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Ziegler C, Slemons I, DeSilva C, Witkowski B, Mir A, Anandakrishnan S, Farmer A, Contreras E, Richardson D, Vranic S, Gatalica Z, Derkach DN. Abstract B094: Novel method for patient stratification in breast carcinoma based upon spatial analysis of tumor microenvironment. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-b094] [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
Breast cancer consists of several intrinsic molecular subtypes, providing the basis for clinical treatment decisions. Lately, it is becoming increasingly recognized that factors other than the intrinsic cancer characteristics, such as immune components’ activity in the tumor microenvironment, have important effects on treatment choices and efficacy. bioSyntagma has developed a method, the Molecular Fingerprint (mPrint®), that enables multiplexed analysis of spatially defined regions in formalin-fixed, paraffin-embedded (FFPE) tumor samples allowing for analysis of the gene signatures unique to the tumor microenvironment. This method was applied to molecularly defined sets of breast cancers and used to evaluate four different tumor regions of interest (ROIs): 1) viable carcinoma proper (>90% cancer cells), 2) fibrotic tumor center (sparse cellularity), 3) interface between viable tumor and inflammatory component (tumor and inflammatory microenvironment) and 4) tissue away from the tumor (normal breast tissue). This was compared to the whole tissue scrapes from each patient block. Each ROI and tissue scrape was analyzed by high throughput qPCR for a panel of 248 genes using SmartChip technology (Takara Bio, USA). Sequential tissue slices from each patient were also analyzed using immunohistochemistry (IHC) for three targets and investigated for correlation with qPCR results for validation of the method. Overall, reasonable concordance was observed in general expression trends between selected IHC and RNA expression. qPCR data were further analyzed using hierarchical clustering analysis and showed that morphologically defined ROI’s cluster completely differently than traditional clustering of entire tissue scrapes. Notably, patient clustering based on morphological regions was independent of the intrinsic cancer subtype, as determined by molecular profiling of whole tissue scrapes, as well as independent of trends in Tumor Mutational Burden (TMB) and Microsatellite Instability (MSI). These findings suggest that current methods of patient stratification based on whole tumor molecular subtyping may be inferior to stratification based on molecular characteristics of the tumor microenvironment.
Citation Format: Colleen Ziegler, Isaiah Slemons, Chris DeSilva, Barbara Witkowski, Alain Mir, Sangeetha Anandakrishnan, Andrew Farmer, Elma Contreras, David Richardson, Semir Vranic, Zoran Gatalica, Dmitry N. Derkach. Novel method for patient stratification in breast carcinoma based upon spatial analysis of tumor microenvironment [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B094. doi:10.1158/1535-7163.TARG-19-B094
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Appelhans BM, French SA, Bradley LE, Lui K, Janssen I, Richardson D. CHECK: A randomized trial evaluating the efficacy and cost-effectiveness of home visitation in pediatric weight loss treatment. Contemp Clin Trials 2019; 88:105891. [PMID: 31740429 DOI: 10.1016/j.cct.2019.105891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Socioeconomically-disadvantaged households have a high prevalence of pediatric overweight/obesity, and also face barriers to accessing weight loss treatment in healthcare settings. Delivering family-based pediatric weight loss treatment in the home setting may enhance its efficacy by facilitating treatment attendance, enabling more tailored treatment recommendations informed by observations of the home environment, and increasing accountability. This paper describes the design of the Creating Health Environments for Chicago Kids (CHECK) Trial, which evaluates the efficacy, cost-effectiveness, and mechanisms of home visitation in family-based pediatric weight loss treatment for children in low-income households. DESIGN CHECK is a two-arm, parallel group, randomized controlled trial that is enrolling N = 266 children, ages 6-12 y, who have overweight/obesity (BMI percentile ≥85) and live in a low-income household. Participants are randomized in a 1:1 ratio to either standard of care family-based weight loss treatment delivered in the home, or the identical intervention delivered in an academic medical center. The primary outcome is change in child BMI z-score from baseline to 12 months. Program delivery costs are rigorously documented to enable cost-effectiveness analyses from the societal and payer perspectives. Objectively-documented changes to the home environment and aspects of intervention delivery (e.g., hours of in-person contact received, quantity of behavioral goals set per session) will be tested as hypothesized treatment mechanisms. IMPLICATIONS Findings will inform the design of future interventions, and treatment dissemination decisions by public health agencies and third-party payers. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03195790.
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Jamal A, Coleman B, Johnstone J, Katz K, Muller MP, Patel S, Melano R, Rebbapragada A, Richardson D, Sarabia A, Mubareka S, Poutanen S, Zhong Z, Kohler P, McGeer A. 512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE? Open Forum Infect Dis 2019. [PMCID: PMC6810994 DOI: 10.1093/ofid/ofz360.581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Though CPE in Canada are mainly acquired abroad, outbreaks/transmission in Canadian hospitals have been reported. We determined the incidence of HA CPE in southern Ontario, Canada, to inform prevention and control programs. Methods Toronto Invasive Bacterial Diseases Network (TIBDN) has performed population-based surveillance for CPE in the Toronto area/Peel region of southern Ontario, Canada, since CPE were first identified in October 2007. Clinical microbiology laboratories report all CPE isolates to TIBDN; annual lab audits are performed. Incidence calculations used first isolates as numerator; denominator (patient-days/fiscal year for Toronto/Peel hospitals) was from the Ontario Ministry of Health and Long-Term Care. Results The incidence of HA CPE has risen from 0 in 2007/2008 to 0.45 and 0.28 per 100,000 patient-days for all and clinical cases, respectively, in 2017/2018 (Figure, P < 0.0001). 190/790 (24%) incident cases of CPE colonization/infection in southern Ontario from October 2007 to December 2018 were likely HA (hospitalized in Ontario with no history of hospitalization abroad/high-risk travel). Eighty (25%) were female and the median age was 73 years (IQR 57–83 years). 157 (83%) had no prior travel abroad and 33 (17%) had prior low-risk travel. 122 (64%) had their CPE identified >72 hours post-admission (of which 83 also had ≥1 other prior Ontario hospitalization); 68 (36%) had their CPE identified at admission but had recent prior Ontario hospitalization. HA cases vs. foreign acquisitions were significantly more likely K. pneumoniae (48% vs. 38%, P = 0.02) and Enterobacter spp. (20% vs. 7%, P < 0.0001) and less likely E. coli (20% vs. 48%, P < 0.0001). Genes of HA vs. foreign acquisitions were significantly more likely blaKPC (34% vs. 12%, P < 0.0001) and blaVIM (12% vs. 2%, P < 0.0001) and less likely blaNDM±OXA (38% vs. 56%, P < 0.0001) and blaOXA (13% vs. 27%, P = 0.0001). 36 (19%) HA cases had a negative CPE screen before their first positive CPE test (10/36 (28%) were on admission). The median incidence of HA CPE per 100,000 patient-days at each hospital was 0.44 (IQR 0.15–0.68) (P < 0.0001). Conclusion A quarter of CPE cases in southern Ontario were HA and the incidence of HA cases is increasing. Most cases were admitted to >1 Ontario hospital. Strategies to control transmission are critical. ![]()
Disclosures All authors: No reported disclosures.
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McGeer A, Plevneshi A, Green K, Coleman B, Nayani S, Rudnick W, Simor A, Gold W, Katz K, Kitai I, Johnstone J, Martin I, Muller MP, Richardson D, Sarabia A. 2716. Persistence of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Serotypes in Invasive Pneumococcal Disease in Adults in Southern Ontario Canada Despite Routine Pediatric Vaccination. Open Forum Infect Dis 2019. [PMCID: PMC6809886 DOI: 10.1093/ofid/ofz360.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In Ontario, Canada, PCV13 is covered for immunocompromised (IC) adults over 50y. PCV13 programs are thought not to be cost-effective in other adults because it is assumed that herd immunity from pediatric vaccination programs (PCV7 since 2005; PCV13 since 2010) will reduce PCV13 disease burden dramatically in adults. We analyzed data from the Toronto Invasive Bacterial Diseases Network (TIBDN) to ask whether PCV13-type invasive pneumococcal disease (IPD) in adults persists in our population. Methods TIBDN performs population-based surveillance for IPD in Toronto+Peel Region, Ontario (pop4.1M). All microbiology laboratories receiving specimens from residents report cases of IPD and submit isolates to a central study lab for serotyping; annual audits are conducted. Demographic, medical and vaccination information are obtained from patients, families and physicians. Population data are from Statistics Canada. Results Since 1995, 10,365 episodes of IPD have been identified; detailed medical information was available for 9,801 (95%) and serotyping for 9411 (91%). Among 8658 adult cases, 4,273 (49%) were in those aged 15–64 years, and 4,285 (51%) in those aged >645 years. The most common diagnoses were pneumonia (5,978/8,025, 74%) and bacteremia without focus (1,030, 13%); 470 (4.6%) cases had meningitis; the case fatality rate (CFR) was 21%. The incidence of disease due to STs in PCV13 in adults declined from 7.0/100,000/year 2001 to 2.9/100,000/year in 2015–2018 and was stable from 2015–2018 (Figure 1). The incidence was > 5/100,000/year in non-IC patients over 65 years, and younger patients with cancer and kidney disease (Figure 2). In IPD from 2015 to 2018, adult patients with PCV13 ST disease were younger (median age 64 years vs. 67 years, P = .03) than other patients; there was no significant difference in the proportion with at least one underlying chronic condition (253, 69% PCV13ST, vs. 541,74% other ST, P = 0.08), or in CFR (59, 16% PCV13 vs. 145, 20% other, P = 0.13). The ST distribution of cases due to PCV13 STs is shown in Figure 3. Conclusion A significant burden of IPD due to PCV13 serotypes persists in adults in our population despite 8 years of routine pediatric PCV13 vaccination. This burden needs to be considered in assessing the value and cost-effectiveness of PCV programs for adults. ![]()
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Disclosures All authors: No reported disclosures.
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Faheem A, Jamal A, Kazi H, Coleman B, Farooqi L, Johnstone J, Katz K, Li A, Melano R, Mubareka S, Muller MP, Patel S, Paterson A, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Zhong Z, McGeer A. 501. Risk of Infection in Persons Colonized with Carbapenemase-Producing Enterobacteriales (CPE) in Ontario, Canada. Open Forum Infect Dis 2019. [PMCID: PMC6811180 DOI: 10.1093/ofid/ofz360.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to assess the risk of subsequent infection among patients colonized by CPE. Methods The Toronto Invasive Bacterial Diseases Network (TIBDN) has conducted population-based surveillance for CPE colonization/infection in Toronto and Peel region, Ontario, Canada, since CPE were first identified (2007). All laboratories report all CPE isolates to TIBDN. Clinical data are collected via patient interview and hospital chart review. Initially colonized patients are followed for 5y; subsequent CPE infection is defined as an episode with onset >3 days after initial detection of CPE colonization that meets National Healthcare Safety Network criteria for infection with a clinical isolate of CPE. Results From 2007 to 2018, 790 persons with CPE colonization/infection were identified. Among 364 cases colonized at identification, 42 (12%) subsequently had at least one clinical isolate, and 23 (6%) had an infection: 8 with bacteremia (primary or secondary), 7 UTI, 5 pneumonia, and 3 other. The median time from identification of colonization to infection was 21 days (IQR 7–38), with a probability of developing an infection of 7% at 3 months, and 18% by 3 years (figure). In 305 cases with data available to date, older persons, those admitted to the ICU, and those with current/recent invasive medical devices were more likely to develop infection (table). Gender, underlying conditions and other procedures were not associated with risk of infection. There was a trend to infections being more likely in patients colonized with K. pneumoniae (52% vs. 35%, P = 0.13). Conclusion The risk of subsequent infection in our cohort was 18%, with highest risk in the first 3 months; most infections occurred in patients requiring intensive care unit admission and invasive medical devices. ![]()
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Disclosures All authors: No reported disclosures.
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Mulpuru S, Li L, Ye L, Hatchette T, Andrew MK, Ambrose A, Boivin G, Bowie W, Chit A, Dos Santos G, ElSherif M, Green K, Haguinet F, Halperin SA, Ibarguchi B, Johnstone J, Katz K, Langley JM, LeBlanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Powis J, Richardson D, Semret M, Shinde V, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA. Effectiveness of Influenza Vaccination on Hospitalizations and Risk Factors for Severe Outcomes in Hospitalized Patients With COPD. Chest 2019; 155:69-78. [PMID: 30616737 DOI: 10.1016/j.chest.2018.10.044] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effectiveness of influenza vaccination in reducing influenza-related hospitalizations among patients with COPD is not well described, and influenza vaccination uptake remains suboptimal. METHODS Data were analyzed from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. The primary outcome was an influenza-related hospitalization. We identified influenza-positive cases and negative control subjects and used multivariable logistic regression with a standard test-negative design to estimate the vaccine effectiveness for preventing influenza-related hospitalizations. RESULTS Among 4,755 hospitalized patients with COPD, 4,198 (88.3%) patients with known vaccination status were analyzed. The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals. Influenza-positive patients (n = 1,833 [38.5%]) experienced higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) compared with influenza-negative patients. Risk factors for mortality in influenza-positive patients included age > 75 years (OR, 3.7 [95% CI, 0.4-30.3]), cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]), residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]). CONCLUSIONS Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD. Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population. TRIAL REGISTRY ClinicalTrials.govNo.:NCT01517191; URL www.clinicaltrials.gov.
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Mazurek KA, Richardson D, Abraham N, Foxe JJ, Freedman EG. Utilizing High-Density Electroencephalography and Motion Capture Technology to Characterize Sensorimotor Integration While Performing Complex Actions. IEEE Trans Neural Syst Rehabil Eng 2019; 28:287-296. [PMID: 31567095 DOI: 10.1109/tnsre.2019.2941574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Studies of sensorimotor integration often use sensory stimuli that require a simple motor response, such as a reach or a grasp. Recent advances in neural recording techniques, motion capture technologies, and time-synchronization methods enable studying sensorimotor integration using more complex sensory stimuli and performed actions. Here, we demonstrate that prehensile actions that require using complex sensory instructions for manipulating different objects can be characterized using high-density electroencephalography and motion capture systems. In 20 participants, we presented stimuli in different sensory modalities (visual, auditory) containing different contextual information about the object with which to interact. Neural signals recorded near motor cortex and posterior parietal cortex discharged based on both the instruction delivered and object manipulated. Additionally, kinematics of the wrist movements could be discriminated between participants. These findings demonstrate a proof-of-concept behavioral paradigm for studying sensorimotor integration of multidimensional sensory stimuli to perform complex movements. The designed framework will prove vital for studying neural control of movements in clinical populations in which sensorimotor integration is impaired due to information no longer being communicated correctly between brain regions (e.g. stroke). Such a framework is the first step towards developing a neural rehabilitative system for restoring function more effectively.
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O'Malley D, Richardson D, Vergote I, Gilbert L, Martin L, Mantia-Smaldone G, Castro C, Provencher D, Matulonis U, Malek K, Moore K. Mirvetuximab soravtansine, a folate receptor alpha (FRa)-targeting antibody-drug conjugate (ADC), in combination with carboplatin and bevacizumab: Initial results from a phase Ib study in patients (pts) with ovarian cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fitzpatrick C, Lowe M, Richardson D. In response to Saunders et al RE: STI testing and rates in MSM using PrEP. HIV Med 2019; 20:e17. [DOI: 10.1111/hiv.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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85
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Harduar Morano L, Richardson D, Proescholdbell S. Descriptive evaluation of methods for identifying work-related emergency department injury visits. Am J Ind Med 2019; 62:568-579. [PMID: 31104330 DOI: 10.1002/ajim.22984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/13/2019] [Accepted: 04/17/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of worker's compensation (WC) as payer underestimates work-related (WR) injuries. We evaluated three methods to identify WR injuries: WC as payer, ICD-9-CM work-status codes E000.0/E000.1, and other ICD-9-CM external cause codes. METHODS We identified injury-related emergency department visits from North Carolina's syndromic surveillance system (2010-2013). Characteristics were compared by indicator. We manually reviewed 800 admission notes to confirm if the visit was WR or non-WR; WR keywords from the review were applied to all visits. RESULTS 133 156 injury-related visits (age, 16 years or older) were identified: WC = 69%, work-status codes = 18%, other ICD-9-CM codes = 13%. Among manually reviewed visits: few visits identified by WC (0.3%) or work-status codes (2%) were non-WR, while 12% of other ICD-9-CM code identified visits were non-WR; 53%, 46%, and 31% of visits identified by WC, work-status codes, and other ICD-9-CM codes were WR, respectively. CONCLUSIONS Findings support use of WC and work-status codes to capture WR injuries; other ICD-9-CM codes should be used with caution or in combination with other indicators.
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Bolyard SC, Reinhart DR, Richardson D. Conventional and fourier transform infrared characterization of waste and leachate during municipal solid waste stabilization. CHEMOSPHERE 2019; 227:34-42. [PMID: 30981968 DOI: 10.1016/j.chemosphere.2019.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
Solid waste and leachate samples from bench-scale anaerobic bioreactors and flushing bioreactors (FBs), containing mature waste were characterized using Fourier Transform Infrared Spectroscopy (FTIR) to provide a better understanding of the changes in waste characteristics when waste transitions from mature to stabilized. Humic acid (HA) extracted from mature waste and waste removed from the FBs were characterized using FTIR and 13C nuclear magnetic resonance. FBs were operated under three different treatment scenarios (flushing with clean water, recirculation of leachate treated by chemical oxidation, and recirculation of leachate treated by chemical oxidation with waste aeration. FTIR spectra of FB waste and leachate supported the stabilization of waste that occurred after the additional treatment. There was a shift in the dominance of organic to inorganic functional groups when compared to changes in conventional parameters that aligned with published values on waste stability. HA extracted from the mature waste were dominated by aliphatic carbon and aromatic carbon was less intense. Treatment by flushing resulted in a decrease in aliphatic carbon and an increase in aromatic carbon. HA extracted from reactors with oxidized leachate recirculation and aeration decreased in aliphatic carbon content, with minimal change in aromatic carbon. Therefore, the additional treatment did not result in an increase in the reactivity potential of the HA which aligns with FTIR and principal component analysis. Results suggest that spectroscopic techniques could be used to assess the stability of waste samples as opposed to more time-consuming analyses.
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Hampton P, Richardson D, Brown S, Goodhead C, Montague K, Olivier P. Usability testing of MySkinSelfie: a mobile phone application for skin self-monitoring. Clin Exp Dermatol 2019; 45:73-78. [PMID: 31021009 DOI: 10.1111/ced.13995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2019] [Indexed: 12/01/2022]
Abstract
Teledermatology generally involves doctors taking images of patients; however, patients increasingly want to own or have easy access to their health data. MySkinSelfie ( http://myskinselfie.com) is a mobile phone application (app) designed to improve the quality, consistency and accessibility of patient-held photos, and was developed to give patients the ability to generate and hold their own skin images to help guide their skin care. This study assessed the usability of this app in a cohort of patients attending a National Health Service Dermatology clinic. Patients were asked to use the app but were not given specific tasks to achieve. Of the 102 patients recruited, 32 downloaded the app and registered an account, 21 took at least one photo (median 5, range 1-103) and 19 completed the usability questionnaire. The majority of questionnaire respondents found the app easy to use but were more neutral on whether it really helped them to manage their skin problem. MySkinSelfie has been shown to be easy to use. Self-monitoring of skin problems may be useful for a subset of patients, and this is likely to depend on diagnosis, age and other patient factors.
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Kohler PP, Melano RG, Patel SN, Shafinaz S, Faheem A, Coleman BL, Green K, Armstrong I, Almohri H, Borgia S, Borgundvaag E, Johnstone J, Katz K, Lam F, Muller MP, Powis J, Poutanen SM, Richardson D, Rebbapragada A, Sarabia A, Simor A, McGeer A. Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada 1. Emerg Infect Dis 2019; 24:1674-1682. [PMID: 30124197 PMCID: PMC6106407 DOI: 10.3201/eid2409.180164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We analyzed population-based surveillance data from the Toronto Invasive Bacterial Diseases Network to describe carbapenemase-producing Enterobacteriaceae (CPE) infections during 2007–2015 in south-central Ontario, Canada. We reviewed patients’ medical records and travel histories, analyzed microbiologic and clinical characteristics of CPE infections, and calculated incidence. Among 291 cases identified, New Delhi metallo-β-lactamase was the predominant carbapenemase (51%). The proportion of CPE-positive patients with prior admission to a hospital in Canada who had not received healthcare abroad or traveled to high-risk areas was 13% for patients with oxacillinase-48, 24% for patients with New Delhi metallo-β-lactamase, 55% for patients with Klebsiella pneumoniae carbapenemase, and 67% for patients with Verona integron-encoded metallo-β-lactamase. Incidence of CPE infection increased, reaching 0.33 cases/100,000 population in 2015. For a substantial proportion of patients, no healthcare abroad or high-risk travel could be established, suggesting CPE acquisition in Canada. Policy and practice changes are needed to mitigate nosocomial CPE transmission in hospitals in Canada.
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DeBono N, Kelly-Reif K, Richardson D, Keil A, Robinson W, Troester M, Marshall S. Mortality among autoworkers manufacturing electronics in Huntsville, Alabama. Am J Ind Med 2019; 62:282-295. [PMID: 30569473 DOI: 10.1002/ajim.22933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Workers raised concerns over suspected excesses of mortality at automotive electronics manufacturing facilities in Huntsville, Alabama. METHODS A study of 4396 UAW members ever-employed at Huntsville facilities between 1972 and 1993 was conducted with mortality follow-up through 2016. Standardized Mortality Ratios (SMRs) were estimated using U.S. and Alabama reference rates. RESULTS Relative to U.S. rates, there was a modest excess of all-cause mortality among White female workers (SMR 1.08, 95%CI: 0.99-1.18) and among all workers hired <1977 at the original plant building (SMR 1.10, 95%CI: 0.99-1.22). There was excess nervous system disorder (SMR 1.24, 95%CI: 0.91-1.65) and brain and nervous system cancer (SMR 1.31, 95%CI: 0.67-2.28) mortality. Estimates for several causes of interest were imprecise. CONCLUSIONS All-cause mortality estimates were greater than anticipated based on results from other UAW cohorts. The excess of nervous system disease mortality is consistent with other studies of electronics workers exposed to lead-solder and chlorinated solvents.
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DeBono N, Richardson D, Keil A, Kelly-Reif K, Robinson W, Troester M, Marshall S. Employment characteristics and cause-specific mortality at automotive electronics manufacturing plants in Huntsville, Alabama. Am J Ind Med 2019; 62:296-308. [PMID: 30791109 DOI: 10.1002/ajim.22963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study was carried out in response to worker concerns over their exposure to lead solder and chlorinated solvents at automotive electronics manufacturing plants in Huntsville, Alabama. METHODS A study of 4396 United Autoworkers members ever-employed at the plants between 1972 and 1993 was conducted with mortality follow-up through 2016. Poisson regression was used to estimate mortality rate ratios (RR) according to employment characteristics, including calendar period of employment. RESULTS Pre-1977 hires exhibited elevated adjusted rates of all-cause (RR, 1.29; 95% confidence interval [CI], 1.09-1.52), cardiovascular (RR, 1.38; 95% CI, 1.03-1.86), and digestive system (RR, 2.31; 95% CI, 1.04-5.10) disease mortality relative to the most recent hire group (1984-1993). Never- versus ever-employment in a skilled trade job was associated with elevated adjusted rates of all-cause, all-cancer, and cardiovascular disease mortality. Nervous system disorder mortality was greatest among 1977-1983 hires. CONCLUSIONS Elevated mortality among pre-1977 hires is consistent with worker concerns over greater exposure to hazards at the original plant building.
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Williams D, Reicher I, Mohammed H, Richardson D. Secondary adrenal insufficiency from steroid use and co-prescribing of cytochrome p450 3A4 inhibitors. HIV Med 2019; 20:e10-e11. [PMID: 30924569 DOI: 10.1111/hiv.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fitzpatrick C, Lowe M, Richardson D. Sexually transmitted infection testing and rates in men who have sex with men (
MSM
) using
HIV
pre‐exposure prophylaxis. HIV Med 2019; 20:e12. [DOI: 10.1111/hiv.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Odom D, Mitra D, Hollis K, Richardson D, Kaye JA, McRoy L. Abstract P6-18-27: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-27] [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
This abstract was withdrawn by the authors.
Citation Format: Odom D, Mitra D, Hollis K, Richardson D, Kaye JA, McRoy L. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-27.
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Rage E, Do M, Demers PA, Fenske N, Kreuzer M, Laurier D, Samet J, Schubauer-Berigan M, Sobotzki C, Tomasek L, Zablotska L, Richardson D. Pooled Uranium Miners Analysis (PUMA): The Setting Up of an International Occupational Cohort. BIO WEB OF CONFERENCES 2019. [DOI: 10.1051/bioconf/20191404003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kelly-Reif K, Sandler D, Shore D, Schubauer-Berigan M, Troester M, Nylander-French L, Richardson D. Cancer incidence and mortality among uranium miners in the Příbram region of the Czech Republic. BIO WEB OF CONFERENCES 2019. [DOI: 10.1051/bioconf/20191404008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Richardson D, Bell C. Public health interventions for reducing HIV, hepatitis B and hepatitis C infections in people who inject drugs. Public Health Action 2018; 8:153. [PMID: 30775273 PMCID: PMC6361494 DOI: 10.5588/pha.18.0093-ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023] Open
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Nichols M, Andrew MK, Hatchette TF, Ambrose A, Boivin G, Elsherif M, Green K, Johnstone J, Katz K, Leblanc J, Loeb M, Mackinnon-Cameron D, Mccarthy A, McElhaney J, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Smyth D, Trottier S, Valiquette L, Webster D, Ye L, McNeil SA. 992. 2016–2017 Influenza Burden of Disease and End-of-Season Influenza Vaccine Effectiveness (VE) Estimates for Preventing Influenza-Related Hospitalization Among Canadian Adults: An Analysis From the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network. Open Forum Infect Dis 2018. [PMCID: PMC6255298 DOI: 10.1093/ofid/ofy210.829] [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: 11/13/2022] Open
Abstract
Background To inform public health decision making around influenza prevention and treatment, ongoing surveillance of the influenza burden of disease and assessment of influenza vaccine effectiveness (VE) is critical. The Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network conducts active surveillance each influenza season to characterize the burden of influenza disease and to provide estimates of influenza VE to prevent influenza-related hospitalization in Canadian adults (≥16 years of age). Methods Active surveillance for influenza was conducted at 13 hospitals in four provinces beginning on November 15, 2016 and ending April 30, 2017. Patients admitted with any respiratory diagnosis or symptom were eligible for enrolment. Eligible patients had a nasopharyngeal swab collected and tested for influenza using polymerase chain reaction (PCR). Patients who tested positive for influenza were considered cases; patients who tested negative for influenza were eligible to become matched controls. Detailed demographic and medical information were obtained from the medical record. Influenza VE was estimated as 1 − odds ratio (OR) of influenza in vaccinated vs. unvaccinated patients × 100% using conditional logistic regression, with corresponding 95% confidence intervals (CIs). Results A total of 1,431 influenza cases were enrolled; the majority were influenza A (n = 1,299) and 100% of patients with known influenza A subtype were A/H3N2. Among all influenza cases, 144 (10.1%) patients were admitted to the intensive care unit (ICU) and 91 (6.4%) patients died within 30 days of discharge. Overall adjusted influenza VE for prevention of influenza-related hospitalization in all ages was 23.3% (95% CI: 2.9–39.4%), with slightly lower VE observed in patients ≥65 years (VE: 19.4%; 95% CI: −7.8–39.8%) and higher VE observed in patients <65 years (VE: 47.9%; 95% CI: 9.9–69.9%). Conclusion Overall, influenza VE was low but effective (VE: 23%) for preventing influenza-related hospitalization during the 2016–2017 season in Canada. Given the low influenza VE observed, continued assessment of influenza VE is crucial to inform immunization policy in Canada and to emphasize the importance of the development and utilization of improved influenza vaccines. Disclosures M. K. Andrew, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. sanofi pasteur: Grant Investigator, Research grant. T. F. Hatchette, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Abbvie: Consultant, Speaker honorarium. J. McElhaney, GSK: Scientific Advisor, Speaker honorarium. sanofi pasteur: Scientific Advisor, Speaker honorarium. A. McGeer, GSK: Grant Investigator, Research grant. Hoffman La Roche: Grant Investigator, Research grant. sanofi pasteur: Grant Investigator, Research grant. A. Poirier, sanofi pasteur: Investigator, Research grant. Actelion: Grant Investigator, Research grant. J. Powis, GSK: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. Synthetic Biologics: Investigator, Grant recipient. M. Semret, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. S. Trottier, CIHR: Grant Investigator, Research grant. S. A. McNeil, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Merck: Collaborator and Consultant, Contract clinical trials and Speaker honorarium. Novartis: Collaborator, Contract clinical trials. sanofi pasteur: Collaborator, Contract clinical trials.
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Farooqi L, Faheem A, Armstrong I, Borgundvaag E, Coleman B, Green K, Jayasinghe K, Johnstone J, Katz K, Kohler P, Li A, Melano R, Muller M, Nayani S, Patel S, Paterson A, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Shafinaz S, Simor AE, Willey B, Wisely L, Zhong Z, McGeer A. 2165. Risk Factors for CPE Colonization in Household Contacts of CPE Colonized/Infected Patients. Open Forum Infect Dis 2018. [PMCID: PMC6253268 DOI: 10.1093/ofid/ofy210.1821] [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: 11/30/2022] Open
Abstract
Background Carbapenemase-producing Enterobacteriaceae (CPE) are a global threat. Risk of transmission of CPE in households remains poorly understood Methods Population-based surveillance for CPE colonization/infection is conducted in Toronto/Peel Region, Canada. In households with ≥1 consenting household contact (HC), groin, rectal swabs and urine samples are submitted every 3 months for both IC and HC until the IC has three consecutive negative swab sets. Swabs/urines are incubated overnight in BHI, direct PCR for carbapenemase genes is performed; specimens positive for PCR are then cultured. Results Eighty-five households and 150 HC have been enrolled. Most common species/gene combinations in IC are: E. coli/NDM (33), E. coli/OXA48 (15), Klebsiella spp./NDM (11). HCs have a median of eight swabs (range 2–14). 12 (8%) HCs were colonized with CPE (median 1.5 pos samples, range 1–8). IC and HC had same gene in 11(92%) cases, and same species/gene in seven (58%) cases. NDM+OXA48 ICs were more likely to have CPE colonized HC, see table. CPE colonized HC were older, more likely to be the IC’s spouse (OR 32, 95% CI 4–260), and more likely to have travelled outside Canada (OR 9.7, 95% CI 1.2–78). Conclusion HC colonization with CPE is uncommon, but not rare, and may be associated with either household transmission, or co-exposure of HC and IC via travel. Spouses are most often colonized. Disclosures S. Poutanen, MERCK: Scientific Advisor, Speaker honorarium; COPAN: Speaker(but not part of a bureau), Travel reimbursement; Accelerate Diagnostics: Investigator, Research support; Bio-Rad: Investigator, Research support; bioMérieux: Investigator, Research support.
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Zhong Z, Faheem A, Farooqi L, Armstrong I, Borgundvaag E, Coleman B, Green K, Jayasinghe K, Johnstone J, Katz K, Kohler P, Li A, Melano R, Muller M, Nayani S, Patel S, Paterson A, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Shafinaz S, Simor AE, Willey B, Wisely L, Mcgeer A. 1205. Emergence of Carbapenemase Producing Enterobacteriaceae in South Central Ontario, Canada. Open Forum Infect Dis 2018. [PMCID: PMC6252420 DOI: 10.1093/ofid/ofy210.1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The spread of CPE is an increasing global threat to patient safety. We describe the introduction and evolution of CPE in south-central Ontario, Canada. Methods The Toronto Invasive Bacterial Diseases Network has performed population based surveillance for CPE in metropolitan Toronto and Peel region from first identified isolates in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for PCR testing for carbapenemases. Demographic and medical data and travel history are collected from chart review and patient/physician interview. Results Since 2007, 659 patients have been identified as colonized/infected with CPE; 362, 57%) have at least one clinical isolate. Annual incidence has increased from 0 in 2006 to 1.3 per 100,000 in 2016/17 (Figure 1). First bacteremia occurred in 2010, the incidence in 2017 was 0.14 per 100,000 population. 388 (59%) patients were male, median age was 70 years (range 3 months–100 years). Most common genes among first isolates were NDM (306, 46%), OX48 (149, 23%), KPC (122, 19%). Most common species were K. pneumoniae (268, 41%) and E. coli (259, 39%). Over time, second species/same gene were identified in 113 (16%) patients. In addition, 34/xxx patients with isolates with NDM and/or OXA-48 subsequently had a second isolate with a different gene/gene combination. Of 518 patients whose travel and hospitalization history are available, patients with VIM were less likely than other patients to have a foreign hospitalization or travel history (9/28 vs. 341/490, P < 0.0001). Patients with KPC were more likely to have a hospitalization history outside Canada and the Indian subcontinent (25/70, 36%), in Canada (47/164,29%) than to have no hospitalization in the last year (13/93, 14%), or a history of hospitalization in the Indian subcontinent (2/191, 1%) (P < 0.001). The number of incident patients with different hospitalization and travel history over time is shown in Figure 2. Conclusion CPE is increasingly recognized in southern Ontario, both in patients with a history of exposure in healthcare in other countries, and to healthcare in Canada. Intensification of control programs is urgently needed. Disclosures S. Poutanen, MERCK: Scientific Advisor, Speaker honorarium. COPAN: Speaker(but not part of a bureau), Travel reimbursement. Accelerate Diagnostics: Investigator, Research support. Bio-Rad: Investigator, Research support. bioMérieux: Investigator, Research support.
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Jamal A, Baqi M, Borgia S, Cicotelli W, Delibasic K, Katz K, Johnstone J, Melano R, Muller M, O’Grady S, Patel S, Richardson D, Paterson A, Li A, McGeer A. 1186. Prevalence of Carbapenemase-Producing Enterobacteriaceae (CPE) in Hospital Drains in Southern Ontario. Open Forum Infect Dis 2018. [PMCID: PMC6252835 DOI: 10.1093/ofid/ofy210.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Hospital waste water systems are an emerging reservoir for CPE. We aimed to describe the prevalence of CPE in hospital drains in southern Ontario, where patients are rarely colonized/infected by CPE. Methods Ten Ontario hospitals identified rooms occupied by CPE+ inpatients from 2007 to 2017. Drain swabs from patient rooms and communal shower rooms were inoculated into BHI + 10% Dey-Engley neutralizing broth and incubated overnight, then PCR on enriched broth for carbapenemase genes as well as culture on McPOD/McMEM were performed. Results Over 10 years in 10 hospitals, 343 CPE+ inpatients exposed 1,205 drains (852 sinks, 353 bathtub/shower drains) in 501 patient rooms and 71 communal shower rooms. 53 (4%) drains in 40 (8%) patient rooms and 10 (14%) communal shower rooms were CPE+ by PCR and culture. CPE+ drains were from 15/475 (3%) hand hygiene sinks, 4/352 (1%) bathroom sinks, 23/272 (9%) bathtubs/showers, and 11/81 (13.6%) communal showers. Eleven (21%) of the CPE+ drains contained 31 CPE gene/species combinations. Patient room drain CPE gene/species combinations are shown in Figure 1: eight (15%) matched the CPE gene/species combination of a room occupant, 23 (43%) matched gene only, and 23 (43%) did not match. 54% of drain isolates were Enterobacter spp. but 9% of patient isolates were Enterobacter spp. There were 155 (13%) additional drains with one or more genes detected by PCR but not culture; 94 (61%) contained VIM (88 bathtub, one bathroom sink, and five hand hygiene sink drains), 33 GES, 17 OXA, 16 IMP, 10 KPC, and five NDM. There were six drains where one or more genes were detected by culture but not PCR; four (67%) were bathtub/shower drains containing an OXA, one bathtub/shower drain containing an NDM, and one hand hygiene sink drain containing a KPC. Conclusion Hospital drains may become a reservoir for CPE, which may persist for years. Sensitivity of PCR and culture for detection of CPE and CP organisms may differ. The presence of “unmatched” drains suggests undetected patient colonization. Risk of transmission from drains to room occupants requires investigation. Disclosures All authors: No reported disclosures.
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