Publications by authors named "Elizabeth Norris"

12 Publications

  • Page 1 of 1

Life threatening abscess in the visceral space with penicillin and metronidazole resistant Prevotella Denticola following use of a laryngeal mask airway: case report.

BMC Anesthesiol 2021 Apr 5;21(1):102. Epub 2021 Apr 5.

Head of the department Nose Throat Ear surgery, University hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium.

Background: Laryngeal mask airways (LMA) are commonly used for airway management. Complications with this device are rare. However, when they do occur, there is a high risk for respiratory problems, necessitating early diagnosis and treatment. We present the first case of a life-threatening abscess spreading in the visceral space caused by a penicillin and metronidazole resistant Prevotella Denticola after the use of an LMA.

Case Presentation: A female patient was admitted to our day care centre for bunion surgery. A single use LMA size 3 (Solus®, intersurgical, Wokingham, Berkshire, United Kingdom) was successfully inserted. After surgery, the patient complained of a sore throat and amoxicillin was prescribed by the general practitioner. Three days after surgery the patient was admitted to the Intensive Care Unit (ICU) for obstructive breathing, due to an abscess in the visceral space. Retropharyngeal and certainly parapharyngeal abscesses in adults are already rare. This case however, is unique because it is the first case of abscess spreading into the visceral space after the use of an LMA. Amoxicillin/clavulanate and vancomycin were started. The abscess was incised 5 days later and microbiology showed 3 positive cultures of the anaerobe Prevotella denticola, resistant for penicillin and metronidazole, but sensitive for amoxicillin/clavulanate. The patient fully recovered.

Conclusion: LMA's are easy to use and are established, safe tools to support ventilation of the airway. In this case, the authors hypothesise a small wound in the lateral pharyngeal wall probably created an opening into the visceral space causing infection with Prevotella denticola, supporting the idea that the pharyngeal mucosal space must be part of the visceral space. Additionally, early recognition and treatment of an LMA induced abscess is necessary to prevent evolution of complications leading to airway obstruction.
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http://dx.doi.org/10.1186/s12871-021-01322-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020545PMC
April 2021

Electrospinning 3D bioactive glasses for wound healing.

Biomed Mater 2020 02 13;15(1):015014. Epub 2020 Feb 13.

Department of Materials, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom.

An electrospinning technique was used to produce three-dimensional (3D) bioactive glass fibrous scaffolds, in the SiO-CaO sol-gel system, for wound healing applications. Previously, it was thought that 3D cotton wool-like structures could only be produced from sol-gel when the sol contained calcium nitrate, implying that the Ca and its electronic charge had a significant effect on the structure produced. Here, fibres with a 3D appearance were also electrospun from compositions containing only silica. A polymer binding agent was added to inorganic sol-gel solutions, enabling electrospinning prior to bioactive glass network formation and the polymer was removed by calcination. While the addition of Ca contributes to the 3D morphology, here we show that other factors, such as relative humidity, play an important role in producing the 3D cotton-wool-like macrostructure of the fibres. A human dermal fibroblast cell line (CD-18CO) was exposed to dissolution products of the samples. Cell proliferation and metabolic activity tests were carried out and a VEGF ELISA showed a significant increase in VEGF production in cells exposed to the bioactive glass samples compared to control in DMEM. A novel SiO-CaO nanofibrous scaffold was created that showed tailorable physical and dissolution properties, the control and composition of these release products are important for directing desirable wound healing interactions.
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http://dx.doi.org/10.1088/1748-605X/ab591dDOI Listing
February 2020

Osteogenic potential of sol-gel bioactive glasses containing manganese.

J Mater Sci Mater Med 2019 Jul 13;30(7):86. Epub 2019 Jul 13.

Department of Metallurgical Engineering and Materials, Federal University of Minas Gerais, School of Engineering, Belo Horizonte, MG, Brazil.

Bioactive glasses (BGs) are widely used for bone regeneration, and allow the incorporation of different ions with therapeutic properties into the glass network. Amongst the different ions with therapeutic benefits, manganese (Mn) has been shown to influence bone metabolism and activate human osteoblasts integrins, improving cell adhesion, proliferation and spreading. Mn has also been incorporated into bioceramics as a therapeutic ion for improved osteogenesis. Here, up to 4.4 mol% MnO was substituted for CaO in the 58S composition (60 mol% SiO, 36 mol% CaO, 4 mol% PO) and its effects on the glass properties and capability to influence the osteogenic differentiation were evaluated. Mn-containing BGs with amorphous structure, high specific surface area and nanoporosity were obtained. The presence of Mn species was confirmed by X-ray photoelectron spectroscopy (XPS). Mn-containing BGs presented no cytotoxic effect on human mesenchymal stem cells (hMSCs) and enabled sustained ion release in culture medium. hMSCs osteogenic differentiation stimulation and influence on the mineralisation process was also confirmed through the alkaline phosphatase (ALP) activity, and expression of osteogenic differentiation markers, such as collagen type I, osteopontin and osteocalcin, which presented higher expression in the presence of Mn-containing samples compared to control. Results show that the release of manganese ions from bioactive glass provoked human mesenchymal stem cell (hMSC) differentiation down a bone pathway, whereas hMSCs exposed to the Mn-free glass did not differentiate. Mn incorporation offers great promise for obtaining glasses with superior properties for bone tissue regeneration.
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http://dx.doi.org/10.1007/s10856-019-6288-9DOI Listing
July 2019

Effects of manganese incorporation on the morphology, structure and cytotoxicity of spherical bioactive glass nanoparticles.

J Colloid Interface Sci 2019 Jul 4;547:382-392. Epub 2019 Apr 4.

Department of Metallurgical Engineering and Materials, Federal University of Minas Gerais, School of Engineering, Belo Horizonte, MG, Brazil. Electronic address:

Bioactive glass nanoparticles (BGNPs) are of great interest in tissue engineering as they possess high dissolution rate and capability of being internalized by cells, releasing their dissolution products with therapeutic benefits intracellularly. A modified Stöber process can be applied to obtain different BGNPs compositions containing therapeutic ions while maintaining controllable particle morphology, monodispersity and reduce agglomeration. Here, BGNPs containing Mn, an ion that has been shown to influence the osteoblast proliferation and bone mineralization, were evaluated. Particles with up to 142.3 ± 10.8 nm and spherical morphology were obtained after MnO incorporation in the SiO - CaO system. X-ray photoelectron spectroscopy (XPS) indicated the presence of Mn species and also a reduction in the number of bridging oxygen bonds due to the Ca and Mn. The Ca and Mn network modifier role on the silica network was also confirmed by magic-angle spinning Si solid-state nuclear magnetic resonance (MAS NMR). MTT evaluation showed no reduction in the mitochondrial metabolic activity of human mesenchymal stem cells exposed to the glass ionic products. Thus, evaluation showed that Mn could be incorporated into BGNPs by the modified Stöber method while maintaining their spherical morphology and features as a promising strategy for tissue regeneration.
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http://dx.doi.org/10.1016/j.jcis.2019.04.016DOI Listing
July 2019

Differential diagnosis of knee pain following a surgically induced lumbosacral plexus stretch injury. A case report.

Physiother Theory Pract 2019 Dec 7;35(12):1355-1362. Epub 2018 Jun 7.

Department of Physical Therapy, Western Kentucky University, Bowling Green, KY, USA.

: Knee joint biomechanics requires an understanding of lower extremity (LE) segmental interactions. In some cases, knee pain may arise as a result of altered LE biomechanics; while in other cases, knee pain may stem from other causes, such as a peripheral nerve injury. : A 33-year-old woman presented via direct access for physical therapist (PT) examination with a chief complaint of left knee pain. The day after undergoing a dilation and curettage (D&C) procedure the patient had an acute onset of gait dysfunction. Over the next few days, the patient developed left anterior knee pain (7/10 at worst) in addition to a significant change in physical functioning (Lower Extremity Functional Scale [LEFS] 38/80). Physical examination revealed left LE weakness, altered sensation, and an absent Achilles deep tendon reflex. : The patient's presentation was consistent with a lumbosacral plexus stretch injury, with S1 being most affected. A physiatrist was consulted and recommended initiating PT treatment with bi-weekly re-examination. The 6-week (14 visits) re-examination revealed abolished left knee pain and improved physical functioning (LEFS 66/80). : Stretch injuries are a known complication of lithotomy positioning. Knowledge of this and the addition of a thorough examination allowed the PT to identify the possible cause of the patient's abrupt onset of left LE dysfunction. Regardless of mode of patient access, screening for referral is crucial and may include referral or, as in this case, consultation with other professionals.
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http://dx.doi.org/10.1080/09593985.2018.1477891DOI Listing
December 2019

Relative and Absolute Reliability of the Professionalism in Physical Therapy Core Values Self-Assessment Tool.

J Allied Health 2018 ;47(1):e45-e48

DPT Program, College of Health and Human Services, Western Kentucky University, 1906 College Heights Blvd. #21031, Bowling Green, KY 42101-1031, USA. Tel 270-745-3232, fax 270-745-3497.

Development of professional behaviors in Doctor of Physical Therapy (DPT) students is an important part of professional education. The American Physical Therapy Association (APTA) has developed the Professionalism in Physical Therapy Core Values Self-Assessment (PPTCV-SA) tool to increase awareness of personal values in practice. The PPTCV-SA has been used to measure growth in professionalism following a clinical or educational experience. There are few studies reporting psychometric properties of the PPTCV-SA. The purpose of this study was to establish properties of relative reliability (intraclass correlation coefficient, iCC) and absolute reliability (standard error of measurement, SEM; minimal detectable change, MDC) of the PPTCV-SA. in this project, 29 first-year students in a DPT program were administered the PPTCVA-SA on two occasions, 2 weeks apart. Paired t-tests were used to examine stability in PPTCV-SA scores on the two occasions. iCCs were calculated as a measure of relative reliability and for use in the calculation of the absolute reliability measures of SEM and MDC. Results of paired t-tests indicated differences in the subscale scores between times 1 and 2 were non-significant, except for three subscales: Altruism (p=0.01), Excellence (p=0.05), and Social Responsibility (p=0.02). iCCs for test-retest reliability were moderate-to-good for all subscales, with SEMs ranging from 0.30 to 0.62, and MDC95 ranging from 0.83 to 1.71. These results can guide educators and researchers when determining the likelihood of true change in professionalism following a professional development activity.
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September 2018

Application of inelastic neutron scattering to studies of CO2 reforming of methane over alumina-supported nickel and gold-doped nickel catalysts.

Phys Chem Chem Phys 2012 Nov 22;14(43):15214-25. Epub 2012 Aug 22.

School of Chemistry, Joseph Black Building, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK.

The methane reforming reaction with carbon dioxide as the oxidant over alumina-supported nickel and gold-doped nickel catalysts is studied using a variety of techniques such as reaction testing, vibrational spectroscopy (inelastic neutron scattering (INS), Raman scattering and infrared absorption), temperature-programmed oxidation (TPO), transmission electron microscopy and X-ray powder diffraction. The quantities of retained carbon and hydrogen are determined by TPO and INS, respectively. Minimal hydrogen retention indicates these catalysts to be very efficient at cycling hydrogen. The relative partitioning of hydrogen within the reaction media is used to formulate a qualitative description of the reaction kinetics. The presence of the gold modifier does not appear to provide any improvement in catalyst performance under the specified reaction conditions.
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http://dx.doi.org/10.1039/c2cp42745aDOI Listing
November 2012

The constructive use of images in medical teaching: a literature review.

JRSM Short Rep 2012 May 21;3(5):33. Epub 2012 May 21.

St Sampson's Medical Practice , Grandes Maisons, Road, St Sampsons, Guernsey GY2 4JY , UK.

This literature review illustrates the various ways images are used in teaching and the evidence appertaining to it and advice regarding permissions and use. Four databases were searched, 23 papers were retained out of 135 abstracts found for the study. Images are frequently used to motivate an audience to listen to a lecture or to note key medical findings. Images can promote observation skills when linked with learning outcomes, but the timing and relevance of the images is important - it appears they must be congruent with the dialogue. Student reflection can be encouraged by asking students to actually draw their own impressions of a course as an integral part of course feedback. Careful structured use of images improve attention, cognition, reflection and possibly memory retention.
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http://dx.doi.org/10.1258/shorts.2012.011158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365786PMC
May 2012

Human factors in resuscitation teaching.

Resuscitation 2012 Apr 25;83(4):423-7. Epub 2011 Nov 25.

Grandes Maisons Road, St Sampson's Medical Practice, Guernsey, Channel Islands GY2 4JS, United Kingdom.

Introduction: There is an increasing interest in human factors within the healthcare environment reflecting the understanding of their impact on safety. The aim of this paper is to explore how human factors might be taught on resuscitation courses, and improve course outcomes in terms of improved mortality and morbidity for patients. The delivery of human factors training is important and this review explores the work that has been delivered already and areas for future research and teaching.

Method: Medline was searched using MESH terms Resuscitation as a Major concept and Patient or Leadership as core terms. The abstracts were read and 25 full length articles reviewed.

Results: Critical incident reporting has shown four recurring problems: lack of organisation at an arrest, lack of equipment, non functioning equipment, and obstructions preventing good care. Of these, the first relates directly to the concept of human factors. Team dynamics for both team membership and leadership, management of stress, conflict and the role of debriefing are highlighted. Possible strategies for teaching them are discussed.

Conclusions: Four strategies for improving human factors training are discussed: team dynamics (including team membership and leadership behaviour), the influence of stress, debriefing, and conflict within teams. This review illustrates how human factor training might be integrated further into life support training without jeopardising the core content and lengthening the courses.
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http://dx.doi.org/10.1016/j.resuscitation.2011.11.001DOI Listing
April 2012

Rhabdomyolysis in MDMA intoxication: a rapid and underestimated killer. "Clean" Ecstasy, a safe party drug?

J Emerg Med 2012 Jun 4;42(6):655-8. Epub 2009 Jun 4.

Department of Intensive Care, Haga Hospital, The Hague, The Netherlands.

Background: Ecstasy is a popular drug among young adults. It is often thought to be safe. The dose of methylenedioxymethamphetamine (MDMA) in a tablet of Ecstasy varies greatly, and there is also a difference in individual response to a dose of MDMA.

Objectives: To increase the awareness of potential mortality in MDMA use.

Case Report: We report the case of a patient with a lethal intoxication after pure MDMA intoxication. The serum toxicology screening showed an elevated level of MDMA (1.5 mg/L) but no other amphetamines or other drugs.

Conclusions: The cause of death was a rapidly evolving hyperkalemia due to rhabdomyolysis. There is still a need to educate the public about the dangers of this so-called "safe" party drug.
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http://dx.doi.org/10.1016/j.jemermed.2009.04.057DOI Listing
June 2012

The associations between air quality and the number of hospital admissions for acute pain and sickle-cell disease in an urban environment.

Br J Haematol 2007 Mar;136(6):844-8

Department of Haematology, King's College London School of Medicine at Guy's, UK.

The clinical severity of sickle-cell disease (SCD) is dependent on genetic and environmental variables. Environmental factors have been poorly studied. We have investigated possible links between air pollution and acute pain in SCD. We retrospectively studied the numbers of daily admissions with acute sickle-cell pain to King's College Hospital, London, in relation to local daily air quality measurements. We analysed 1047 admissions over 1400 d (1st January 1998-31st October 2001). Time series analysis was performed using the cross-correlation function (CCF). CCF showed a significant association between increased numbers of admissions and low levels of nitric oxide (NO), low levels of carbon monoxide (CO) and high levels of ozone (O(3)). There was no association with sulphur dioxide (SO(2)), nitrogen dioxide or PM(10) (dust). The significant results were further examined using quartile analysis. This confirmed that high levels of O(3) and low levels of CO were associated with increased numbers of hospital admissions. Low NO levels were also associated with increased admissions but did not reach statistical significance on quartile analysis. Our study suggests air quality has a significant effect on acute pain in SCD and that patients should be counselled accordingly. The potential beneficial effect of CO and NO is intriguing and requires further investigation.
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http://dx.doi.org/10.1111/j.1365-2141.2007.06493.xDOI Listing
March 2007

Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial.

Lancet 2005 Jul 16-22;366(9481):205-10

Academic Division of Child Health, University of Nottingham, Derbyshire Children's Hospital, Uttoxeter Road, Derby DE22 3DT, UK.

Background: Rectal diazepam and buccal midazolam are used for emergency treatment of acute febrile and afebrile (epileptic) seizures in children. We aimed to compare the safety and efficacy of these drugs.

Methods: A multicentre, randomised controlled trial was undertaken to compare buccal midazolam with rectal diazepam for emergency-room treatment of children aged 6 months and older presenting to hospital with active seizures and without intravenous access. The dose varied according to age from 2.5 to 10 mg. The primary endpoint was therapeutic success: cessation of seizures within 10 min and for at least 1 hour, without respiratory depression requiring intervention. Analysis was per protocol.

Findings: Consent was obtained for 219 separate episodes involving 177 patients, who had a median age of 3 years (IQR 1-5) at initial episode. Therapeutic success was 56% (61 of 109) for buccal midazolam and 27% (30 of 110) for rectal diazepam (percentage difference 29%, 95% CI 16-41). Analysing only initial episodes revealed a similar result. The rate of respiratory depression did not differ between groups. When centre, age, known diagnosis of epilepsy, use of antiepileptic drugs, prior treatment, and length of seizure before treatment were adjusted for with logistic regression, buccal midazolam was more effective than rectal diazepam.

Interpretation: Buccal midazolam was more effective than rectal diazepam for children presenting to hospital with acute seizures and was not associated with an increased incidence of respiratory depression.
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http://dx.doi.org/10.1016/S0140-6736(05)66909-7DOI Listing
September 2005