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Kruper L, McDonnell K, Bonner J, Tsang KK, Jones V, Mortimer J, Lindsey SS, Solomon I, Hampel H, Park W, Idos GE, Gray S, Gruber S. Abstract PD14-03: PD14-03 Reappraising the Fanconi Anemia DNA repair pathway in breast cancer risk and precision intervention: Insights and opportunities from the City of Hope INSPIRE study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd14-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Fanconi Anemia (FA) proteins facilitate homologous recombination (HR)-mediated repair of DNA interstrand cross-links. Germline monoallelic, pathogenic/likely pathogenic (P/LP) variants in the highly-penetrant (HP) breast cancer (BC) FA genes, BRCA1 (FANCS), BRCA2 (FANCD1) and PALB2 (FANCN)), compromise HR and predispose to hereditary BC. The effects of monoallelic, pathogenic variants in other non-HP BC FA genes upon HR and BC predisposition remain less understood. In this investigation we report the germline mutational landscape of FA gene P/LP variants and somatic molecular consequences of patients with BC diagnoses from City of Hope’s (COH) INSPIRE (Implementing Next-generation Sequencing for Precision Intervention and Risk Evaluation) study.
Methods: COH-INSPIRE is a universal access study open to all patients at COH with a personal and/or family history of cancer. Patients undergo custom panel-based germline genetic testing to detect P/LP single nucleotide variants (SNVs), short insertions/deletions (indels) and exon-level deletions/duplications in 155 cancer-predisposition genes including the HP BC FA genes and 15 non-HP BC FA genes [FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCJ (BRIP1), FANCL, FANCM, FANCO (RAD51C), FANCP (SLX4), FANCQ (ERCC4) and FANCU (XRCC2)]. Patients’ tumor specimens undergo somatic tumor (>400X)-normal (>180X) whole exome and transcriptome sequencing (>50 million reads). Somatic sequencing identifies P/LP SNVs, indels, copy number events, and fusions. Secondary analyses assessed somatic homologous recombination deficiency (HRD) by examining tumor mutational signatures, as well as an ensemble HRD score derived by combining individual genomic loss of heterozygosity, telomeric allelic imbalance and large-scale molecular transition scores. Reference comparison of germline and somatic features to current FDA therapeutic guidelines and NIH clinical trials registrations determined eligibility for precision therapeutic intervention and clinical trial enrollment.
Results: Of 7,584 patients enrolled in COH-INSPIRE, 1,651 (21.8%) patients had a BC diagnosis. Germline panel testing of BC patients identified 204 (12.4%) with germline P/LP variant in a FA gene. Greater than one third of FA gene-altered BC patients (37.7%) carried a P/LP variant in a non-HP BC FA gene. We observed that BC patients with a non-HP BC FA gene variant may demonstrate HR compromise as evidenced by presence of a Signature 3 mutational profile or an elevated combined HRD score (> 33 and/or > 42). (Table 1) Further, we identified ostensible segregation of triple negative BC in a family harboring a germline pathogenic variant in FANCG. With regard to precision clinical actionability (i.e. qualification for targeted therapeutic intervention [PARP inhibitor (PARPi)] and/or clinical trial) for patients with advanced stage BC: All patients with germline P/LP HP BC FA gene variant and 20.7% (N=16) of patients with a P/LP FA non-HPBC FA gene variant met criteria for treatment with on/off-label PARPi. 100% of patients with advanced BC with germline P/LP HP BC or non-HPBC FA gene variant qualified for a clinical trial.
Conclusions: Patients with BC often carry a germline monoallelic, P/LP FA gene variant; in more than one third, the FA gene alteration occurs in a non-HP BC FA gene. BC patients harboring a monoallelic germline non-HP BC P/LP FA gene may exhibit somatic mutational signatures and HRD scoring consistent with compromise of HR. Somatic tumor evaluation of BC patients with germline P/LP non-HP BC FA gene variants expands opportunities for precision therapeutic intervention and clinical trial enrollment. Continued appraisal will clarify emerging questions of germline non-HP P/LP FA gene-associated autosomal dominant BC risk and management as well as facilitate optimization of precision BC care.
Table 1 Summary Molecular Features of BC patients with P/LP Variants in FA gene from COH-INSPIRE
Citation Format: Laura Kruper, Kevin McDonnell, Joseph Bonner, Kevin K. Tsang, Veronica Jones, Joanne Mortimer, Sidney S. Lindsey, Ilana Solomon, Heather Hampel, Wai Park, Gregory E. Idos, Stacy Gray, Stephen Gruber. PD14-03 Reappraising the Fanconi Anemia DNA repair pathway in breast cancer risk and precision intervention: Insights and opportunities from the City of Hope INSPIRE study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD14-03.
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Mortimer J, Lindsey SS, Solomon I, Park W, Sturgeon D, Blazer K, Gray S, Bonner J, Xia X, Gruber S. Abstract P1-05-03: Prevalence of BRCA1/2 mutations in an underrepresented population of women with breast cancer: Observations from the City of Hope INSPIRE study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p1-05-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Table 1. Incidence of BRCA 1 and 2 mutations by Race and Ethnicity BRCA1 BRCA2 BRCA1 or 2 VUS/Negative Native American 0 1 1 6 Asian 2 3 5 150 Black/African American 3 2 5 48 Native Hawaiian or Pacific Islander 0 0 0 5 Other 1 1 1* 26 White 25 17 42 688 Unknown 0 0 0 20 Declined 1 0 1 24 TOTAL 32 24 55 967 * Patient had both BRCA1 and BRCA2 mutations
Citation Format: Joanne Mortimer, Sidney S. Lindsey, Ilana Solomon, Wai Park, Duveen Sturgeon, Kathleen Blazer, Stacy Gray, Joseph Bonner, Xiaoyu Xia, Stephen Gruber. Prevalence of BRCA1/2 mutations in an underrepresented population of women with breast cancer: Observations from the City of Hope INSPIRE study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-03.
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Jones C, Gray S, Brown M, Brown J, Mc Closkey E, Rai B, Clarke N, Sachdeva A. Fracture and fall risk in men with advanced or metastatic prostate cancer treated with novel androgen receptor signalling inhibitors: A systematic review and meta-analysis of randomised controlled trials. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gaal A, Shimchuk A, Gray S, Bloomquist D, Dillon J. Are postoperative antibiotics required after orthognathic surgery? Int J Oral Maxillofac Surg 2023; 52:211-218. [PMID: 35780069 DOI: 10.1016/j.ijom.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study was to investigate and compare the frequency of surgical site infection (SSI) between orthognathic patients who received only intraoperative antibiotics and patients who received intraoperative antibiotics plus postoperative antibiotics. A retrospective study was performed of patients treated by a single surgeon over the years 2006-2012 and 2016-2019. The primary predictor variable was antibiotic exposure. The control group received no postoperative prophylactic antibiotics. The study group received postoperative antibiotics. Both groups received prophylactic intraoperative antibiotics and performed postoperative chlorhexidine rinses. The primary outcome was SSI frequency. Univariate, bivariate, and multiple logistic regression analyses were performed; statistical significance was set at P ≤ 0.05. The sample comprised 333 patients. Their mean age was 30.7 ± 11.8 years. The study group included 129 patients (38.7%); the control group included 204 patients (61.3%). The frequency of SSI was 17.1% in the study group and 26.5% in the control group (P = 0.048). In the multivariable logistic regression, only alcohol consumption was significantly associated with an increased risk of SSI (odds ratio 2.46, 95% confidence interval 1.36-4.44; P = 0.003). In patients undergoing orthognathic surgery, postoperative antibiotic exposure in addition to intraoperative prophylaxis approached but was not statistically significant for a decreased risk of SSI (P = 0.067).
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Thomas N, Stankard A, Cosgrave N, Conlon B, Monahan P, Halpin T, Britton D, Byrne P, McShane S, Sohail I, Grogan AM, Reilly A, Thapa A, Alsubaie N, Rane P, O'Connor J, Gray S, Kaja A, Gehani K, Kovalyshyn V, O'Brien H. 92 CONTINUING TO ‘BE HIP’: ORTHOGERIATRIC SERVICE IMPROVEMENTS IN 2021. Age Ageing 2022. [PMCID: PMC9620584 DOI: 10.1093/ageing/afac218.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Scotland first demonstrated that adherence to nationally agreed hip fracture standards improve patient survival, reduces the duration of admission, and reduces the need for high dependency care. Our study aims to assess adherence to the Irish Hip Fracture Standards (IHFS) in our hospital for 2021 amidst the COVID-19 pandemic, translating to improved clinical outcomes for our patients. Methods The IHF database was retrospectively analysed, comparing quarters 1-4 in 2021 with our 2020 results. Results IHFS1, patient time to the ward < 4hours, was maintained at 67% in 2021 versus 71% overall in 2020. There was improvement in IHFS2, time to surgery within 48 hours, up to 73% in 2021 versus 66% in 2020. IHFS3 was 4% in 2021 versus 3% overall in 2020. Further improvements were noted for IHFS4, with 95% of patients reviewed by a Geriatrician in 2021 versus 87% in 2020. IHFS5 also improved with 97% of patients receiving a bone health assessment in 2021 versus 87% in 2020. Moreover, IHFS6, improved with 97% of patients undergoing a specialised falls assessment in 2021 versus 87% in 2020. Conclusion The improvement in 2021 figures is reflective of the return of redeployed services during the COVID-19 pandemic inclusive of the Orthogeriatric Service, the Fracture Liaison Service Advanced Nurse Practitioner, the Trauma Co-ordinator, and the specialist Orthopaedic ward complete with its Orthopaedic nurses and Multi-Disciplinary Team, and improved Emergency Department pathways. These continued improvements in the IHFS further emphasise that success is dependent on a team that is joined at the hip
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Stankard A, Thomas N, Cosgrave N, Conlon B, Monaghan P, Halpin T, English D, Byrne P, McShane S, Sohail I, Grogan AM, Reilly A, Thapa A, Alsubaie N, Rane P, O'Connor J, Gray S, Kaja A, Gehani K, Kovalyshyn V, O'Brien H. 258 RISING TO THE CHALLENGE: ORTHOGERIATRIC SERVICE IMPROVEMENT AND COVID-19. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Nationally agreed hip fracture standards have contributed to the improvement of outcomes in hip fracture patients. In 2020, our hospital was awarded “The Golden Hip” for achieving highest compliance with Irish Hip Fracture Standards (IHFS) nationally for 2019.
Methods
Data from the Irish Hip Fracture Database (IHFD)was retrospectively analysed to assess our performance in 2020 versus 2019 in hip fracture patients over sixty. Multiple quality improvement interventions were put in place throughout 2019 to ensure improvement in IHFS1-6 compliance: Creation of the Hip Fracture Pathway Subgroup, IHFS 1 Breaches Audit, Orthogeriatric input at Orthopaedic inductions, weekly Multi-disciplinary Team meetings, a Nutritional Hip Fracture Pathway and addition of the Fracture Liaison Service Advanced Nurse Practitioner.
Results
There were 239 hip fracture patients in 2020 vs 249 in 2019. IHFS1 compliance improved with the percentage of patients admitted to the Orthopaedic ward within 4 hours increasing to 71% in 2020 from 56% in 2019. There was improvement in IHFS2-time to surgery <48 hours- 66% in 2020 vs 60% in 2019. IHFS3-pressure ulcer rate-was at the national average, 3% in 2020 vs 2% in 2019. IHFS4 (reviewed by a Geriatrician), IHFS5 (received a bone health assessment) and IHFS6 (received a specialised falls assessment) were lower overall; 87% in 2020 vs 98% in 2019. For all quarters (Q),43% of patients met all IHFS in our hospital in 2020 vs 32% in 2019, resulting in €90,000 in Best Practice Tariff funding.
Conclusion
Lower results for IHFS 4,5 and 6 reflect the arrival of the COVID-19 pandemic which led to redeployment of the Orthogeriatric Service and redeployment of the MDT from end of Q1 to Q3. When services in 2020 were preserved,1 in 2 hip fracture patients met all IHFS, vs 1 in 3 patients in 2019. Despite the pandemic, we continued to achieve the highest level of IHFS compliance nationally, being awarded a second consecutive “Golden Hip” for 2020.
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Andemariam B, Inati A, Colombatti R, Minniti C, Brown C, Hottmann M, Gray S, Hoppe C, Montealegre-Golcher F, Yue P. TRIALS IN PROGRESS: THE THRIVE STUDIES EVALUATING THE EFFICACY, SAFETY, AND LONG-TERM TREATMENT WITH INCLACUMAB, A P-SELECTIN INHIBITOR, IN PATIENTS WITH SICKLE CELL DISEASE. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Nehoray B, Slavin TP, Sun CL, Hurley K, King E, Tsang KK, Cervantes A, Mokhnatkin JV, Sand S, Mejia R, Reb A, Samimi G, Gray S, Blazer KR, Weitzel JN. Cross-sectional clinical cancer genomics community of practice survey analysis of provider attitudes and beliefs regarding the use of deceased family member tissue to guide living family member genetic cancer risk assessment. J Genet Couns 2022; 31:1164-1172. [PMID: 35617031 PMCID: PMC9529780 DOI: 10.1002/jgc4.1587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
Next-generation tumor tissue sequencing techniques may result in the detection of putative germline pathogenic variants (PVs), raising the possibility that germline cancer predisposition could be identified from archival medical tissue samples of deceased relatives. The approach, termed traceback, is designed to inform risk management recommendations for living family members. Provider perspectives regarding traceback testing have not yet been explored, so we conducted a cross-sectional survey of Clinical Cancer Genomics Community of Practice providers regarding their attitudes and beliefs toward traceback testing. Self-reported demographics, provider characteristics, attitudes and perceived barriers were collected. We evaluated responses in the context of whether providers had previous experience with traceback testing. Data were analyzed using chi-square and Fisher's exact testing. Among 207 respondents (of 816 eligible), most were women (89.4%), white (85.5%), and not Hispanic or Latino (89.7%). US-based providers represented the majority of respondents (87.4%). Relatively, few providers 32 of 207 (15.5%) had previous experience with traceback. Among the individuals without experience in traceback, 84.0% thought there would be barriers to implementation; however, only 68.8% of individuals with previous traceback experience agreed (p = .04). Respondents in both groups thought that traceback would be valuable in their practice (82.6%, p = .22) and that they would feel comfortable discussing the concept (83.6%, p = .83), interpreting the results (72.2%, p = .24), and discussing the results with their patients (80.7%, p = .38). Patient interest and cost were seen as less of a barrier by those with experience with traceback testing. Recurrent themes obtained in open-ended responses are also presented. Overall, providers believe that traceback would be a valuable tool in their practice. Individuals with previous experience identified less barriers with implementation of this testing, highlighting an area for future research and education.
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Henderson B, Maguire P, Keartland S, Barr M, Crulhas B, Keating G, Fitzmaurice G, Gray S, Nicholson S, Finn S, Gately K. EP02.01-002 Development of Circulating and Tissue Biomarkers Predicting Immune Phenotype and Response to Immunotherapy in NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Achebe M, Hassab H, Alkindi S, Brown C, Telfer P, Biemond B, Gordeuk V, Lipato T, Alfa Cissé O, Darson F, Tonda M, Gray S, Howard J. Sécurité et efficacité à long terme du voxelotor chez des patients atteints de drépanocytose : résultats d’une étude d’extension en ouvert de l’essai de phase 3 HOPE. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dagnone JD, Brooks J, Mann M, Cameron B, Gray S, Poonja Z, Lim R. Reconceptualizing ER physician wellness in the midst of the pandemic: survival through the lens of personal agency. CAN J EMERG MED 2022; 24:16-19. [PMID: 34928492 PMCID: PMC8686091 DOI: 10.1007/s43678-021-00253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022]
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van Hove M, Gray S. Biodiversity and human health: the case for public health action. Perspect Public Health 2021; 141:319-321. [PMID: 34816771 DOI: 10.1177/17579139211053366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Scheper J, Bruner S, Flume P, McCoy L, Gray S, Bullington W. 241: The impact of implementing specialty pharmacy services within a cystic fibrosis clinic. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gray S. The Impact of Online Nutrition Education on WIC Client Retention and Redemption of the Cash Value Benefit of Fruit/Vegetables. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wing S, Sosa E, Benmarhnia T, Yang JA, Gray S, Jankowska M, Erhunmwunsee L. Abstract 784: Association of neighborhood socioeconomic status and aggressive non-small cell lung cancer biology. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Lung cancer is the leading cause of cancer-related deaths in the US. While smoking remains the most common cause for non-small cell lung cancer (NSCLC), less research exists on the role of adverse social conditions and neighborhood socioeconomic status (nSES) in the development of specific NSCLC somatic mutations. Neighborhood conditions can be influenced by economic, housing, education, transportation, and environmental factors. Understanding the relationship between NSCLC biology and nSES is vital in addressing disproportionately high rates of NSCLC incidence and poor outcomes among marginalized communities in the US. While neighborhood deprivation indices have been linked to aggressive biology in other cancers, the link to somatic mutations in NSCLC is unknown. The purpose of this analysis is to identify relationships between exposure to adverse nSES conditions and somatic KRAS mutations, a marker of aggressive NSCLC biology.
Methods: We analyzed NSCLC patients who received care at the City of Hope Comprehensive Cancer Center in Duarte, CA from 2015-2018 and received somatic KRAS testing of their lung tumor tissue as a part of their care. The patients' medical record was abstracted for data including demographics and disease characteristics. The patients' home address was geocoded and assigned a census tract-level exposure to several indices of nSES conditions including the California Health Places Index (HPI), the US Department of Housing and Urban Development Labor Market Engagement Index (LME), and the Area Deprivation Index (ADI). We used several logistic regressions to model the presence of somatic KRAS mutations in relation to exposure to various adverse nSES conditions. Odds ratios (ORs) were adjusted for age at diagnosis, sex, cigarette smoking, race/ethnicity, insurance status, cancer stage, cancer histology, and exposure to PM2.5.
Results: Of 426 eligible NSCLC patients, 28% tested positive for a KRAS mutation, 54% were non-Hispanic White, 66% were stage IV, and 83% had adenocarcinomas. The risk of a KRAS mutation was significantly elevated among patients living in places with lower HPI scores (OR 1.92, 95% CI: 1.11 - 3.32) and lower LME (OR 1.16, 95% CI: 1.05 - 1.28). In adjusted models, PM2.5, ADI, and other nSES indices were not significantly associated with risk of a KRAS mutation.
Conclusions: We found that NSCLC patients living in deprived neighborhood conditions as measured by the California HPI and LME were more likely to have a somatic KRAS mutation. This relationship shows that nSES may be an important determinant of aggressive NSCLC biology. However, our results also indicate that deprivation is a complex mixture of domains and regionally specific influences. These findings indicate that future research may need to consider locally specific nSES measures as a dynamic marker of neighborhood conditions in addition to nationally derived indexes such as the ADI.
Citation Format: Sam Wing, Ernesto Sosa, Tarik Benmarhnia, Jiue-An Yang, Stacy Gray, Marta Jankowska, Loretta Erhunmwunsee. Association of neighborhood socioeconomic status and aggressive non-small cell lung cancer biology [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 784.
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Altinoluk-Davis F, Gray S, Bray I. Measuring the effectiveness of catch-up MMR delivered by school nurses compared to signposting to general practice on improving MMR coverage. J Public Health (Oxf) 2021; 42:416-422. [PMID: 32052033 DOI: 10.1093/pubmed/fdaa004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study assesses whether increased coverage of the measles, mumps and rubella (MMR) vaccination differs between areas where school nurses deliver catch-up MMR doses to adolescents in school settings, compared to signposting to general practice. METHODS A retrospective cohort study was conducted using Child Health Information Services records within the NHS England South (South Central) commissioning boundary. The sample population included children born 1 September 2000-31 August 2001, in school year 9 during the 2014-15 academic year. RESULTS The primary outcome findings show an increase in coverage of at least one dose of MMR by 1.6% (n = 334) in the cohort receiving catch-up MMR, compared to 0.2% (n = 12) in the cohort signposted to general practice. Over time, the difference in increase between the two cohorts was 1.4%, analysed using the chi-squared comparison of proportions test, providing strong evidence (P < 0.0001) that school nurse delivery of catch-up MMR is effective at increasing coverage. The findings also suggest that school nurse delivery of catch-up MMR may benefit Black, Asian and minority ethnic children and those from more deprived backgrounds. CONCLUSIONS It is recommended that commissioners of school-aged immunization services incorporate the delivery of catch-up MMR doses in their contracts with school nurses.
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Gray S. ES15.03 Effective and Interpretable Reporting of Genotyping Results. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Waddington T, Mambetsariev I, Pharaon R, Fricke J, Baroz AR, Romo H, Ghanem B, Gray S, Salgia R. Therapeutic Potential of Olaparib in Combination With Pembrolizumab in a Young Patient With a Maternally Inherited BRCA2 Germline Variant: A Research Report. Clin Lung Cancer 2021; 22:e703-e707. [PMID: 33640299 DOI: 10.1016/j.cllc.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/19/2022]
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Welsh P, Welsh C, Celis-Morales C, Brown R, Ferguson L, Gray S, Mark P, Lewsey J, Lyall D, Gill J, Pell J, Jhund P, De Lemos J, Willeit P, Sattar N. Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction and estimating benefits from novel interventions. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lipoprotein (a) (Lp(a)) measurement may help guide CVD risk prediction, is thought to be causal in several CVD outcomes, and phase 3 intervention trials of Lp(a) lowering agents are underway. We aimed to investigate the population attributable fraction due to elevated Lp(a) and its utility in CVD risk prediction.
Methods
In 413,724 participants from UK Biobank, associations of serum Lp(a) with composite fatal/nonfatal CVD (n=10,065 events), fatal CVD (n=3247), coronary heart disease (n=16,649), ischaemic stroke (n=3191), and peripheral vascular disease (n=2716) were compared using Cox models. Predictive utility was determined by C-index changes. The population attributable fraction was estimated.
Results
Median Lp(a) was 19.7nmol/L (interquartile interval 7.6–75.3nmol/L). 20.8% had Lp(a) values >100nmol/L; 9.2% had values >175nmol/L. After adjustment for classical risk factors, in participants with no baseline CVD and not taking a statin, 1 standard deviation increment in log Lp(a) was associated with a HR for fatal/nonfatal CVD of 1.09 (95% CI 1.07–1.11). Associations were similar for fatal CVD, coronary heart disease, and peripheral vascular disease. Adding Lp(a) to a prediction model containing traditional CVD risk factors improved the C-index by +0.0017 (95% CI 0.0009, 0.0026). We estimated that having Lp(a) values >100nmol/L accounts for 5.7% of CVD events in the whole cohort. We modelled that an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above ∼175nmol/L may be expected to reduce CVD risk by 20.3%, assuming causality, and an achieved Lp(a) reduction of 80%.
Conclusions
Population screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs to those with markedly elevated levels, if such drugs prove efficacious.
Population attributable fractions: Lp(a)
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Chest, Heart, and Stroke Association Scotland and British Heart Foundation
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Saade D, Bharucha-Goebel D, Zein W, Norato G, Rybin D, Cheung K, Charnas L, Paredes E, Inati S, Foley A, Gray S, Bönnemann C. HEREDITARY NEUROPATHIES & ALS. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lim M, Greene J, Baird AM, Gray S, McNevin C, McDermott R, Finn S. 1972P Circular RNA is associated with enzalutamide resistant prostate cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gray S, Clough T, Mcgee Y, Murphy T, Poulikakos D. Increased risk of COVID-19 in haemodialysis healthcare workers in a tertiary centre in the North West of England. J Hosp Infect 2020; 106:390-391. [PMID: 32763332 PMCID: PMC7403103 DOI: 10.1016/j.jhin.2020.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023]
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Dial J, Chan F, Mezger C, Parker H, Zangla K, Wong D, Gray S. Comprehensive Vocational Evaluation System for Visually Impaired and Blind Persons. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2020. [DOI: 10.1177/0145482x9108500404] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to validate the appropriateness of the Comprehensive Vocational Evaluation System (CVES) for evaluating the work potential and independent living levels of visually impaired and blind individuals. The CVES was administered to 237 clients of the Texas Commission for the Blind (TCB), and the results were used to predict the vocational placement and independent living levels of these clients as determined by the TCB staff. The results indicated that the CVES is significantly related to work and independent living outcomes for visually impaired and blind people.
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Green B, Wong E, Andrews S, Hampshire-Jones K, McKinnon S, Brooks C, McAdam R, Gray S, Vickers C, Blake Y, Sekhon G, Merrick S, Faerber J, Mather P, Gilbert E, McBride R, Coombes A, Walker M, Owen A, Davies J, Richardson S, Carr S, Mapson R, Spivey J, Draper S, Kendall F, Hubbard G, Stratton R. Increased protein intake is associated with improved hand grip strength and quality of life in home enterally tube fed adults using a high-energy, high-protein feed. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee X, Nagarajan T, Evison M, Grundy S, Al-Najjar H, Brockelsby C, Randles V, Rice M, Dildar B, King J, Chlerigh R, Allen R, Sundar R, Gray S. Clinical effectiveness of routine brain imaging in the management of lung cancer prior to curative treatments. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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