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Mundi N, Theurer J, Warner A, Yoo J, Fung K, MacNeil D, Dhaliwal S, Winquist E, Palma DA, Nichols AC. The impact of seasonal operating room closures on wait times for oral cancer surgery. Curr Oncol 2018; 25:67-72. [PMID: 29507486 DOI: 10.3747/co.25.3726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre. Methods A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated. Our primary endpoint was the wait time from consultation to definitive surgery. Exposure variables were defined according to wait time intervals occurring during time periods with reduced operating room hours. Results Overall case volume rose significantly from 2006 to 2014 (p < 0.001), while operating room hours remained stable (p = 0.555). Patient wait times for surgery increased from 16.3 days prior to 2003 to 25.5 days in 2015 (p = 0.008). Significant variability in operating room hours was observed by month, with lowest reported for July and August (p = 0.002). The greater the exposure to these months, the more likely patients were to wait longer than 28 days for surgery (odds ratio per day [or]: 1.07, 95% confidence interval [ci]: 1.05 to 1.10, p < 0.001). Individuals seen in consultation preceding a month with below average operating room hours had a higher risk of disease recurrence and/or death (hazard ratio [hr]: 1.59, 95% ci: 1.10 to 2.30, p = 0.014). Conclusions Scheduled reductions in available operating room hours contribute to prolonged wait times and higher disease recurrence. Further work is needed to identify strategies maximizing efficient use of health care resources without negatively affecting patient outcomes.
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Perera S, Warner A, Almotasen R, Boldt G, Matsuoka H, Yan B, Sey M, Rahman A, Palma DA, Asfaha S. A95 THE EFFICACY OF SURVEILLANCE COLONOSCOPY ON SURVIVAL IN INFLAMMATORY BOWEL DISEASE ASSOCIATED COLORECTAL CANCER: A SYSTEMATIC REVIEW & META-ANALYSIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ronden M, van Sörnsen de Koste J, Johnson C, Slotman B, Spoelstra F, Haasbeek C, Blom G, Bongers E, Warner A, Ward A, Palma D, Senan S. Incidence of High-Risk Radiologic Features in Patients Without Local Recurrence After Stereotactic Ablative Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018; 100:115-121. [DOI: 10.1016/j.ijrobp.2017.09.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022]
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Laba JM, Senan S, Schellenberg D, Harrow S, Mulroy L, Senthi S, Swaminath A, Kopek N, Pantarotto JR, Pan L, Pearce A, Warner A, Louie AV, Palma DA. Identifying barriers to accrual in radiation oncology randomized trials. ACTA ACUST UNITED AC 2017; 24:e524-e530. [PMID: 29270062 DOI: 10.3747/co.24.3662] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Data about factors driving accrual to radiation oncology trials are limited. In oncology, 30%-40% of trials are considered unsuccessful, many because of poor accrual. The goal of the present study was to inform the design of future trials by evaluating the effects of institutional, clinician, and patient factors on accrual rates to a randomized radiation oncology trial. Methods Investigators participating in sabr-comet (NCT01446744), a randomized phase ii trial open in Canada, Europe, and Australia that is evaluating the role of stereotactic ablative radiotherapy (sabr) in oligometastatic disease, were invited to complete a survey about factors affecting accrual. Institutional ethics approval was obtained. The primary endpoint was the annual accrual rate per institution. Univariable and multivariable linear regression analyses were used to identify factors predictive of annual accrual rates. Results On univariable linear regression analysis, off-trial availability of sabr (p = 0.014) and equipoise of the referring physician (p = 0.014) were found to be predictive of annual accrual rates. The annual accrual rates were lower when centres offered sabr for oligometastases off-trial (median: 3.7 patients vs. 8.4 patients enrolled) and when referring physicians felt that, compared with having equipoise, sabr was beneficial (median: 4.8 patients vs. 8.4 patients enrolled). Multivariable analysis identified perceived level of equipoise of the referring physician to be predictive of the annual accrual rate (p = 0.023). Conclusions The level of equipoise of referring physicians might play a key role in accrual to radiation oncology randomized controlled trials. Efforts to communicate with and educate referring physicians might therefore be beneficial for improving trial accrual rates.
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Louie A, Li L, Jenkyn KB, Allen B, Warner A, Rodrigues G, Palma D, Shariff S. P2.14-009 Assessing the Value of Radiotherapy for Lung Cancer in the Intensive Care Unit – A Population-based analysis. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chen H, Ali E, Warner A, Rodrigues G, Louie A. Treatment, Technology, and Time Trends in the Management of Limited-Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Correa R, Warner A, Johnson C, Rodrigues G, Ahmad B, Louie A. A Prospective, Phase 1 Dose-Escalation Trial of Stereotactic Ablative Radiation Therapy As an Alternative to Cytoreductive Nephrectomy for Primary Renal Tumors in the Setting of Metastatic Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bauman G, Chen J, Rodrigues G, Commisso K, Mamedov A, Musunuru H, Davidson M, Mills T, Warner A, Loblaw D. Extreme Hypofractionation for High Risk Prostate Cancer: Dosimetric Correlations With Rectal Bleeding. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Laba J, Senan S, Schellenberg D, Harrow S, Mulroy L, Senthi S, Swaminath A, Kopek N, Pantarotto J, Pan L, Pearce A, Warner A, Louie A, Palma D. Identifying Barriers to Accrual in Radiation Oncology Randomized Trials: Insights From a Trial of Stereotactic Radiation for Oligometastatic Disease. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Corkum M, Liu W, Palma D, Dinniwell R, Bauman G, Warner A, Mishra M, Louie A. Online Advertising and Marketing Claims by Providers of Proton Beam Therapy: Are They Guideline Based? Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Siva S, Muacevic A, Staehler M, Warner A, Gandhidasan S, Ponsky L, Ellis R, Kaplan I, Mahadevan A, Chu W, Onishi H, Lo S, Teh B, Swaminath A, Correa R, Louie A. Individual Patient Data Meta-analysis of SBRT Kidney: A Report From the International Radiosurgery Oncology Consortium for Kidney (IROCK). Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Egner W, Cook T, Harper N, Garcez T, Marinho S, Kong KL, Nasser S, Thomas M, Warner A, Hitchman J, Floss K. Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project. Clin Exp Allergy 2017; 47:1318-1330. [DOI: 10.1111/cea.12993] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 07/14/2017] [Indexed: 11/27/2022]
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Chen H, Senan S, Nossent E, Boldt G, Warner A, Palma D, Louie A. Treatment-Related Toxicity in Patients with Early Stage Non–Small Cell Lung Cancer and Co-Existing Interstitial Lung Disease: A Systematic Review. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.01.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loblaw A, Pickles T, Crook J, Martin AG, Vigneault E, Souhami L, Cury F, Morris J, Catton C, Lukka H, Cheung P, Sethukavalan P, Warner A, Yang Y, Rodrigues G. Stereotactic Ablative Radiotherapy Versus Low Dose Rate Brachytherapy or External Beam Radiotherapy: Propensity Score Matched Analyses of Canadian Data. Clin Oncol (R Coll Radiol) 2017; 29:161-170. [DOI: 10.1016/j.clon.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/25/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023]
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Helou J, Thibault I, Chu W, Munoz P, Erler D, Rodrigues G, Warner A, Chan K, Chow E, Korol R, Davidson M, Chung H. Acute Quality of Life Changes After Stereotactic Ablative Radiation Therapy for Liver Metastasis: A Prospective Cohort Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Louie A, Chen H, Van Werkhoven E, Smit E, Palma D, Paul M, Warner A, Widder J, Groen H, van Den Borne B, De Jaeger K, Rodrigues G, Slotman B, Senan S. Quality of Life Following Stereotactic Ablative Radiation Therapy Versus Surgery for Early-Stage Lung Cancer: Results From the ROSEL Randomized Controlled Trial and a Systematic Review. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.040] [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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Humphreys J, Warner A, Verstappen S, Lunt M, Dixon W. THU0078 Moderate Alcohol Consumption Is Not Associated with Serum Liver Abnormalities in Patients with Rheumatoid Arthritis Taking Methotrexate: Data from The Clinical Practice Research Database (CPRD):. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tekatli H, Tetar S, Warner A, Palma D, Verbakel W, Nguyen T, Spoelstra F, Gaede S, Slotman B, Senan S. 197PD: Identifying dosimetric predictors of toxicity in multiple lung tumors treated with stereotactic ablative radiotherapy (SABR). J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rodrigues G, Wang T, Warner A, Pickles T, Crook J, Martin A, Vigneault E, Cury F, Souhami L, Morris W, Catton C, Lukka H. Post–Biochemical Failure Risk Stratification to Predict Survival in Prostate Cancer: A Recursive Partitioning Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Palma D, Senan S, Warner A, Louie A, Slotman B, Rodrigues G. The Impact of Thoracic Radiation Therapy on Survival in Extensive-Stage Small Cell Lung Cancer: A Meta-Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nguyen T, Goodman C, Boldt G, Warner A, Palma D, Rodrigues G, Lock M, Mishra M, Zaric G, Louie A. A Systematic Review of Health Economic Evaluations in Radiation Oncology. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yeung T, Rodrigues G, Lagerwaard F, Palacios M, Bohoudi O, Bruynzeel A, Mattonen S, Warner A, Johnson C, Ward A. Prediction of Stereotactic Radiosurgery Brain Metastasis Lesion Control Using Radiomic Features. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vaziri ND, Barton CH, Warner A, Toohey J, Lintner C, Hung E, Mullin P, Samiminia B, O'Donnell M, Mallot K. Comparison of four dialyzer-dialysate combinations: effects on blood gases, cell counts, complement contact factors and fibrinolytic system. CONTRIBUTIONS TO NEPHROLOGY 2015; 37:111-9. [PMID: 6713863 DOI: 10.1159/000408560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Humphreys JH, Warner A, Chipping J, Marshall T, Lunt M, Symmons DPM, Verstappen SMM. Mortality trends in patients with early rheumatoid arthritis over 20 years: results from the Norfolk Arthritis Register. Arthritis Care Res (Hoboken) 2014; 66:1296-301. [PMID: 24497371 PMCID: PMC4226330 DOI: 10.1002/acr.22296] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/28/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine mortality rates in UK patients with early rheumatoid arthritis (RA) from 1990-2011 and compare with population trends. METHODS The Norfolk Arthritis Register (NOAR) recruited adults with ≥2 swollen joints for ≥4 weeks: cohort 1 (1990-1994), cohort 2 (1995-1999), and cohort 3 (2000-2004). At baseline, serum rheumatoid factor and anti-citrullinated protein antibody were measured and the 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria were applied. Patients were followed for 7 years, until emigration or death. The UK Office for National Statistics notified the NOAR of the date and cause of deaths, and provided mortality rates for the Norfolk population. All-cause and cardiovascular-specific standardized mortality ratios (SMRs) were calculated. Poisson regression was used to compare mortality rate ratios (MRRs) between cohorts and then, with cubic splines, to model rates by calendar year. Analyses were performed in patients 1) with early inflammatory arthritis, 2) classified as having RA, and 3) autoantibody positive. RESULTS A total of 2,517 patients were included, with 1,639 women (65%) and median age 55 years, and 1,419 (56%) fulfilled the 2010 RA criteria. All-cause and cardiovascular-specific SMRs were significantly elevated in the antibody-positive groups. There was no change in mortality rates over time after accounting for changes in the population rates. In RA patients, all-cause MRRs, compared to cohort 1, were 1.13 (95% confidence interval [95% CI] 0.84-1.52) and 1.00 (95% CI 0.70-1.43) in cohorts 2 and 3, respectively. CONCLUSION Mortality rates were increased in patients with RA and SMRs were particularly elevated in those who were autoantibody positive. Compared to the general population, mortality rates have not improved over the past 20 years.
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Rodrigues G, Senan S, Oberije C, Tsujino K, Wiersma T, Moreno-Jimenez M, Kim T, Marks L, Rengan R, De Petris L, Ramella S, DeRuyck K, Rodriguez De Dios N, Warner A, Bradley J, Palma D. Is Intermediate Radiation Dose Escalation With Concurrent Chemotherapy for Stage III Non-Small Cell Lung Cancer Beneficial?: A Multi-institutional Propensity-Score Matched Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chiang A, Thibault I, Rodrigues G, Palma D, Warner A, Poon I, Soliman H, Jain S, Cheung P. Accelerated Hypofractionation Versus Stereotactic Ablative Radiation Therapy (SABR) for Early-Stage Non-Small Cell Lung Cancer: Results of a Propensity Score–Matched Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Loblaw D, Pickles T, Crook J, Martin A, Vigneault E, Catton C, Lukka H, Cheung P, Sethukavalan P, Warner A, Yang Y, Rodrigues G. Stereotactic Ablative Radiation Therapy Versus Low-Dose-Rate Brachytherapy: A Propensity Matched Analysis of Canadian Data. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ashworth A, Senan S, Palma D, Riquet M, Ahn Y, Ricardi U, Congedo M, Gomez D, Wright G, Melloni G, Milano M, Sole C, De Pas T, Carter D, Warner A, Rodrigues G. An Individual Patient Data Meta-analysis of Outcomes and Prognostic Factors After Treatment of Oligometastatic Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Louie A, Rodrigues G, Haasbeek C, Warner A, Lagerwaard F, Palma D, Slotman B, Senan S. Predicting Survival following Stereotactic Ablative Radiotherapy in Early-Stage Lung Cancer: A Recursive Partitioning Analysis to Define Risk Groups. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoefig CS, Warner A, Vennström B, Mittag J. Elucidating the actions of 3-Iodothyroacetic acid in thermoregulation and cardiovascular function. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Casey S, Louie A, Rodrigues G, Palma D, Yaremko B, Dar A, Yu E, Aivas I, Warner A, Gaede S. The Impact of Respiratory Gating on Toxicity Outcomes for Locally-Advanced Lung Cancer Treated With Radical Intensity Modulated Radiation Therapy and Chemotherapy. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stark L, Warner A, Lehmann H, Boothby N, Ager A. Measuring the incidence and reporting of violence against women and girls in liberia using the 'neighborhood method'. Confl Health 2013; 7:20. [PMID: 24059598 PMCID: PMC3850791 DOI: 10.1186/1752-1505-7-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper reports on the use of a "neighborhood method" to measure the nature and incidence of violence against women and girls in post-conflict Liberia. METHODS The study population comprised females in Montserrado and Nimba counties. Study participants were randomly selected for interviews using multi-stage cluster sampling. 30 clusters of households were sampled in each county. Information on incidents of domestic violence and rape within the preceding 18 months was collected with regard to females of all ages in the respondent's household, and those of her four closest neighbors to make up the full sample. FINDINGS Households in the sample contained 7015 females (1687 girls, 4586 women, 742 age missing) in Montserrado and 6632 (2070 girls, 4167 women, 95 age missing) in Nimba. In the previous 18 months 54.1% (CI 53.1-55.1) and 55.8% (CI 54.8-56.8) of females in Montserrado and Nimba respectively were indicated to have experienced non-sexual domestic abuse; 19.4% (CI 18.6-20.2) and 26.0% (CI 25.1-26.9) of females in Montserrado and Nimba respectively to have been raped outside of marriage; and 72.3% (CI 70.7-73.9) and 73.8% (CI 72.0-75.7) of married or separated women in Montserrado and Nimba respectively to have experienced marital rape. Husbands and boyfriends were reported as the perpetrators of the vast majority of reported violence. Strangers were reported to account for less than 2% of the perpetrators of rape in either county. Incidents were most commonly disclosed to other family members or to friends and neighbors, and less often to formal authorities such as the police, court or community leaders. Incidents were approaching fifty times more likely to be reported to police if perpetrated by strangers rather than intimate partners. CONCLUSIONS Violence against women and girls is widespread in the areas studied. Programming needs to address the fact that this violence is primarily occurring in the household, where most incidents go unreported outside the immediate family or social circle. Police and hospital reports severely under-represent these known perpetrators. Inter-interviewer variance and differences in reports for self and neighbors for some outcomes caution the precision and validity of some estimates. However, the potential utility of the neighborhood method for estimating prevalence rates with an accuracy suitable for programmatic purposes in conflict-affected and post-conflict settings is noted.
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den Elzen W, Lefèbre–van de Fliert A, Virgini V, Mooijaart S, Frey P, Kearney P, Kerse N, Mallen C, McCarthy V, Muth C, Rosemann T, Russell A, Schers H, Stott D, de Waal M, Warner A, Westendorp R, Rodondi N, Gusekloo J. International variation in GP treatment strategies for subclinical hypothyroidism in older adults. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.482] [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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Bongers E, Botticella A, Palma D, Warner A, Haasbeek C, Verbakel W, Slotman B, Ricardi U, Senan S. 50O PREDICTORS FOR RADIATION PNEUMONITIS AFTER SABR FOR HIGH-RISK LUNG TUMORS. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Louie AV, Chan E, Hanna M, Bauman GS, Fisher BJ, Palma DA, Rodrigues GB, Warner A, D'Souza DP. Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine. ACTA ACUST UNITED AC 2013; 20:90-6. [PMID: 23559871 DOI: 10.3747/co.20.1260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive deficits from brain tumours may impair the ability to safely operate a motor vehicle. Although certain jurisdictions in Canada legally require that physicians report patients who are unfit to drive, criteria for determining fitness are not clearly defined for brain tumours. METHODS Patients receiving brain radiotherapy at our institution from January to June 2009 were identified using the Oncology Patient Information System. In addition to descriptive statistics, details of driving assessment were reviewed retrospectively. The Fisher exact test was used to determine factors predictive of reporting a patient to the Ontario Ministry of Transportation (mto) as unfit to drive. A logistic regression model was constructed to further determine factors predictive of reporting. RESULTS Of the 158 patients available for analysis, 48 (30%) were reported to the mto, and 64 (41%) were advised to stop driving. With respect to the 53 patients with seizures, a report was submitted to the mto for 30 (57%), and a documented discussion about the implications of driving was held with 35 (66%). On univariate analysis, younger age, a central nervous system primary, higher brain radiotherapy dose, unifocal disease, and the presence of seizures were predictive of physician reporting (p < 0.05). On logistic regression modelling, the presence of seizures (odds ratio: 3.9) and a higher radiotherapy dose (odds ratio: 1.3) remained predictive of reporting. INTERPRETATION Physicians frequently do not discuss the implications of driving with brain tumour patients or are not properly documenting such advice (or both). Clear and concise reporting guidelines need to be drafted given the legal, medical, and ethical concerns surrounding this public health issue.
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Verbakel W, Bongers E, Botticella A, Warner A, Palma D, Haasbeek C, Slotman B, Ricardi U, Senan S. PD-0095: Dosimetric parameters predictive for radiation pneumonitis after SABR for high-risk lung tumors. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32401-4] [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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87
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Verstegen NE, Oosterhuis JWA, Palma DA, Rodrigues G, Lagerwaard FJ, van der Elst A, Mollema R, van Tets WF, Warner A, Joosten JJA, Amir MI, Haasbeek CJA, Smit EF, Slotman BJ, Senan S. Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis. Ann Oncol 2013; 24:1543-8. [PMID: 23425947 DOI: 10.1093/annonc/mdt026] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic ablative radiotherapy (SABR) are both used for early-stage non-small-cell lung cancer. We carried out a propensity score-matched analysis to compare locoregional control (LRC). PATIENTS AND METHODS VATS lobectomy data from six hospitals were retrospectively accessed; SABR data were obtained from a single institution database. Patients were matched using propensity scores based on cTNM stage, age, gender, Charlson comorbidity score, lung function and performance score. Eighty-six VATS and 527 SABR patients were matched blinded to outcome (1:1 ratio, caliper distance 0.025). Locoregional failure was defined as recurrence in/adjacent to the planning target volume/surgical margins, ipsilateral hilum or mediastinum. Recurrences were either biopsy-confirmed or had to be PET-positive and reviewed by a tumor board. RESULTS The matched cohort consisted of 64 SABR and 64 VATS patients with the median follow-up of 30 and 16 months, respectively. Post-SABR LRC rates were superior at 1 and 3 years (96.8% and 93.3% versus 86.9% and 82.6%, respectively, P = 0.04). Distant recurrences and overall survival (OS) were not significantly different. CONCLUSION This retrospective analysis found a superior LRC after SABR compared with VATS lobectomy, but OS did not differ. Our findings support the need to compare both treatments in a randomized, controlled trial.
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Murphy M, Samms R, Warner A, Bolborea M, Barrett P, Fowler MJ, Brameld JM, Tsintzas K, Kharitonenkov A, Adams AC, Coskun T, Ebling FJP. Increased responses to the actions of fibroblast growth factor 21 on energy balance and body weight in a seasonal model of adiposity. J Neuroendocrinol 2013; 25:180-9. [PMID: 22958332 DOI: 10.1111/j.1365-2826.2012.02383.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/24/2012] [Accepted: 09/02/2012] [Indexed: 12/17/2022]
Abstract
The present study aimed to investigate the actions of fibroblast growth factor 21 (FGF21) on energy balance in a natural model of relative fatness, the Siberian hamster. Hamsters were studied under long days (LD) to promote weight gain, or short days to induce weight loss, and treated with rhFGF21 (3 mg/kg/day) via s.c. minipumps for 14 days. On days 7-9, detailed assessments of ingestive behaviour, metabolic gas exchange and locomotor activity were made. FGF21 caused substantial (P < 0.0001) weight loss in the fat LD state but not in the lean SD state: at the end of the study, FGF21-treated hamsters in LD lost 18% of body weight compared to vehicle controls, which is comparable to the natural body weight loss observed in SD. Epididymal fat pads, a correlate of total carcass fat content, were reduced by 19% in FGF21 treated hamsters in LD, whereas no difference was found in SD. Body weight loss in LD was associated with a reduction in food intake (P < 0.001) and a decreased respiratory exchange ratio (P < 0.001), indicating increased fat oxidation. Treatment with FGF21 maintained the normal nocturnal increase in oxygen consumption and carbon dioxide production into the early light phase in hamsters in LD, indicating increased energy expenditure, although locomotor activity was unaffected. These data suggest a greater efficacy of FGF21 in hamsters in LD compared to those in SD, which is consistent with both the peripheral and possibly central actions of FGF21 with respect to promoting a lean phenotype. The observed differences in FGF21 sensitivity may relate to day length-induced changes in adipose tissue mass.
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Lee-Rife S, Malhotra A, Warner A, Glinski AM. What Works to Prevent Child Marriage: A Review of the Evidence. Stud Fam Plann 2012; 43:287-303. [DOI: 10.1111/j.1728-4465.2012.00327.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Louie A, Lane S, Palma D, Warner A, Cao J, Rodrigues G. Radiation Therapy for Intubated Patients With Malignant Airway Obstruction: Futile or Facilitating Extubation? Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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91
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Senan S, Verstegen N, Palma D, Rodrigues G, Lagerwaard F, van der Elst A, Mollema R, Warner A, Slotman B, Oosterhuis J. Patterns of Disease Recurrence Following Either Stereotactic Ablative Radiation Therapy (SABR) or Lobectomy by Video-assisted Thoracoscopic Surgery (VATS) in Stage I-II Non-small Cell Lung Cancer: Outcomes of a Propensity Score-matched Analysis. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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92
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Casey S, Louie A, Rodrigues G, Palma D, Yaremko B, Dar A, Yu E, Aivas I, Warner A, Gaede S. Impact of Respiratory Gating on Toxicity Outcomes for Locally Advanced Lung Cancer Treated With Radical Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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93
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Sumner T, Hetherington J, Seymour RM, Li L, Varela Rey M, Yamaji S, Saffrey P, Margoninski O, Bogle IDL, Finkelstein A, Warner A. A composite computational model of liver glucose homeostasis. II. Exploring system behaviour. J R Soc Interface 2012; 9:701-6. [PMID: 22319112 DOI: 10.1098/rsif.2011.0783] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Using a composite model of the glucose homeostasis system, consisting of seven interconnected submodels, we enumerate the possible behaviours of the model in response to variation of liver insulin sensitivity and dietary glucose variability. The model can reproduce published experimental manipulations of the glucose homeostasis system and clearly illustrates several important properties of glucose homeostasis-boundedness in model parameters of the region of efficient homeostasis, existence of an insulin sensitivity that allows effective homeostatic control and the importance of transient and oscillatory behaviour in characterizing homeostatic failure. Bifurcation analysis shows that the appearance of a stable limit cycle can be identified.
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Ogden J, Gupta GR, Fisher WF, Warner A. Looking back, moving forward: Towards a game-changing response to AIDS. Glob Public Health 2011; 6 Suppl 3:S285-92. [DOI: 10.1080/17441692.2011.621966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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95
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Gupta GR, Ogden J, Warner A. Moving forward on women's gender-related HIV vulnerability: the good news, the bad news and what to do about it. Glob Public Health 2011; 6 Suppl 3:S370-82. [PMID: 22011135 DOI: 10.1080/17441692.2011.617381] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The global response to AIDS has triggered unprecedented attention to gender inequality and the role it plays in shaping the vulnerability of women. Tragically, however, this attention has not yet led to wide-scale transformations in gender roles, or reductions in gender-related risk. This paper reviews both knowledge and action on the impact of gender inequality on women in the context of HIV prevention, and argues that, while much is known, and while effective strategies do exist, impact on a population level will not be achieved unless gender considerations are integrated into an evidence-informed comprehensive national strategy. Such a strategy must be implemented by national governments within an enabling policy and legal environment for change; be driven and owned as much as possible, by communities who are empowered with skills and resources to put their own ideas and capabilities into action; and include people living with HIV as equal partners.
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Abstract
Individual behaviour change interventions and technological approaches to HIV prevention can only be effective over time if the broader social environment in which health-related decisions are made facilitate their uptake. People need to be not only willing but also able to take up and maintain preventive behaviours, seek testing, treatment and care for HIV. This paper presents findings and recommendations of the Social Drivers Working Group of the aids2031 initiative, which focus on how to ensure that efforts to address the root causes of HIV vulnerability are integrated into AIDS responses at the national level. Specific guidance is given on how to operationalise a structural approach.
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Hetherington J, Sumner T, Seymour RM, Li L, Rey MV, Yamaji S, Saffrey P, Margoninski O, Bogle IDL, Finkelstein A, Warner A. A composite computational model of liver glucose homeostasis. I. Building the composite model. J R Soc Interface 2011; 9:689-700. [PMID: 21676967 DOI: 10.1098/rsif.2011.0141] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A computational model of the glucagon/insulin-driven liver glucohomeostasis function, focusing on the buffering of glucose into glycogen, has been developed. The model exemplifies an 'engineering' approach to modelling in systems biology, and was produced by linking together seven component models of separate aspects of the physiology. The component models use a variety of modelling paradigms and degrees of simplification. Model parameters were determined by an iterative hybrid of fitting to high-scale physiological data, and determination from small-scale in vitro experiments or molecular biological techniques. The component models were not originally designed for inclusion within such a composite model, but were integrated, with modification, using our published modelling software and computational frameworks. This approach facilitates the development of large and complex composite models, although, inevitably, some compromises must be made when composing the individual models. Composite models of this form have not previously been demonstrated.
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Jethwa PH, Warner A, Fowler MJ, Murphy M, de Backer MW, Adan RAH, Barrett P, Brameld JM, Ebling FJP. Short-days induce weight loss in Siberian hamsters despite overexpression of the agouti-related peptide gene. J Neuroendocrinol 2010; 22:564-75. [PMID: 20367758 DOI: 10.1111/j.1365-2826.2010.02001.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many vertebrates express profound annual cycles of body fattening, although it is not clear whether these represent differential activity of the central pathways known to mediate homeostatic control of food intake and energy expenditure, or whether the recent discovery of a major role for pars tuberalis-ependymal signalling points towards novel mechanisms. We examined this in the Siberian hamster (Phodopus sungorus) by using gene transfection to up-regulate a major orexigenic peptide, agouti-related peptide (AgRP), and then determined whether this increased anabolic drive could prevent the short-day induced winter catabolic state. Infusions of a recombinant adeno-associated virus encoding an AgRP construct into the hypothalamus of hamsters in the long-day obese phase of their seasonal cycle produced a 20% gain in body weight over 6 weeks compared to hamsters receiving a control reporter construct, reflecting a significant increase in food intake and a significant decrease in energy expenditure. However, all hamsters showed a significant, prolonged decrease in body weight when exposed to short photoperiods, despite the hamsters expressing the AgRP construct maintaining a higher food intake and lower energy expenditure relative to the control hamsters. Visualisation of the green fluorescent protein reporter and analysis of AgRP-immunoreactivity confirmed widespread expression of the construct in the hypothalamus, which was maintained for the 21-week duration of the study. In conclusion, the over-expression of AgRP in the hypothalamus produced a profoundly obese state but did not block the seasonal catabolic response, suggesting a separation of rheostatic mechanisms in seasonality from those maintaining homeostasis of energy metabolism.
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Ladenson PW, McCarren M, Morkin E, Edson RG, Shih MC, Warren SR, Barnhill JG, Churby L, Thai H, O'Brien T, Anand I, Warner A, Hattler B, Dunlap M, Erikson J, Goldman S. Effects of the thyromimetic agent diiodothyropropionic acid on body weight, body mass index, and serum lipoproteins: a pilot prospective, randomized, controlled study. J Clin Endocrinol Metab 2010; 95:1349-54. [PMID: 20080837 DOI: 10.1210/jc.2009-1209] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Widespread thyroid hormone actions offer the possibility of developing selective thyromimetic analogs with salutary metabolic properties. Consequently, effects of diiodothyropropionic acid (DITPA) on body weight, serum lipoproteins, and bone metabolism markers were studied in a prospective, controlled, double-blind 24-wk trial, which was primarily designed to assess treatment of stable chronic heart failure. DESIGN Eighty-six patients (aged 66 +/- 11 yr, mean +/- sd) were randomized (1:2) to placebo or an escalating DITPA dose (90 to 180, 270, and 360 mg/d) over 8 wk until serum TSH was less than 0.02 mU/liter. Patients were studied at 2, 4, 6, 8, 16, and 24 wk and after 4 wk off study drug. Only 21 DITPA-treated and 27 placebo patients completed the full 24 wk of therapy. RESULTS DITPA therapy lowered serum TSH levels and, to a lesser extent, serum T(3) and T(4), but there were no differences in clinical manifestations of thyrotoxicosis or hypothyroidism. Serum total and low-density lipoprotein cholesterol levels both decreased on DITPA; there was a transient decrease in triglycerides and no change in high-density lipoprotein cholesterol. DITPA therapy was associated with significant reduction in body weight, 12.5 lb at 24 wk. Increases in serum osteocalcin, N-telopeptide, and deoxypyridinoline levels were consistent with increased bone turnover on DITPA. CONCLUSION This investigation of DITPA actions demonstrated its efficacy in reducing body weight and lowering total and low-density lipoprotein cholesterol levels. However, DITPA's adverse effects at doses used resulted in a high dropout rate and potentially dangerous skeletal actions were observed.
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Munne S, Fischer J, Escudero T, Warner A, Colls P, Cohen J. New recommendations for male factor and repeated pregnancy loss patients who are considering IVF and are at risk of having translocations. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.07.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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