title: Mortality in the Waikato Hospital Systemic Sclerosis Cohort

authors: Ooi, Clement

subjects: Science & Technology

abstract: Objective

To characterize the causes of mortality and standardised mortality ratio in a cohort of patients with systemic sclerosis (SSc).
Methods

A cohort of 132 patients enrolled at the Waikato Systemic Sclerosis Clinic was prospectively followed from 2005 to 2016. Patient demographics, diagnoses and laboratory reports were used to assess risk of mortality and generate standardised mortality ratios (SMR). Survival was analyzed using Kaplan-Meier methods.
Results

Of the cohort of 132 patients, 20 (15%) were deceased by the end of the study period. The median age of diagnosis and death was 52 years (range 13–86) and 71 years (range 42–87) respectively. Seventy percent of deaths were SSc related and the leading causes of death were due to pulmonary arterial hypertension (PAH), interstitial lung disease (ILD) and scleroderma renal crisis (SRC). Patients diagnosed after the age of 60 had renal or cardiac manifestations and were associated with a significantly increased risk of mortality. The overall SMR was 2.59 (95% CI 1.67–4.01) and was higher in those with diffuse versus limited SSc (6.46, 95% CI 3.08–13.54 vs. 1.93, 95% CI 1.10–3.41) and males (4.17, 95% CI 1.74–10.02 vs. 2.30, 95% CI 1.39–3.81).
Conclusion

This study demonstrated an increased risk of mortality in patients with SSc relative to that of the general population. An excess in risk was observed particularly in those with diffuse SSc and in males. Renal and cardiac involvement were found to be significant indicators of mortality and reinforces the necessity of screening for these complications.

text: Mortality in the Waikato Hospital Systemic Sclerosis Cohort Objective

To characterize the causes of mortality and standardised mortality ratio in a cohort of patients with systemic sclerosis (SSc).
Methods

A cohort of 132 patients enrolled at the Waikato Systemic Sclerosis Clinic was prospectively followed from 2005 to 2016. Patient demographics, diagnoses and laboratory reports were used to assess risk of mortality and generate standardised mortality ratios (SMR). Survival was analyzed using Kaplan-Meier methods.
Results

Of the cohort of 132 patients, 20 (15%) were deceased by the end of the study period. The median age of diagnosis and death was 52 years (range 13–86) and 71 years (range 42–87) respectively. Seventy percent of deaths were SSc related and the leading causes of death were due to pulmonary arterial hypertension (PAH), interstitial lung disease (ILD) and scleroderma renal crisis (SRC). Patients diagnosed after the age of 60 had renal or cardiac manifestations and were associated with a significantly increased risk of mortality. The overall SMR was 2.59 (95% CI 1.67–4.01) and was higher in those with diffuse versus limited SSc (6.46, 95% CI 3.08–13.54 vs. 1.93, 95% CI 1.10–3.41) and males (4.17, 95% CI 1.74–10.02 vs. 2.30, 95% CI 1.39–3.81).
Conclusion

This study demonstrated an increased risk of mortality in patients with SSc relative to that of the general population. An excess in risk was observed particularly in those with diffuse SSc and in males. Renal and cardiac involvement were found to be significant indicators of mortality and reinforces the necessity of screening for these complications.

year: 2017

title: A pilot randomised controlled trial of oral doxycycline after endoscopic sinus surgery and its effects on the sinonasal microbiome

authors: Challis, Jacinda M.

subjects: endoscopic sinus surgery

abstract: Oral antibiotics are commonly prescribed after endoscopic sinus surgery (ESS) despite minimal clinical data supporting this practice. We aim to assess the effect of post-ESS doxycycline on clinical outcomes and on the diversity and composition of the sinonasal microbiome. Methods: Samples from the middle meatus were collected from twelve patients undergoing ESS to treat chronic rhinosinusitis. Patients were double-blind randomised to receive either oral doxycycline or placebo in the post-operative period. Further samples were collected at two weeks and three months post-operatively. The sinonasal microbiome was characterized using 16S ribosomal RNA (rRNA) gene amplicon sequencing. SNOT-22 scores, Lund Mackay scores, and Modified Lund Mackay Endoscopic Scores (MLMES) were collected. Results: After ESS, bacterial diversity increased while SNOT-22 score decreased for both treatments. Microbiome composition diverged between treatments, and random forest analysis identified nine taxa that may distinguish treatment groups. There was no significant difference in SNOT-22 score, 3-month MLMES or bacterial diversity between the placebo and doxycycline groups. The trends for all of these measures favour placebo. Conclusion: In this pilot study, we detected no significant difference between placebo and antibiotic treatments in clinical outcome. As patient symptoms improved after ESS, we detected a concurrent increase in the diversity of the sinonasal microbiome. Our data highlight the need for and facilitate the design of future larger studies to explore the relationship between prophylactic antibiotics and post-ESS recovery.

text: A pilot randomised controlled trial of oral doxycycline after endoscopic sinus surgery and its effects on the sinonasal microbiome Oral antibiotics are commonly prescribed after endoscopic sinus surgery (ESS) despite minimal clinical data supporting this practice. We aim to assess the effect of post-ESS doxycycline on clinical outcomes and on the diversity and composition of the sinonasal microbiome. Methods: Samples from the middle meatus were collected from twelve patients undergoing ESS to treat chronic rhinosinusitis. Patients were double-blind randomised to receive either oral doxycycline or placebo in the post-operative period. Further samples were collected at two weeks and three months post-operatively. The sinonasal microbiome was characterized using 16S ribosomal RNA (rRNA) gene amplicon sequencing. SNOT-22 scores, Lund Mackay scores, and Modified Lund Mackay Endoscopic Scores (MLMES) were collected. Results: After ESS, bacterial diversity increased while SNOT-22 score decreased for both treatments. Microbiome composition diverged between treatments, and random forest analysis identified nine taxa that may distinguish treatment groups. There was no significant difference in SNOT-22 score, 3-month MLMES or bacterial diversity between the placebo and doxycycline groups. The trends for all of these measures favour placebo. Conclusion: In this pilot study, we detected no significant difference between placebo and antibiotic treatments in clinical outcome. As patient symptoms improved after ESS, we detected a concurrent increase in the diversity of the sinonasal microbiome. Our data highlight the need for and facilitate the design of future larger studies to explore the relationship between prophylactic antibiotics and post-ESS recovery.

year: 2022-04-08

title: Exploring the constitution of environment education as situated, critical processes of learning and change: A collaborative synthesis across diverse regional contexts

authors: Eames, Chris W.

subjects: Critical approaches

abstract: This article offers a set of unique vignettes or stories that attempt to illustrate examples of critical approaches to environmental education (EE) in diverse contexts. It draws from the experiences of five environmental educators in four different regions of the world. We detail the history of the emergence of critical consciousness in education in Brazil, and its application in a Brazilian region, then move to examples of critical educational responses to oppression in New Zealand and Zimbabwe, before closing with a critical examination of innovative teaching and research in Europe. Through this breadth of endeavour, we identify commonalities across these contexts such as the importance of participatory action and research to examine peopleenvironment relations, particularly as constituted by indigenous peoples, and to interpret realities in ways that empower through learning-led social-ecological change. We argue that this critical approach can foster emancipation through individual and collective learning in EE processes within very different contexts.

text: Exploring the constitution of environment education as situated, critical processes of learning and change: A collaborative synthesis across diverse regional contexts This article offers a set of unique vignettes or stories that attempt to illustrate examples of critical approaches to environmental education (EE) in diverse contexts. It draws from the experiences of five environmental educators in four different regions of the world. We detail the history of the emergence of critical consciousness in education in Brazil, and its application in a Brazilian region, then move to examples of critical educational responses to oppression in New Zealand and Zimbabwe, before closing with a critical examination of innovative teaching and research in Europe. Through this breadth of endeavour, we identify commonalities across these contexts such as the importance of participatory action and research to examine peopleenvironment relations, particularly as constituted by indigenous peoples, and to interpret realities in ways that empower through learning-led social-ecological change. We argue that this critical approach can foster emancipation through individual and collective learning in EE processes within very different contexts.

year: 2018