About
257
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8,243
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Introduction
Started at MORU May 2022
Additional affiliations
December 2015 - present
October 2003 - December 2015
March 1992 - May 1994
Medical Research Council Unit, The Gambia
Education
October 1994 - June 2003
May 1986 - September 1987
October 1981 - June 1985
Publications
Publications (257)
Background
The majority of colorectal cancers (CRCs) are detected after symptomatic presentation to primary care. Given the shared symptoms of CRC and benign disorders it is challenging to manage this risk of missed diagnosis. Colonoscopy resources cannot keep pace with increasing demand. There is a pressing need for access to simple triage tools i...
Introduction
Incisional Hernia (IH) is a common complication of colorectal surgery. Given high recurrence rates and associated morbidity, emphasis must be on prevention of IH. There is an association between surgeon volume and outcomes in hernia surgery, yet little evidence regarding impact of the experience of the surgeon performing abdominal wall...
Background
Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.
Methods
A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colore...
Background
Incisional hernias can cause chronic pain and complications and affect quality of life. Surgical repair requires health-care resources and has a significant associated failure rate. A prospective, multicentre, single-blinded randomised controlled trial was conducted to investigate the clinical effectiveness and cost-effectiveness of the...
Background
Skin cancer, including melanoma and non-melanoma (keratinocyte), is increasing in incidence in the UK. Accounting for half of all cancers in England and Wales, the disease significantly impacts overstretched dermatology services. Research suggests that 86% of melanoma is preventable with modified sun exposure. Educating children about su...
p>The original version of this Article contained errors in Table 1 and Table 3. In Table 1, in the group “Already taking antibiotics at emergency call, n (%)”, the number of patients in “Intervention (n = 62)” and “Control (n = 52)” were interchanged. The incorrect and correct values appear below. Incorrect:(Table preseneted.)</p
Abstract
Background Common memory aids for people with dementia at home are recommended. However, rigorous evaluation is lacking, particularly what guidance or support is valued.
Objective To investigate effects of memory aids and guidance by dementia support practitioners (DSPs) for people in early-stage dementia through a pragmatic, randomised...
Introduction
Most individuals newly diagnosed with type 1 diabetes (T1D) have 10%–20% of beta-cell function remaining at the time of diagnosis. Preservation of residual beta-cell function at diagnosis may improve glycaemic control and reduce longer-term complications.
Immunotherapy has the potential to preserve endogenous beta-cell function and the...
Severe sepsis is a time critical condition which is known to have a high mortality rate. Evidence suggests that early diagnosis and early administration of antibiotics can reduce morbidity and mortality from sepsis. The prehospital phase of emergency medical care may provide the earliest opportunity for identification of sepsis and delivery of life...
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate...
Background
While morbidity attributable to podoconiosis is relatively well studied, its pattern of mortality has not been established.
Methods
We compared the age-standardised mortality ratios (SMRs) of two datasets from northern Ethiopia: podoconiosis patients enrolled in a 1-y trial and a Health and Demographic Surveillance System cohort.
Resul...
Suspected colorectal cancer (CRC) referrals based on non-specific symptoms currently lead to large numbers of patients being referred for invasive investigations and poor yield in cancer detection. Secondary care diagnostics, particularly endoscopy, struggle to meet the ever-increasing demand and patients face lengthy waits from the point of referr...
Objective:
To explore patients' experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury.
Design:
Qualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture.
Setting:
Patients treated by para...
Background
Podoconiosis is a disease of the lymphatic vessels of the lower extremities that is caused by chronic exposure to irritant soils. It results in leg swelling, commonly complicated by acute dermatolymphangioadenitis (ADLA), characterised by severe pain, fever and disability.
Methods
We conducted cost-effectiveness and social outcome analy...
Background
Sepsis is a common condition which kills approximately 44,000 people annually in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve outcomes. Paramedics frequently attend patients with sepsis, and are well placed to provide early diagnosis and treatment. We aimed to assess whether a multi-ce...
In sub-Saharan Africa, children below 5 years bear the greatest burden of severe malaria because they lack naturally acquired immunity that develops following repeated exposure to infections by Plasmodium falciparum. Antibodies at the surface of P. falciparum infected erythrocytes (IEs) play an important role in this immunity. In children under the...
Background:
In managing hip fracture, effective pain relief before admission to hospital is difficult without risking side effects. Although emergency departments routinely use fascia iliaca compartment block (FICB), there has been little evaluation of its use by paramedics before hospital admission. We aimed to assess whether a multi-centre rando...
Background:
Children with medically complicated severe acute malnutrition (SAM) have high risk of inpatient mortality. Diarrhea, carbohydrate malabsorption, and refeeding syndrome may contribute to early mortality and delayed recovery. We tested the hypothesis that a lactose-free, low-carbohydrate F75 milk would serve to limit these risks, thereby...
Objectives
To explore paramedics’ experience of delivering fascia iliaca compartment block ( FICB) to patients with suspected hip fracture at the scene of injury.
Design
Focus groups within a randomised controlled trial.
Setting
Paramedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and...
Background
Up to 40% of patients with suspected hip fracture report inadequate or no pre-hospital pain management. Morphine may raise risk of complications and may be avoided by paramedics. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FIC...
Background
Routine pre-hospital pain management for hip fracture is inadequate, with risk of potentially fatal complications, particularly from morphine. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fra...
Background
Adequate pain relief in prehospital care is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by clinicians...
Background
RAPID (Rapid Analgesia for Prehospital Hip Disruption) study was a small study to determine the feasibility of undertaking a randomised controlled trial to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block (FICB) as early pain relief to patients who have fractured a hip at the scene of t...
Background:
Stunting is the most common manifestation of childhood undernutrition worldwide. Children presenting with severe acute malnutrition (SAM) are often also severely stunted. We evaluated linear growth and its determinants after medically complicated SAM.
Methods:
We performed secondary analysis of clinical trial data (NCT00934492) from...
Background
Rapid Analgesia for Prehospital Hip Disruption was a small study designed to determine the feasibility of undertaking a randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block as early prehospital pain relief to patients with a fractured hip. The objective...
Background
Research to improve prehospital treatment and care requires the participation of clinical and managerial staff from ambulance services to test interventions and collect research data. Researchers work closely with individuals and organisations with prehospital clinical, managerial and policy expertise to plan, deliver and disseminate res...
Background:
Podoconiosis (also known as endemic, non-filarial elephantiasis) affects about 4 million subsistence farmers in tropical Africa. Poor awareness of the condition and inadequate evidence for the efficacy of treatment mean that no government in an endemic country yet offers lymphoedema management for patients with podoconiosis. Among pati...
Background:
Goals of treating childhood severe acute malnutrition (SAM), in addition to anthropometric recovery and preventing short-term mortality, include reducing the risks of subsequent serious infections. How quickly and how much the risk of serious illness changes during rehabilitation are unknown but could inform improving the design and sc...
Table S1: Distribution of rickets across the recruitment sites.
Table S2: Distribution of Life‐threatening events during one year follow‐up.
Table S3: Effects of baseline rickets on changes in anthropometry during 12 months follow‐up using imputed data for missing values.
Table S4: Number of missing monthly anthropometry records during follow up th...
Aim
Pre-hospital pain management for hip fracture is inadequate, with risk of complications, particularly from morphine. Fascia Iliaca Compartment Block (FICB) is used in hospital. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture at the scene of injury.
Method
We held three focus groups wi...
Aim
Sepsis is common; it kills at least 44 000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce morbidity and mortality of people with sepsis. Paramedics frequently come into contact with patients with sepsis, and are well placed to provide early treatment. This feasibility study aims to find out whet...
Aim
Pain relief in prehospital care is a challenge in trauma, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long term outcomes may be adversely affected by administration of opiates. Fascia Iliaca Compartment Block (FICB) is routinely undertaken by hospital clinicians, but has not been fully evaluated...
Background:
Sepsis is a common condition which kills between 36,000 and 64,000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve the health and well-being of people with sepsis. Paramedics frequently come into contact with patients with sepsis and are well placed to provide early...
The effects of rickets on children recovery from severe acute malnutrition (SAM) are unknown. Rickets may affect both growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life-threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated...
Background
Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) i...
Background
Hyperbilirubinaemia is a major cause of neonatal morbidity. Early identification of those infants most at risk might allow the development of targeted primary preventative therapy and follow-up. The objective of this study was to assess whether arterial umbilical cord bilirubin (aUCB) level at delivery predicts the development of neonata...
Background: The first models of malaria transmission assumed a completely mixed and homogeneous population of parasites. Recent models include spatial heterogeneity and variably mixed populations. However, there are few empiric estimates of parasite mixing with which to parametize such models.
Methods : Here we genotype 276 single nucleotide polymo...
Background
Bloodstream infection is a common cause of morbidity in children aged <5 years in developing countries. In studies reporting bacteremia in Africa, coagulase-negative Staphylococci (CoNS) are commonly isolated. However, it is currently unclear whether children who are highly susceptible to infection because of severe acute malnutrition (S...
Blood volume sampled and time to culture positivity.
(DOCX)
Outcomes amongst children with CoNS.
The model includes adjustment of age as a categorical variable (age <18 months or ≥18 months).
(DOCX)
Clinical features of CoNS amongst 643 children with a positive HIV antibody test.
The model includes adjustment of age as a categorical variable (age <18 months or age ≥18 months).
(DOCX)
Univariable analysis of associations with CoNS amongst all admissions.
(DOCX)
Flow diagram.
Study participants.
(TIF)
Objectives
To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality.
Design
Growth curve construction and longitudinal cohort study.
Setting
United States and intern...
Supplementary figure: MUAC-for-age chart in girls for clinical and programmatic use
Supplementary information: appendix tables 1-8 and figures 1-9
Supplementary figure: MUAC-for-age chart in boys for clinical and programmatic use
OBJECTIVES: To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality. DESIGN: Growth curve construction and longitudinal cohort study. SETTING: United States and inter...
Background:
We investigated the poorly understood impact of declining malaria transmission on maintenance of antibodies to P. falciparum merozoite antigens and infected erythrocytes (IEs), including functional immunity.
Methods:
In a 3-year longitudinal cohort of 300 Kenyan children, antibodies to different merozoite AMA1 and MSP2 alleles, IE su...
Background:
Malaria control strategies need to respond to geographical hotspots of transmission. Detection of hotspots depends on the sensitivity of the diagnostic tool used.
Methods:
We conducted cross-sectional surveys in 3 sites within Kilifi County, Kenya, that had variable transmission intensities. Rapid diagnostic test (RDT), microscopy, a...
Background:
Neonatal mortality remains high in sub-Saharan Africa, and a third of deaths are estimated to result from infection. Whilst coagulase negative staphylococci (CoNS) are leading neonatal pathogens in resource-rich settings, their role, and the need for early anti-staphylococcal treatment in empiric antibiotic guidelines, is unknown in su...
Reference intervals for clinical laboratory parameters are important for assessing eligibility, toxicity grading and management of adverse events in clinical trials. Nonetheless, haematological and biochemical parameters used for clinical trials in sub-Saharan Africa are typically derived from industrialized countries, or from WHO references that a...
95% reference ranges with 90% confidence intervals for selected haematological parameters for Kilifi children aged 1–17 months stratified by gender.
(PDF)
95% reference ranges with 90% confidence intervals for selected white blood cells parameters for Kilifi Children aged 1–17 months stratified by gender.
(PDF)
Selected haematological parameters for Kenyan infants aged 1 to less than 12 months, compared to published data from Tanzania and United States/Europe.
(PDF)
95% reference ranges with 90% confidence intervals for selected biochemistry parameters for Kilifi Children aged 1–17 months stratified by gender.
(PDF)
Table S1. Patient profile at admission by KHDSS residence.
Table S2. Univariable analysis of factors associated with post‐discharge mortality.
Table S3. Multivariable analysis of factors associated with 1‐year post‐discharge mortality.
Table S4. Association between nutritional status and post‐discharge mortality.
Introduction
HIV causes defects in memory B cells in children, but the mechanisms of those defects have not been fully elucidated. One possible mechanism is the lack of T-cell help to B cells during immune reactions. However, few studies have assessed the effect of HIV on follicular helper T cells (TFH cells) in children.
Methods
In this study, fo...
Representative flow-cytometry plots showing the gating strategy for identifying various subsets of follicular-homing CD4 T cells.
(PDF)
Representative flow-cytometry plots showing the gating strategy for identifying resting memory B cells.
(PDF)
Background: There is an increasing recognition of malnutrition among infants under 6 mo of age (U6M). Current diagnosis criteria use weight-for-length z scores (WLZs), but the 2006 WHO standards exclude infants shorter than 45 cm. In older children, midupper arm circumference (MUAC) predicts mortality better than does WLZ. Outcomes may also be infl...
