )and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured as markers of endothelial activation. RESULTS: The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H(2)O(2 )production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. CONCLUSION: In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1-3 postoperatively. It is proposed that by allowing orthopaedic surgeons access to alternative laboratory markers such as CD11b, H(2)O(2 )and elastase, CD62L, vWF and sICAM-1, an accurate assessment of the extent of inflammation due to surgery per se could be made. Ultimately, the leukocyte and endothelial markers assessed during this investigation may have a role in monitoring potential infectious complications that can occur during the postoperative period.
    • Total Phenols, Antioxidant Capacity and Antibacterial Activity of Manuka Honey Extract.

      Chau, Tsz Ching; Owusu-Apenten, Richard K.; Nigam, Poonam S.; Ulster University; University of Chester; (Science Domain International, 2017-10-28)
      Aims: To evaluate total phenols content (TPC), antioxidant capacity (TAC) and antibacterial activity of Manuka honey extract (MHE) and to compare such properties with those for unfractionated Manuka honey. Study Design: In vitro study. Place and Duration of Study: School of Biomedical Sciences, Ulster University, Coleraine, UK. Between September 2016 and September 2017. Methodology: MHE was prepared by solvent extraction using ethyl acetate. TPC was determined by Folin-Ciocalteu assay. The iron (III) reducing antioxidant capacity (IRAC) method was used to determine TAC. Antibacterial activity was evaluated using disc diffusion assay and 96-well microtiter plate methods with absorbance measured at 600 nm. Results: The TPC for MHE was 30-fold higher than the value for Manuka honey (33420±1685 mg vs. 1018±78 mg GAE/kg) while TAC values were~ 100-times greater (83,198±7064 vs. 793±104 TEAC, respectively). Antibacterial activity assessed by disc diffusion for Manuka honey (18.5 mm on S. aureus and 20 mm on E. coli) was two times greater than for MHE (9mm for both S. aureus and E. coli). The 96-well microtiter plate assay confirmed the greater antibacterial activity for Manuka
    • Track cycling: An analysis of the pacing strategies employed during the devil elimination race

      Gill, Kevin; Worsfold, Paul R.; White, Christopher; University of Chester (Cardiff Metropolitan University, 2014-04-01)
      This study aimed to provide a description of the pacing requirements of the track cycling Elimination race, and to identify effective pacing strategies to maximise overall Omnium medal opportunity. Six male, and six female elite competitive races were investigated using half-lap split times. Selected dependant variables were; mean speed and variation in speed. Spearman’s Rho correlations were used to test patterns between dependant variables and the final finishing position of riders. One-way ANOVAs were also applied to test for differences in dependant variables, between successful (top 6 finishers) and unsuccessful groups (7th-12th). Pacing patterns of the men's and women's races were complex, but followed an overall positive and variable pacing pattern, with men's race quarter speeds of 52.8km/h (±1.9), 52.1km/h (±2.1), 51.1km/h (±2.2), and 49.5km/h (±5.5). In general, differences in pacing strategy were not found to significantly influence the success of riders unless employed late in the race. Results are discussed for the application and the development of effective elimination race strategies and tactics.
    • Training nurses in Mental Health Assessment using GMHAT/PC in India

      Jones, Steven; Keenan, Paul; Danivas, Vijay; Krishna, Murali; Rajendra, Rajgopal; University of Chester (Indian Psychiatric Society, 2017-07-23)
      Book chapter; Training of Indian general nurses in a hospital setting required the structure offered by the Global Mental Health Assessment Tool (GMHAT) that would provide a framework to underpin mental health assessment training. Attitudes of those undertaking the training and current levels of knowledge and awareness to mental health issues was explored prior to any training occurring in the use of GMHAT, that we considered fundamental to good mental health practice
    • Transcobalamin polymorphism and serum holo-transcobalamin in relation to Alzheimer's disease

      McCaddon, Andrew; Bleenow, Kaj; Hudson, Peter R.; Hughes, Alan; Barber, Joan; Gray, Rob; Davies, Gareth K.; Williams, John H. H.; Duguid, Jennifer; Lloyd, Alwyn; et al. (S. Karger AG, 2004)
      Isoforms of the vitamin B<12< carrier protein transcobalamin (TC) might influence its cellular availability and contribute to the association between disrupted single-carbon metabolism and Alzheimer's disease (AD). We therefore investigated the relationships between the TC 776C>G (Pro259Arg) genetic polymorphism, total serum cobalamin and holo-TC levels, and disease onset in 70 patients with clinically diagnosed AD and 74 healthy elderly controls. TC 776C>G polymorphism was also determined for 94 histopathologically confirmed AD patients and 107 controls. Serum holo-TC levels were significantly higher in TC 776C homozygotes (p = 0.04). Kaplan-Meier survival functions differed between homozygous genotypes (Cox's F-Test F(42, 46) = 2.1; p = 0.008) and between 776C homozygotes and heterozygotes (Cox's F test F(46, 108) = 1.7; p = 0.02). Proportionately fewer TC 776C homozygotes appear to develop AD at any given age, but this will require confirmation in a longitudinal study.
    • Transient fatigue is not influenced by ball-in-play time during elite rugby league matches

      Waldron, Mark; Highton, Jamie M.; Thomson, Edward; Twist, Craig; University of Chester (Lippincott, Williams & Wilkins, 2017-03-13)
      The capacity to sustain high-speed running is important for rugby league players. Transient fatigue, described as a reduction in high-speed running in the 5-min after a peak 5-min period, is a phenomenon observed during rugby league matches. This concept has recently been questioned based on the proposed confounding influence of ball-in-play time during these periods. Therefore, this study examined the changes in high-speed running (> 14 km∙h-1) of elite rugby league players, as well as ball-in-play time, during the peak, subsequent and mean 5-min periods of five competitive matches using 5 Hz GPS devices. The suitability of ball-in-play time as a covariate was also evaluated. The high-speed running and ball-in-play time was different between peak (26.7 ± 5.5 m∙min-1 and 177 ± 37 s) and subsequent (12.1 ± 6.2 m∙min-1 and 147 ± 37 s) 5-min periods (P < 0.05; most likely ↓). However, there was no relationship (r = 0.01 to -0.13; P > 0.05) between ball-in-play time and high-speed running and ball-in-play time was not independent of the match period. This study has reaffirmed the presence of transient fatigue during elite rugby league matches but questioned the influence of ball-in-play time as a confounding factor. These observations have implications for the design of appropriate training practices and informing tactical strategies employed by coaches. Most importantly, any practitioner wishing to measure transient fatigue could follow a similar statistical approach taken herein and, based on the current findings would not need to account for ball-in-play time as a confounding variable.
    • Tspan18 is a novel regulator of the Ca2+ channel Orai1 and von Willebrand factor release in endothelial cells.

      Noy, Peter J.; Gavin, Rebecca L.; Colombo, Dario; Haining, Elizabeth J.; Reyat, Jasmeet S.; Payne, Holly; Thielmann, Ina; Lokman, Adam B.; Neag, Georgiana; Yang, Jing; et al. (2018-12-20)
      Ca entry via Orai1 store-operated Ca channels in the plasma membrane is critical to cell function, and Orai1 loss causes severe immunodeficiency and developmental defects. The tetraspanins are a superfamily of transmembrane proteins that interact with specific partner proteins and regulate their trafficking and clustering. The aim of this study was to functionally characterize tetraspanin Tspan18. We show that Tspan18 is expressed by endothelial cells at several-fold higher levels than most other cell types analyzed. Tspan18-knockdown primary human umbilical vein endothelial cells have 55-70% decreased Ca mobilization upon stimulation with the inflammatory mediators thrombin or histamine, similar to Orai1-knockdown. Tspan18 interacts with Orai1, and Orai1 cell surface localization is reduced by 70% in Tspan18-knockdown endothelial cells. Tspan18 over-expression in lymphocyte model cell lines induces 20-fold activation of Ca -responsive NFAT signaling, in an Orai1-dependent manner. Tspan18-knockout mice are viable. They lose on average 6-fold more blood in a tail-bleed assay. This is due to Tspan18 deficiency in non-hematopoietic cells, as assessed using chimeric mice. Tspan18-knockout mice have 60% reduced thrombus size in a deep vein thrombosis model, and 50% reduced platelet deposition in the microcirculation following myocardial ischemia-reperfusion injury. Histamine- or thrombin-induced von Willebrand factor release from endothelial cells is reduced by 90% following Tspan18-knockdown, and histamine-induced increase of plasma von Willebrand factor is reduced by 45% in Tspan18-knockout mice. These findings identify Tspan18 as a novel regulator of endothelial cell Orai1/Ca signaling and von Willebrand factor release in response to inflammatory stimuli. [Abstract copyright: Copyright © 2018, Ferrata Storti Foundation.]
    • Tuberculosis notification in a private tertiary care teaching hospital in South India: a mixed-methods study

      Siddaiah, Archana; Ahmed, Mohammad Naseer; Kumar, Ajay M. V.; D’Souza, George; Wilkinson, Ewan; Maung, Thae Maung; Rodrigues, Rashmi (BMJ Publishing Group, 2019-02-05)
      Objectives India contributes approximately 25% of the ‘missing’ cases of tuberculosis (TB) globally. Even though ~50% of patients with TB are diagnosed and treated within India’s private sector, few are notified to the public healthcare system. India’s TB notification policy mandates that all patients with TB are notified through Nikshay (TB notification portal). We undertook this study in a private hospital to assess the proportion notified and factors affecting TB notifications. We explored barriers and probable solutions to TB notification qualitatively from health provider’s perspective. Study setting Private, tertiary care, teaching hospital in Bengaluru, South India. Methodology This was a mixed-methods study. Quantitative component comprised a retrospective review of hospital records between 1 January 2015 and 31 December 2017 to determine TB notifications. The qualitative component comprised key informant interviews and focus groups to elicit the barriers and facilitators of TB notification. Results Of 3820 patients diagnosed and treated, 885 (23.2%) were notified. Notifications of sputum smear-positive patients were significantly more likely, while notifications of children were less likely. Qualitative analysis yielded themes reflecting the barriers to TB notification and their solutions. Themes related to barriers were: (1) basic diagnostic procedures and treatment promote notification; (2) misconceptions regarding notification and its process are common among healthcare providers; (3) despite a national notification system other factors have prevented notification of all patients; and (4) establishing hospital systems for notification will go a long way in improving notifications. Conclusions The proportion of patients with TB notified by the hospital was low. A comprehensive approach both by the hospital management and the national TB programme is necessary for improving notification. This includes improving awareness among healthcare providers about the requirement for TB notifications, establishing a single notification portal in hospital, digitally linking hospital records to Nikshay and designating one person to be responsible for notification.
    • Two independent proteomic approaches provide a comprehensive analysis of the synovial fluid proteome response to Autologous Chondrocyte Implantation

      Hulme, Charlotte H.; Wilson, Emma L.; Fuller, Heidi R.; Roberts, Sally; Richardson, James B.; Gallacher, Pete; Peffers, Mandy J.; Shirran, Sally L.; Botting, Catherine H.; Wright, Karina T.; et al. (BioMed Central, 2018-05-02)
      Background: Autologous chondrocyte implantation (ACI) has a failure rate of approximately 20%, but it is yet to be fully understood why. Biomarkers are needed that can pre-operatively predict in which patients it is likely to fail, so that alternative or individualised therapies can be offered. We previously used label-free quantitation (LF) with a dynamic range compression proteomic approach to assess the synovial fluid (SF) of ACI responders and non-responders. However, we were able to identify only a few differentially abundant proteins at baseline. In the present study, we built upon these previous findings by assessing higher-abundance proteins within this SF, providing a more global proteomic analysis on the basis of which more of the biology underlying ACI success or failure can be understood. Methods: Isobaric tagging for relative and absolute quantitation (iTRAQ) proteomic analysis was used to assess SF from ACI responders (mean Lysholm improvement of 33; n = 14) and non-responders (mean Lysholm decrease of 14; n = 13) at the two stages of surgery (cartilage harvest and chondrocyte implantation). Differentially abundant proteins in iTRAQ and combined iTRAQ and LF datasets were investigated using pathway and network analyses. Results: iTRAQ proteomic analysis confirmed our previous finding that there is a marked proteomic shift in response to cartilage harvest (70 and 54 proteins demonstrating ≥ 2.0-fold change and p < 0.05 between stages I and II in responders and non-responders, respectively). Further, it highlighted 28 proteins that were differentially abundant between responders and non-responders to ACI, which were not found in the LF study, 16 of which were altered at baseline. The differential expression of two proteins (complement C1s subcomponent and matrix metalloproteinase 3) was confirmed biochemically. Combination of the iTRAQ and LF proteomic datasets generated in-depth SF proteome information that was used to generate interactome networks representing ACI success or failure. Functional pathways that are dysregulated in ACI non-responders were identified, including acute-phase response signalling. Conclusions: Several candidate biomarkers for baseline prediction of ACI outcome were identified. A holistic overview of the SF proteome in responders and non-responders to ACI  has been profiled, providing a better understanding of the biological pathways underlying clinical outcome, particularly the differential response to cartilage harvest in non-responders.
    • A UK consensus on optimising CVD secondary prevention care: perspectives from multidisciplinary team members

      The ICON (Integrating Care Opportunities across the NHS) CVD Secondary Prevention Working Group (2019-10-03)
      Although overall cardiovascular (CV) mortality has declined in recent years, patients with clinically manifest cardiovascular disease (CVD) remain at increased risk of recurrent CV events. To minimise the likelihood of future CV events following an acute myocardial infarction (MI), changes in diet and lifestyle, alongside pharmaceutical interventions, such as dual antiplatelet therapy, a β-blocker, an ACE inhibitor, and a statin, are recommended within current clinical guidelines. The use of cardiac rehabilitation (CR) programmes has been shown to be highly effective in reducing mortality and morbidity following MI, and a cost-benefit analysis suggests that increasing the uptake of CR to 65% among eligible patient would result in potential cost savings of over £30 million annually for the NHS. The involvement of a multidisciplinary team (MDT) of healthcare professionals is central to delivering post-MI care, with initial and/or ongoing input from cardiologists, hospital-based specialist pharmacists, specialist nurses, GPs, dietitians, smoking cessation specialists and practice-based and community pharmacists, among others. This consensus statement was developed based on a meeting of HCPs actively involved in delivering CV secondary prevention care at primary and secondary care centres across the UK. Recognising that HCP team configuration and availability of resources/services vary by location, the authors have focused on three common themes which have broad relevance in CVD secondary prevention, specifically: integration of care, medicines optimisation, and encouraging patient activation. Opportunities for MDT members to improve outcomes in post-MI patients are suggested and examples of best practice models which have been implemented successfully are described.
    • UKCES: Understanding Human Centred Management

      York, Peter; Bonwick, Graham A.; Birch, Catherine S.; University of Chester (UKCES, 2016-04-03)
      The Human Centred Management project was required to solve the problem of supply chain inefficiencies brought about by unproductive human behaviours. Specifically, the project sought to used Behavioural Economics to improve the decisions made by making people aware of their illogical ‘Biases’ and ‘Heuristics’. Use of Transactional Analysis to make people more aware of their impressions and their audience to reduce antagonism in communication. Combine these methods using Behavioural Management Theory to create one unified approach which will create a 21st century solution to behavioural inefficiencies. The project primarily targeted two supply chains, led by two larger or ‘Prime’ organisations that had SME’s feeding the production process. The two supply chains underwent a number of interventions in the form of one-to-one sessions, workshops, master classes and simulations, in order to understand and influence the behavioural inefficiencies they were suffering. An Action Research methodology was used to both provide a flexible approach and also generate qualitative data. Before each intervention, questionnaire data and in some cases a behavioural health check was carried out in order to gain baseline data. Once complete the same questionnaires were completed and interviews with key participants were carried out. The interventions were a success producing a large amount of positive change and behavioural insights for analysis. Such improvements included dramatically improving the supply chain communication leading to claims of improved supply chain effectiveness over all, development of closer ties between supply chains in a geographically separated area and improved logical decision making where managers are aware of their biases and take the time to reflect on all the options. The three areas of psychology introduced proved to combine extremely well, complimenting one another’s weaker areas in order to produce the unified approach envisaged. Behavioural Economics was found to be an excellent analytical tool capable of deconstructing the root causes of behaviours. Transactional Analysis provided a suite of easily implementable and practical techniques for improving communication. Behavioural Management Theory provided a flexible approach to implementing the changes required. From the experience of the project and analysis of the data a Behavioural Framework was generated in order to allow other supply chains to benefit from this effective 21st century solution to behavioural inefficiencies.
    • UKRIGS - What is it?

      Burek, Cynthia V.; University College Chester (Geologists' Association, 2004)
    • Underlying cause discovered for a prior idiopathic AMI

      Godfrey, Richard; O’Hanlon, Rory; Wilson, Mathew G.; Buckley, John P.; Sharma, Sanjay; Whyte, Greg; Brunel University ; St Vincent’s University Hospital, Ireland ; Qatar Orthopaedic and Sports Medicine Hospital ; Kings College Hospital, London ; Liverpool John Moores University (2011-03-30)
      The authors previously reported on an active, young male with normal coronaries who sustained an acute myocardial infarction (AMI). The acute cause was a coronary thrombus; however, the cause of this thrombus and a definitive diagnosis remained elusive for 18 months until a new series of events, including symptoms of breathlessness, dizziness and collapse led to acute hospital admission. CT scan revealed numerous deep venous thromboses in the right leg and bilateral pulmonary emboli (PE). Acute pharmacological thrombolysis eliminated breathlessness and significantly reduced the risk of mortality. Clinical consensus suggests a coagulopathy, requiring indefinite treatment with Warfarin. In young individuals presenting with AMI, lifestyle, personal, family and clinical history should be considered and coronary artery disease should not be assumed until further tests have eliminated coagulopathy. In those presenting with breathlessness and a history which includes AMI, a CT scan is indicated to eliminate concerns of venous thromboembolism generally and PE specifically where untreated survival times are short.
    • Understanding family support at Sure Start Blacon (Cheshire)

      Thurston, Miranda (Centre for Public Health Research, University of Chester, 15/06/2006)
      This presentation discusses a study of Sure Start in Blacon between 1 April 2004 and 31 March 2005 to discover how families engage with family support and the impact of such support.
    • Understanding mothers' engagement with antenatal parent education services: A critical analysis of a local Sure Start Service

      Pearson, Charlotte; Thurston, Miranda; University of Chester (Wiley, 2006-03-17)
      This article discusses the findings of a local evaluation of a Sure Start parent education programme designed to improve parental engagement with antenatal services.
    • Understanding physical education

      Green, Ken; University of Chester (SAGE, 2008-01-24)
      This book discusses the nature and purpose of physical education; extra-curriculr physical education; and gender, social class, health, youth, ethnicity, disability in relation to physical education.
    • Understanding the impact of the Cheshire Children’s Fund: Findings from 11 family case studies

      Ward, Fiona; Powell, Katie; Thurston, Miranda (University of Chester, 2007-12)
      The Children’s Fund was created in 2000 as part of the Government’s commitment to tackle disadvantage amongst children and young people. The aim of the Fund was to facilitate the development of more extensive and better co-ordinated early intervention services for children and young people aged 5 to 13 years who were at risk of social exclusion. Cheshire Children’s Fund, the local response to this national initiative, is guided by the Children’s Fund Partnership which is made up of representatives from local voluntary and statutory organisations. The aim of this research was to explore the impact of a number of projects which had received funding from the Cheshire Children’s Fund, specifically to learn how these projects had worked with children and families where there had been a positive outcome. The objectives of the research were to identify, for each child or family, the reasons for the provision of a service, the type of service that had been provided, and the impact that it had had on their lives. The research explored the factors that enabled a positive outcome for each family: the similarities and differences between the cases were also examined to determine whether any contributing factors were present across the services. The 11 projects were selected to cover a range of themes to reflect the breadth of the Children’s Fund work in Cheshire. They provided a range of services under the headings of crime prevention, promoting inclusion, success in schools and family support.