Publications by authors named "A G White"

5,729 Publications

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Effects of Stricter Management Guidelines on Return-to-Competition Timeframes Following Concussion in Professional Australian Rules Football: An Exploratory Analysis.

Sports Med 2021 May 15. Epub 2021 May 15.

Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, Australia.

Background: Management of concussion remains a serious issue for professional sports, particularly with the growing knowledge on the consequences of repetitive concussion. One primary concern is the subjective assessment of recovery that dictates the time until a concussed athlete is returned-to-competition. In response to this concern, the Australian Football League (AFL) changed its policy in 2020 such that medical clearance for return-to-competition was extended from 1 day, to a minimum of 5 days, prior to the next scheduled match.

Objective: We sought to explore the impact of the AFL policy change by asking whether time to return-to-competition after concussion was increased in the 2020 season relative to previous years.

Methods: Retrospective data on injury and return-to-competition were sourced from publicly available tables published by the AFL. Our primary exploration compared the number of matches missed and the number of days missed in concussed players across 2017-2020 inclusive, with secondary exploration analysing the proportion of players returning to play 12 days or longer.

Results: Analysis of data from 166 concussed players revealed no increase in the number of matches missed in 2020 relative to previous years as would have been expected from an extended recovery protocol. Comparing 2020 relative to 2017-2019, we found that there was an overall moderate reduction in median time to return-to-competition (RTC) in 2020 (10 vs 13 days, respectively d = - 0.345) and a significant reduction in players taking more than 12 days to RTC (p = 0.046).

Conclusion: This exploratory study demonstrates that clubs may not have followed policy change around concussion management designed to increase time to RTC. Ongoing auditing is required to ensure player clearance meets policy goals, highlighting the need for objective measures for RTC after concussion.
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http://dx.doi.org/10.1007/s40279-021-01484-zDOI Listing
May 2021

The direct mycobacterial growth inhibition assay (MGIA) for the early evaluation of TB vaccine candidates and assessment of protective immunity: a protocol for non-human primate cells.

F1000Res 2021 30;10:257. Epub 2021 Mar 30.

Nuffield Department of Medicine, The Jenner Institute, Oxford, OX3 7DQ, UK.

The only currently available approach to early efficacy testing of tuberculosis (TB) vaccine candidates is preclinical challenge models. These typically include mice, guinea pigs and non-human primates (NHPs), which must be exposed to virulent in a 'challenge' experiment following vaccination in order to evaluate protective efficacy. This procedure results in disease development and is classified as 'Moderate' in severity under EU legislation and UK ASPA licensure. Furthermore, experiments are relatively long and animals must be maintained in high containment level facilities, making them relatively costly. We describe an protocol for the direct mycobacterial growth inhibition assay (MGIA) for use in the macaque model of TB vaccine development with the aim of overcoming some of these limitations. Importantly, using an assay in place of challenge represents a significant refinement to the existing procedure for early vaccine efficacy testing. Peripheral blood mononuclear cell and autologous serum samples collected from vaccinated and unvaccinated control animals are co-cultured with mycobacteria in a 48-well plate format for 96 hours. Adherent monocytes are then lysed to release intracellular mycobacteria which is quantified using the BACTEC MGIT system and colony-forming units determined relative to an inoculum control and stock standard curve. We discuss related optimisation and characterisation experiments, and review evidence that the direct NHP MGIA provides a biologically relevant model of vaccine-induced protection. The potential end-users of the NHP MGIA are academic and industry organisations that conduct the assessment of TB vaccine candidates and associated protective immunity using the NHP model. This approach aims to provide a method for high-throughput down-selection of vaccine candidates going forward to efficacy testing, thus expediting the development of a more efficacious TB vaccine and offering potential refinement and reduction to the use of NHPs for this purpose.
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http://dx.doi.org/10.12688/f1000research.51640.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097740PMC
March 2021

The Care-coordination Approach to Learning Lupus Self-Management: a patient navigator intervention for systemic lupus inpatients.

Lupus Sci Med 2021 May;8(1)

Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

Objective: The Care-coordination Approach to Learning Lupus Self-Management (CALLS) study was designed to improve SLE disease self-management. This study aims to assess the benefits of the intervention compared with existing lupus care.

Methods: Participants were randomly assigned to participate in 12-weekly phone sessions with the patient navigator that included structured educational content, care coordination and patient-centred support services, or a usual care control condition. Validated measures of health literacy, self-efficacy, patient activation and disease activity were collected. We used least squares means and linear mixed-effects regression models for each outcome variable to assess the changes in outcome, from baseline to postintervention and to estimate the difference in these changes between the intervention and control group.

Results: Thirty participants were enrolled and 14 were randomised to the treatment group. For perceived lupus self-efficacy, there was a significant increase in mean score for the intervention group, but not for the control group. With regard to disease activity, the experimental group experienced a slight decrease in mean flare score in the previous 3 months, whereas the control group experienced a slight increase, but this finding did not reach statistical significance. Trends were similar in self-reported global disease activity, but none of the findings were significant. Health literacy and patient activation measure scores remained largely unchanged throughout the study for the two groups.

Conclusion: These findings suggest that the CALLS intervention may work to improve aspects of SLE disease self-management. Future research will be needed to validate these findings long-term.

Trial Registration Number: NCT04400240.
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http://dx.doi.org/10.1136/lupus-2021-000482DOI Listing
May 2021

Combination of ectopic pancreas and intestinal malrotation presenting as non-specific right iliac fossa pain in a SARS-CoV-2 positive patient.

BMJ Case Rep 2021 May 10;14(5). Epub 2021 May 10.

General Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.

We describe the case of a 31-year-old man who presented with a 3-day history of right iliac fossa pain with associated nausea and vomiting. He denied any previous incidents of abdominal pain and had no relevant medical history or family history to note. Given the typical history, examination findings of localised peritonism and infection risk, he was taken to theatre for laparoscopic appendicectomy without diagnostic imaging. Intraoperatively, we noted gut malrotation and an inflammatory jejunal mass which was resected after converting to a mini-laparotomy. The inflammatory mass was reported to be an ectopic pancreatic tissue from histology. Given that this patient had tested positive for SARS-CoV-2 on admission, we propose a possible case of SARS-CoV-2 infection triggering inflammation of the ectopic pancreatic tissue.
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http://dx.doi.org/10.1136/bcr-2021-241926DOI Listing
May 2021

COVID-19 in a series of patients with aspirin-exacerbated respiratory disease.

J Allergy Clin Immunol Pract 2021 May 6. Epub 2021 May 6.

Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA.

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http://dx.doi.org/10.1016/j.jaip.2021.04.060DOI Listing
May 2021