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"Roberts, Keith J."
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The constraints-led approach principles for sports coaching and practice design
\"A Constraints-Based Methodology for Sport provides students and practitioners with the theoretical knowledge required to implement constraints-led approaches in their work. Seeking to bridge the divide between theory and practice, the book sets out an 'environment design framework', including practical tools and guidance for the application of the framework in coaching and skill acquisition settings. It includes chapters on constraints-led approaches in coaching children, golf, athletics and hockey, and provides applied reading for undergraduate and postgraduate students of motor learning, skill acquisition and developing sport expertise\"-- Provided by publisher.
Book
Transplantation of discarded livers following viability testing with normothermic machine perfusion
There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.
The shortage of viable donated livers limits patient access to liver transplantation. Here the authors report the use of normothermic machine perfusion to help identify viable organs from livers discarded based on current clinical criteria, which are then transplanted to recipients in a single-arm clinical trial.
Journal Article
Consensus for the management of pancreatic exocrine insufficiency: UK practical guidelines
IntroductionPancreatic exocrine insufficiency is a finding in many conditions, predominantly affecting those with chronic pancreatitis, pancreatic cancer and acute necrotising pancreatitis. Patients with pancreatic exocrine insufficiency can experience gastrointestinal symptoms, maldigestion, malnutrition and adverse effects on quality of life and even survival.There is a need for readily accessible, pragmatic advice for healthcare professionals on the management of pancreatic exocrine insufficiency.Methods and analysisA review of the literature was conducted by a multidisciplinary panel of experts in pancreatology, and recommendations for clinical practice were produced and the strength of the evidence graded. Consensus voting by 48 pancreatic specialists from across the UK took place at the 2019 Annual Meeting of the Pancreatic Society of Great Britain and Ireland annual scientific meeting.ResultsRecommendations for clinical practice in the diagnosis, initial management, patient education and long term follow up were developed. All recommendations achieved over 85% consensus and are included within these comprehensive guidelines.
Journal Article
The Impact of Ischaemic Type Biliary Lesions on Healthcare Costs After Liver Transplantation With Grafts From Donors After Circulatory Death
To ensure long-term follow-up consecutive whole static cold storage (SCS) DCD liver transplants between 2016 and 2018 were reviewed from our prospectively maintained institutional database. The total hospital costs were significantly higher amongst the ITBL group, with an average cost per patient of £111,675.80 (Range: £3,116-£271,278) compared to £17,817.11 (Range: £3,982 - £93,171) in the matched “No ITBL” control group (Table 1). TABLE 1 Tertiary centre hospital episode Unit cost NHS tariff code No ITBL (n = 19) ITBL (n = 19) p-value N Mean cost per pt N Mean cost per pt Subsequent Operative Procedures Retransplant £80,000 N/A 0 £0 10 £42,105.26 0.012 Incisional hernia repair £6,760 FF60A 3 £1,067 0 £0.00 0.418 Hepaticojejunostomy £21,495 GA03C 0 £0 1 £1,131.32 0.795 Laparotomy and washout £21,495 GA03C 1 £1,131 3 £3,393.95 0.583 Interventional Radiology ERCP £9,653 GB09D 4 £2,032 20 £10,161.05 0.234 PTC drainage/imaging £1,830 YG06Z 5 £482 4 £385.26 1 TIPPS with stent £5,274 YA10Z 0 £0 1 £277.58 0.795 Angiogram+/-stenting £5,274 YA10Z 2 £555 1 £277.58 1 Hepatic venogram £5,274 YA10Z 1 £278 6 £1,665.47 1 CT guided drain £10,005 YF04A 2 £1,053 4 £2,106.32 0.603 US guided drain £10,005 YF04A 4 £2,106 19 £10,005.00 0.402 Fluoroscopic guided drain £10,005 YF04A 0 £0 2 £1,053.16 0.795 CT liver ablation £7,563 YG01A 1 £398 0 £0.00 0.795 Diagnostic Radiology CT £95 RD24Z 28 £140 73 £365.00 0.146 MRI Liver £178 RD03Z 3 £28 8 £74.95 0.37 MRCP £116 RD01A 11 £67 46 £280.84 <0.001 US abdomen £55 RD42Z 105 £304 205 £593.42 0.006 US guided biopsy £907 YF05Z 5 £239 22 £1,050.21 0.043 NM £1,045 YG12Z 0 £0 2 £110.00 0.583 CXR £28 N/A 74 £109 164 £241.68 0.085 AXR £28 N/A 0 £0 9 £13.26 0.172 PICC £1,729 YR42A 2 £182 13 £1,183.00 0.37 Transjugular biopsy £1,676 YG10Z 1 £88 4 £352.84 1 Tubogram £1,045 YG12Z 0 £0 2 £110.00 0.795 Follow-up OPA £206 306 622 £7,114 650 £7,417.37 1 Readmission ITU Bed Days £2,737 N/A 5 £720.26 67 £9,651.53 Readmission Ward Bed Days £397 N/A 61 £1,274.58 939 £19,620.16 0.002 Total cost - - - £17,817.11 - £111,675.80 0.007 Comparison of healthcare costs after index liver transplantation between ITBL and no ITBL controls. Recent evidence, including a randomised controlled trial, has shown that HOPE also reduces the risk of NAS after DCD donation compared to static cold storage [16–18].
Journal Article
Casting a Wider NET: Pancreatic Exocrine Insufficiency Induced by Somatostatin Analogues among Patients with Neuroendocrine Tumours?
Somatostatin-analogues (SSAs) are a first-line treatment of unresectable neuroendocrine tumours (NETs). However, SSAs inhibit pancreatic secretions, which could lead to pancreatic exocrine insufficiency (PEI). PEI is known to be detrimental to patient quality of life and nutritional status. This study aimed to evaluate the effect of SSAs on pancreatic exocrine function in patients with NETs, using the 13C-mixed triglyceride breath test (13C-MTGT). Exocrine function was assessed using the 13C-MTGT at baseline and after a third SSA injection (two months). A quotient of 13CO2/12CO2 was measured by mass spectrometry, and the cumulative percent dose recovered at 6 h (cPDR) is reported. The secondary endpoints investigated were change in weight, HbA1C, and vitamin D levels. Ten patients completed the study. Exocrine function reduced in all patients (n = 10) following SSA therapy (median reduction from baseline: −23.4% (range: −42.1–0.5%, p = 0.005)). vitamin D levels decreased in all but one patient (median decrease from baseline: −26.5%, (−44.7–10%; p = 0.038)), and median HbA1C levels increased by 8.0% (0–59.3%; p = 0.008). Change in weight was not significant (median decrease from baseline: −0.21% (−4.5–3.5%, p = 1.000)). SSA therapy has a consistent impact on exocrine function from early in the treatment course, but the long-term clinical effects of this remain to be defined. Further studies are required to determine the clinical relevance of this observation and optimise the management of PEI in this cohort.
Journal Article
Assessing impact, needs and quality-of-life among informal carers of people with pancreatic cancer, a prospective study: the PAN-CARER study protocol
IntroductionApproximately 10 300 people are diagnosed with pancreatic cancer each year in the UK. The cancer and its treatment inflict a significant physical, functional and emotional burden on patients. Research suggests that patients have many ongoing needs for support and care, but that these needs are not met by existing services. Family members often step in to fill this gap and provide support and care during and after treatment. Research in other cancers shows that this informal caregiving can place a very heavy burden on carers. However, there are few studies in the international literature that have focused on informal carers in pancreatic cancer; none have been conducted in the UK.Methods and analysisTwo complementary research methods will be utilised. First, a longitudinal quantitative study of 300 carers investigating, using validated questionnaires to assess the impact of caregiving (Caregiver Reaction Assessment), the unmet needs of carers (Supportive Care Needs Survey) and the quality-of-life (Short Form 12-item health survey), will be conducted. Second, qualitative interviews will be conducted with up to 30 carers to explore their experiences in more depth. Mixed-effects regression models will be applied to survey results to determine how impact, needs and quality-of-life vary over time, compare outcomes between carers of patients with operable and inoperable disease and identify social factors which affect outcomes. Interview data will undergo reflexive thematic analysis.Ethics and disseminationThe protocol has been approved by the Health Research Authority of the UK (Ethical approval IRAS ID 309503). Findings will be published in peer-reviewed journals and presented at national and international conferences.
Journal Article
Extended Versus Standard Lymphadenectomy for Pancreatic Head Cancer: Meta-Analysis of Randomized Controlled Trials
Introduction
The evidence for improved prognostic assessment and long-term survival for extended pancreatoduodenectomy (EPD) compared to standard pancreatoduodenectomy (SPD) in patients with carcinoma of the head of the pancreas has not been considered from only randomized controlled trials (RCTs).
Methods
The aim of this study was to conduct a systematic review and meta-analysis of the outcomes comparing SPD and EPD in RCTs. Searches were performed on MEDLINE, Embase and Cochrane databases using MeSH keyword combinations: ‘pancreatic cancer’, ‘pancreaticoduodenectomy’, ‘extended’, ‘randomized’ and ‘lymphadenectomy’. RCTs published up to 2014 were included. Overall post-operative survival, morbidity, 30-day mortality and length of hospital stay were the outcomes assessed.
Results
Five eligible RCTs with 546 participants were included (EPD = 276 and SPD = 270). EPD was associated with a significantly higher number of excised lymph nodes (LNs) compared to SPD (mean difference = 15.73, 95 % confidence interval (CI) = 9.41–22.04;
P
< 0.00001;
I
2
= 88 %). LN metastasis was detected in 58–68 and 55–70 % of patients who had EPD and SPD, respectively. EPD did not improve overall survival (hazard ratio (HR) = 0.88, 95 % CI = 0.75–1.03;
P
= 0.11) but did worsen post-operative morbidity compared to SPD (risk ratio (RR) = 1.23; 95 % CI = 1.01–1.50;
P
= 0.004;
I
2
= 9 %). There were no differences in the 30-day mortality (RR = 0.81; 95 % CI = 0.32–2.06;
P
= 0.66;
I
2
= 0 %) or length of hospital stay (mean difference = 1.39, 95 % CI = −2.31 to 5.09;
P
= 0.46;
I
2
= 67 %).
Conclusion
SPD is associated with reduced morbidity, but equivalent long-term benefits compared to patients undergoing EPD.
Journal Article
Preoperative C-Reactive Protein-to-Albumin Ratio and Its Ability to Predict Outcomes of Pancreatic Cancer Resection: A Systematic Review
Objectives. To evaluate the ability of the c-reactive protein-to-albumin ratio (CAR) in predicting outcomes in patients undergoing pancreatic cancer resection. Methods. A systematic search of electronic information sources and bibliographic reference lists was conducted. Survival outcomes and perioperative morbidity were the evaluated outcome parameters. Results. Eight studies reporting a total of 1056 patients undergoing pancreatic cancer resection were identified. The median cut-off value for CAR was 0.05 (range 0.0003–0.54). Using multivariate analysis, all studies demonstrated that a higher CAR value was an independent and significant predictor of poor overall survival in patients undergoing pancreatic cancer resection. The estimated hazard ratio (HR) ranged from 1.4 to 3.6. Although there was a positive correlation between the reported cut-off values for CAR and HRs for overall survival, it was weak and non-significant (r = 0.36, n = 6, p = 0.480). There was significant between-study heterogeneity. Conclusions. Preoperative CAR value seems to be an important prognostic score in predicting survival outcomes in patients undergoing pancreatic cancer resection. However, the current evidence does not allow the determination of an optimal cut-off value for CAR, considering the heterogeneous reporting of cut-off values by the available studies and the lack of knowledge of their sensitivity and specificity. Future research is required.
Journal Article
OceanMesh2D 1.0: MATLAB-based software for two-dimensional unstructured mesh generation in coastal ocean modeling
OceanMesh2D is a set of MATLAB functions with preprocessing and post-processing utilities to generate two-dimensional (2-D) unstructured meshes for coastal ocean circulation models. Mesh resolution is controlled according to a variety of feature-driven geometric and topo-bathymetric functions. Mesh generation is achieved through a force balance algorithm to locate vertices and a number of topological improvement strategies aimed at improving the worst-case triangle quality. The placement of vertices along the mesh boundary is adapted automatically according to the mesh size function, eliminating the need for contour simplification algorithms. The software expresses the mesh design and generation process via an objected-oriented framework that facilitates efficient workflows that are flexible and automatic. This paper illustrates the various capabilities of the software and demonstrates its utility in realistic applications by producing high-quality, multiscale, unstructured meshes.
Journal Article
A Regression-Based Approach for Cool-Season Storm Surge Predictions along the New York–New Jersey Coast
A multilinear regression (MLR) approach is developed to predict 3-hourly storm surge during the coolseason months (1 October–31 March 31) between 1979 and 2012 using two different atmospheric reanalysis datasets and water-level observations at three stations along the New York–New Jersey coast (Atlantic City, New Jersey; the Battery in New York City; and Montauk Point, New York). The predictors of the MLR are specified to represent prolonged surface wind stress and a surface sea level pressure minimum for a boxed region near each station. The regression underpredicts relatively large (≥95th percentile) storm maximum surge heights by 6.0%–38.0%. Abias-correction technique reduces the average mean absolute error by 10%–15% at the various stations for storm maximum surge predictions. Using the same forecast surface winds and pressures from the North American Mesoscale (NAM) model between October and March 2010–14, raw and bias-corrected surge predictions at the Battery are compared with raw output from a numerical hydrodynamic model’s [the Stevens Institute of Technology New York Harbor Observing and Prediction System (SITNYHOPS)] predictions. The accuracy of surge predictions between the SIT-NYHOPS output and biascorrected MLR model at the Battery are similar for predictions that meet or exceed the 95th percentile of storm maximum surge heights.
Journal Article