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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Johnston K, Powell LC, Popoff E, L'Italien GJ, Pawinski R, Ahern A, Large S, Tran T, Jenkins A. Cost-effectiveness of rimegepant oral lyophilisate compared to best supportive care for the acute treatment of migraine in the UK. J Med Econ 2024; 27:627-643. [PMID: 38590236 DOI: 10.1080/13696998.2024.2340932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
AIMS Migraine is the most common disabling headache disorder and is characterized by recurrent throbbing head pain and symptoms of photophobia, phonophobia, nausea, and vomiting. Rimegepant 75 mg, an oral lyophilisate calcitonin gene-related peptide antagonist, is the first treatment approved for both the acute and preventative treatment of migraine, and the first acute therapy approved in over 20-years. The objective was to assess the cost-utility of rimegepant compared with best supportive care (BSC) in the UK, for the acute treatment of migraine in the adults with inadequate symptom relief after taking at least 2 triptans, or for whom triptans are contraindicated or not tolerated. MATERIALS AND METHODS A de novo model was developed to estimate incremental costs and quality-adjusted life years (QALYs), structured as a decision tree followed by Markov model. Patients received rimegepant or BSC for a migraine attack and were assessed for response (pain relief at 2-h). Responders and non-responders followed different pain trajectories over 48-h cycles. Non-responders discontinued treatment while responders continued treatment for subsequent attacks, with a proportion discontinuing over time. Data sources included a post-hoc pooled analysis of the phase 3 acute rimegepant trials (NCT03235479, NCT03237845, NCT03461757), and a long-term safety study (NCT03266588). The analysis was conducted from the perspective of the UK National Health Service and Personal Social Services over a 20-year time horizon. RESULTS Rimegepant resulted in an incremental cost-utility ratio (ICUR) of £10,309 per QALY gained vs BSC, which is cost-effectiveness at a willingness to pay threshold of £30,000/QALY. Rimegepant generated +0.44 incremental QALYs and higher incremental lifetime costs (£4,492). Improved QALYs for rimegepant were a result of less time spent with severe and moderate headache pain. CONCLUSION This study highlights the economic value of rimegepant which was found to be cost-effective for the acute treatment of migraine in adults unsuitable for triptans.
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Affiliation(s)
- Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | - Lauren C Powell
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
| | - Evan Popoff
- Broadstreet Health Economics and Outcomes Research, Vancouver, Canada
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Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Toribio JAL, Lomata K, Fullman S, Jenkins A, Borja E, Arif S, McKercher J, Blake D, Garcia A, Whittington RJ, Underwood F, Marais BJ. Assessing risks for bovine and zoonotic tuberculosis through spatial analysis and a questionnaire survey in Fiji - A pilot study. Heliyon 2023; 9:e22776. [PMID: 38125425 PMCID: PMC10730600 DOI: 10.1016/j.heliyon.2023.e22776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/11/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
Mycobacterium bovis causes tuberculosis in cattle and when transmitted to humans typically causes extra-pulmonary tuberculosis (EPTB). Bovine tuberculosis (bTB) has a global distribution and is controlled in most countries to protect animal and public health. Recent studies revealed that bTB is established on dairy farms in Fiji where EPTB cases have been reported in people. The aims of this pilot investigation were to look for putative zoonotic TB (EPTB) cases in people and to evaluate practices that might contribute to the persistence and transmission of M. bovis between cattle and to humans. Existing data sets were shared between the Fiji Ministry of Agriculture and Ministry of Health and a questionnaire-based survey was implemented using One Health principles. Statistically significant co-location and close proximity of EPTB cases and bovine TB affected farms were identified. The bTB infection status of farms was significantly associated with unfenced water sources where cattle grazed. Of 247 households, 65 % shared drinking water sources with cattle and 36 % consumed raw milk without boiling, while 62 % of participants reported backyard slaughter of cattle. Several participants reported current symptoms potentially suggestive of TB (chronic cough) but the impact of smoking and history of previous TB treatment could not be evaluated. Farmers had limited understanding of the practices required to prevent bTB at farm level. Further study is recommended and should include an assessment of lifetime EPTB diagnoses, classification of farms based on more recent bTB test data and molecular typing of mycobacterial isolates from humans, cattle and the environment. A targeted awareness and education approach is required to reduce the future risk of zoonotic TB and to help ensure uptake of recommendations and practices aimed at controlling and preventing bTB.
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Affiliation(s)
- Jenny-Ann L.M.L. Toribio
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, NSW, Australia
| | - Keresi Lomata
- Ministry of Agriculture, Koronivia Research Station, Koronivia, Republic of Fiji
| | - Sam Fullman
- Ministry of Health and Medical Services, Dinem House, 88 Amy Street, Suva, Republic of Fiji
| | - Aaron Jenkins
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, NSW, Australia
- Edith Cowan University, Centre for People, Place and Planet, 270 Joondalup Drive, Joondalup, WA, Australia
| | - Elva Borja
- Ministry of Agriculture, Koronivia Research Station, Koronivia, Republic of Fiji
| | - Shumaila Arif
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, NSW, Australia
| | - Jarrad McKercher
- Edith Cowan University, Centre for People, Place and Planet, 270 Joondalup Drive, Joondalup, WA, Australia
| | - David Blake
- Edith Cowan University, Centre for People, Place and Planet, 270 Joondalup Drive, Joondalup, WA, Australia
| | - Anabel Garcia
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, NSW, Australia
| | - Richard J. Whittington
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, NSW, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, NSW, Australia
| | - Frank Underwood
- Ministry of Health and Medical Services, Dinem House, 88 Amy Street, Suva, Republic of Fiji
| | - Ben J. Marais
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, NSW, Australia
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Jordan JR, Miles BWJ, Gudmundsson GH, Jamieson SSR, Jenkins A, Stokes CR. Increased warm water intrusions could cause mass loss in East Antarctica during the next 200 years. Nat Commun 2023; 14:1825. [PMID: 37005432 PMCID: PMC10067810 DOI: 10.1038/s41467-023-37553-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/22/2023] [Indexed: 04/04/2023] Open
Abstract
The East Antarctic Ice Sheet (EAIS) is currently surrounded by relatively cool water, but climatic shifts have the potential to increase basal melting via intrusions of warm modified Circumpolar Deep Water (mCDW) onto the continental shelf. Here we use an ice sheet model to show that under the current ocean regime, with only limited intrusions of mCDW, the EAIS will likely gain mass over the next 200 years due to the increased precipitation from a warming atmosphere outweighing increased ice discharge due to ice-shelf melting. However, if the ocean regime were to become dominated by greater mCDW intrusions, the EAIS would have a negative mass balance, contributing up to 48 mm of SLE over this time period. Our modelling finds George V Land to be particularly at risk to increased ocean induced melting. With warmer oceans, we also find that a mid range RCP4.5 emissions scenario is likely to result in a more negative mass balance than a high RCP8.5 emissions scenario, as the relative difference between increased precipitation due to a warming atmosphere and increased ice discharge due to a warming ocean is more negative in the mid range RCP4.5 emission scenario.
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Affiliation(s)
- James R Jordan
- Department of Geography and Environmental Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK.
- Laboratoire de Glaciologie, Université libre de Bruxelles (ULB), Brussels, Belgium.
| | - B W J Miles
- Department of Geography, Durham University, Durham, DH1 3LE, UK
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - G H Gudmundsson
- Department of Geography and Environmental Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - S S R Jamieson
- Department of Geography, Durham University, Durham, DH1 3LE, UK
| | - A Jenkins
- Department of Geography and Environmental Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - C R Stokes
- Department of Geography, Durham University, Durham, DH1 3LE, UK
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Yuce H, Sun X, Lip GYH. Delaying clinical events among patients with non-valvular atrial fibrillation treated with oral anticoagulants: Insights from the ARISTOPHANES study. Eur J Intern Med 2023; 108:37-42. [PMID: 36456387 DOI: 10.1016/j.ejim.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/30/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral anticoagulants (OACs) mitigate stroke and systemic embolism (SE) risk in non-valvular atrial fibrillation (AF) patients but can increase the risk of major bleeding (MB). This study analyzed the gains in event-free time for these outcomes among OAC treatment options represented in the ARISTOPHANES study. METHODS This sub-analysis consisted of NVAF patients who initiated warfarin, apixaban, dabigatran, or rivaroxaban from 01JAN2013-30SEP2015, with data pooled from Medicare and 4 US commercial claims databases. Propensity score matching was conducted between non-vitamin K antagonist OAC (NOAC) and warfarin cohorts in each database and results were pooled. Laplace regression was used to evaluate the delay in time to stroke/SE and MB events between NOACs and warfarin and between NOACs after the first 12-months of follow-up. RESULTS The population included 466,991 patients (167,413 warfarin; 108,852 apixaban; 37,724 dabigatran; and 153,002 rivaroxaban). Event-free time gain (95% confidence interval) for apixaban versus warfarin was 101 days (78- 124) for stroke/SE and 116 (103- 130) days for MB. The gain in event-free time for dabigatran versus warfarin was 45 days (3- 87) for stroke/SE and 92 (68- 116) days for MB. The gain in event-free time for rivaroxaban versus warfarin was 63 days (42- 84) for stroke/SE but event-free time decreased by 18 (-31-6) days for MB. CONCLUSIONS Over 12 months after initiation, apixaban and dabigatran conferred progressive increases in event free time for stroke/SE and MB vs warfarin, whereas rivaroxaban conferred an increase in stroke/SE-free time but a loss in MB-free time vs warfarin.
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Affiliation(s)
- Steven Deitelzweig
- Ochsner Clinic Foundation, Department of Hospital Medicine, New Orleans, LA, USA and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.
| | | | - Amiee Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Nipun Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Jenny Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | - Huseyin Yuce
- New York City College of Technology, City University of New York, New York, NY, USA
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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van de Wal RSW, Nicholls RJ, Behar D, McInnes K, Stammer D, Lowe JA, Church JA, DeConto R, Fettweis X, Goelzer H, Haasnoot M, Haigh ID, Hinkel J, Horton BP, James TS, Jenkins A, LeCozannet G, Levermann A, Lipscomb WH, Marzeion B, Pattyn F, Payne AJ, Pfeffer WT, Price SF, Seroussi H, Sun S, Veatch W, White K. A High-End Estimate of Sea Level Rise for Practitioners. Earths Future 2022; 10:e2022EF002751. [PMID: 36590252 PMCID: PMC9787942 DOI: 10.1029/2022ef002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
Sea level rise (SLR) is a long-lasting consequence of climate change because global anthropogenic warming takes centuries to millennia to equilibrate for the deep ocean and ice sheets. SLR projections based on climate models support policy analysis, risk assessment and adaptation planning today, despite their large uncertainties. The central range of the SLR distribution is estimated by process-based models. However, risk-averse practitioners often require information about plausible future conditions that lie in the tails of the SLR distribution, which are poorly defined by existing models. Here, a community effort combining scientists and practitioners builds on a framework of discussing physical evidence to quantify high-end global SLR for practitioners. The approach is complementary to the IPCC AR6 report and provides further physically plausible high-end scenarios. High-end estimates for the different SLR components are developed for two climate scenarios at two timescales. For global warming of +2°C in 2100 (RCP2.6/SSP1-2.6) relative to pre-industrial values our high-end global SLR estimates are up to 0.9 m in 2100 and 2.5 m in 2300. Similarly, for a (RCP8.5/SSP5-8.5), we estimate up to 1.6 m in 2100 and up to 10.4 m in 2300. The large and growing differences between the scenarios beyond 2100 emphasize the long-term benefits of mitigation. However, even a modest 2°C warming may cause multi-meter SLR on centennial time scales with profound consequences for coastal areas. Earlier high-end assessments focused on instability mechanisms in Antarctica, while here we emphasize the importance of the timing of ice shelf collapse around Antarctica. This is highly uncertain due to low understanding of the driving processes. Hence both process understanding and emission scenario control high-end SLR.
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Affiliation(s)
- R. S. W. van de Wal
- Institute for Marine and Atmospheric Research UtrechtUtrecht UniversityTA UtrechtThe Netherlands
- Department of Physical GeographyUtrecht UniversityTA UtrechtThe Netherlands
| | - R. J. Nicholls
- Tyndall Centre for Climate Change ResearchUniversity of East AngliaNorwichUK
| | - D. Behar
- San Francisco Public Utilities CommissionSan FranciscoCAUSA
| | - K. McInnes
- Climate Change Research CentreUNSW AustraliaSydneyNSWAustralia
| | - D. Stammer
- Centrum für Erdsystemforschung und NachhaltigkeitUniversität HamburgHamburgGermany
| | - J. A. Lowe
- Met Office Hadley CentreExeterUK
- Priestley CentreUniversity of LeedsLeedsUK
| | - J. A. Church
- Climate Change Research CentreUNSW AustraliaSydneyNSWAustralia
- Australian Centre for Excellence in Antarctic Science (ACEAS)University of TasmaniaHobartTASAustralia
| | - R. DeConto
- Department of GeosciencesUniversity of Massachusetts‐AmherstAmherstMAUSA
| | - X. Fettweis
- Department of GeographySPHERES Research UnitUniversity of LiègeLiègeBelgium
| | - H. Goelzer
- NORCE Norwegian Research CentreBjerknes Centre for Climate ResearchBergenNorway
| | | | - I. D. Haigh
- School of Ocean and Earth ScienceUniversity of SouthamptonNational Oceanography CentreSouthamptonUK
| | - J. Hinkel
- Adaptation and Social LearningGlobal Climate ForumBerlinGermany
| | - B. P. Horton
- Earth Observatory of SingaporeNanyang Technological UniversitySingaporeSingapore
- Asian School of the EnvironmentNanyang Technological UniversitySingaporeSingapore
| | - T. S. James
- Natural Resources CanadaGeological Survey of CanadaSidneyBCCanada
| | - A. Jenkins
- Department of Geography and Environmental SciencesNorthumbria UniversityNewcastle upon TyneUK
| | - G. LeCozannet
- Coastal Risks and Climate Change UnitRisks and Prevention DivisionBRGMOrléansFrance
| | - A. Levermann
- Potsdam Institute for Climate Impact ResearchPotsdamGermany
- LDEOColumbia UniversityNew YorkNYUSA
- Physics InstituteUniversity of PotsdamPotsdamGermany
| | - W. H. Lipscomb
- Climate and Global Dynamics LaboratoryNational Center for Atmospheric ResearchBoulderCOUSA
| | - B. Marzeion
- Institute of Geography and MARUM ‐ Center for Marine Environmental SciencesUniversity of BremenBremenGermany
| | - F. Pattyn
- Laboratoire de GlaciologieUniversité libre de BruxellesBrusselsBelgium
| | - A. J. Payne
- School of Geographical SciencesUniversity of BristolBristolUK
| | - W. T. Pfeffer
- INSTAAR and Department of Civil, Environmental, Architectural EngineeringUniversity of ColoradoBoulderCOUSA
| | - S. F. Price
- Theoretical DivisionLos Alamos National LaboratoryLos AlamosNMUSA
| | - H. Seroussi
- Thayer School of EngineeringDartmouth CollegeHanoverNHUSA
| | - S. Sun
- Coastal Risks and Climate Change UnitRisks and Prevention DivisionBRGMOrléansFrance
| | - W. Veatch
- US Army Corps of Engineers, HeadquartersWashingtonDCUSA
| | - K. White
- US Department of DefenseOffice of the Deputy Assistant Secretary of Defense (Environment and Energy Resilience)DCWashingtonUSA
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Garozzo D, Rispoli R, Graziano F, Gerardi RM, Grotenhuis A, Jenkins A, Sammons V, Visocchi M, Pinazzo S, Lima R, Martinez F, Emamhadi M, Pedro MT, Shirwari HS, Guedes F, Bhagavatula ID, Shukla DP, Bhat ID, Ojo OA, Tirsit A, Gonzales-Gonzales ME, Luna F, Kretschmer T, Benzel E, Cappelletto B. Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future. Front Surg 2022; 9:908540. [PMID: 35836607 PMCID: PMC9274114 DOI: 10.3389/fsurg.2022.908540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.
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Affiliation(s)
- D Garozzo
- Department of Neurosurgery, Mediclinic Parkview Hospital, Dubai, UAE
| | - R Rispoli
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario Santa Maria della Misericordia di Udine, Udine, Italy
| | - F Graziano
- Department of Neurosurgery, ARNAS Garibaldi Hospital, Catania, Italy
| | - R M Gerardi
- Department of Neurosurgery, University Hospital, Palermo, Italy
| | - A Grotenhuis
- Department of Neurosurgery, Radboud UMC, Nijmegen, The Netherlands
| | - A Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - V Sammons
- Department of Neurosurgery, North Shore Private Hospital, Sydney, Australia
| | - M Visocchi
- Department of Neurosurgery, Agostino Gemelli IRCCS, Rome, Italy
| | - S Pinazzo
- Department of Neurosurgery, Hospital Maciel, Montevideo, Uruguay
| | - R Lima
- Department of Neurosurgery, Hospital de Clínicas, Montevideo, Uruguay
| | - F Martinez
- Department of Neurosurgery, Hospital de Clínicas, Montevideo, Uruguay
| | - M Emamhadi
- Brachial plexus and peripheral nerve injury center, Guilan University of Medical Sciences, Rasht, Iran
| | - M T Pedro
- Peripheral Nerve Unit, Department of Neurosurgery, BKH Günzburg at Ulm University, Günzburg, Germany
| | - H S Shirwari
- Department of Neurosurgery, Dawodzai Medical Complex, Jalalabad, Afghanistan
| | - F Guedes
- Division of Neurosurgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - D P Shukla
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - I D Bhat
- Department of Neurosurgery, RV Astor Hospital Sarakki Jp Nagar, Bengaluru, India
| | - O A Ojo
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - A Tirsit
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Gonzales-Gonzales
- Department of Neurosurgery, Hospital Civil de Guadalajara, Guadalajara, Jalisco, Mexico
| | - F Luna
- Departament of Neurosurgery, Hospital Clínico Regional de Concepción, Universidad de Concepción. Concepcion, Chile
| | - T Kretschmer
- Dept. of Neurosurgery & Neurorestoration, Neurosurgical Intensive Care, Neurooncological Centre (DKG) Klinikum Klagenfurt, Klagenfurt, Austria
| | - E Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States of America
| | - B Cappelletto
- SOC Chirurgia Vertebro-Midollare, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Universitario Santa Maria della Misericordia di Udine, Udine, Italy
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9
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Curl C, Varma U, Raaijmakers A, Hemphill K, Janssens J, Jenkins A, Mellor K, Delbridge L. Treatment of Type 1 Diabetes With Metformin Reduces Diastolic Dysfunction and Cardiac Lipid Accumulation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Nelson S, Drabarek D, Jenkins A, Negin J, Abimbola S. How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review. BMJ Open 2021; 11:e053320. [PMID: 34857572 PMCID: PMC8640661 DOI: 10.1136/bmjopen-2021-053320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services. DESIGN Realist review. DATA SOURCES PubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Criteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible). ANALYSIS Inductive and deductive coding was used to generate context-mechanism-outcome configurations. RESULTS 73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one's behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation. CONCLUSIONS The findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.
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Affiliation(s)
- Sarah Nelson
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aaron Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Joel Negin
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Seye Abimbola
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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11
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Lovett K, Yuce H, Lip G. Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: an ARISTOPHANES analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patient-centered outcomes, such as home time, are becoming increasingly important quality-of-life measures. There are limited data on the impact of oral anticoagulants (OACs) on home time among patients with non-valvular atrial fibrillation.
Purpose
This analysis, based on the previously published ARISTOPHANES study, used five US insurance claims databases (CMS Medicare and four commercial databases) to compare home time among NVAF patients who were prescribed non-vitamin K antagonist OACs (NOACs).
Methods
Adult NVAF patients who were newly prescribed apixaban, dabigatran, or rivaroxaban (01JAN2013–30SEP2015) were selected. Time at home was calculated as the number of days from the index date (NOAC prescription) without any of the following: an inpatient, skilled nursing facility (SNF) or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days from index date without any events from the home time endpoint or any days with a claim for bleeding, stroke/systemic embolism (S/SE), AF, or an INR test. Time at home and without external AF-related care were measured during the 180 days of follow-up; patients were required to have been alive and have 180 days of follow-up post index. In each database, three 1:1 NOAC-NOAC propensity-score-matched (PSM) cohorts were created before combining the databases. For each NOAC-NOAC matched cohort, Poisson regression was conducted to compare time at home and time at home without external AF-related care.
Results
After PSM, 37,314 apixaban-dabigatran, 107,236 apixaban-rivaroxaban, and 37,693 rivaroxaban-dabigatran patient pairs were created of which 37–44% had 180 days of follow-up available. Across the NOAC cohorts, approximately 21–25% of patients had an admission to a hospital, SNF, nursing facility, rehabilitation center, or hospice during the 180-day follow-up. The time at home was generally consistent between the NOAC cohorts (177 days); however, apixaban patients had 0.5 more days at home compared to rivaroxaban patients. Across all NOAC cohorts, 7–8% had a claim for a S/SE, 11–15% had a claim for bleeding, and 15–22% had an INR test, while 87–89% of all patients had an AF-claim during the 180-day follow-up. Patients prescribed apixaban had 1 more day at home without external AF-related care compared to dabigatran, and 1.5 more days at home without external AF-related care compared to rivaroxaban. Dabigatran had <1 more day at home without external AF-related care compared to rivaroxaban.
Conclusion
Among NVAF patients treated with NOACs, there were small differences in the time at home and time at home without external AF-related care during the first 6 months of NOAC treatment. As NVAF is a chronic condition, it is important to understand the impact of NOAC treatment on these patient-centered outcomes.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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12
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Deitelzweig S, Keshishian A, Kang A, Jenkins A, Atreja N, Schuler P, Jiang J, Lovett K, Yuce H, Lip G. Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants versus warfarin. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical trials and real-world database studies have shown the benefits of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin; however, measures of functional outcomes are critical in evaluating a patient's quality of life. Previous measures of time spent out of hospital in a home setting and time spent receiving disease-related care among non-valvular atrial fibrillation (NVAF) patients are lacking in the current literature.
Purpose
This analysis was based on the previously published ARISTOPHANES study, and used multiple data sources to evaluate the amount of time spent at a patient's home among NVAF patients who were prescribed NOACs versus warfarin.
Methods
This retrospective observational study used US data from CMS Medicare and four commercial databases to select adult NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30SEP2015). Time at home and time at home without external AF-related care were measured during the 180 days after the index date (OAC prescription). Time at home was defined as days from index date without any of the following: an inpatient, skilled nursing facility or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days away from home and days with a claim for bleeding, stroke/systemic embolism, AF, or an INR test. Each day a claim was observed was counted as one day. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. After PSM, a subgroup of patients who were alive and had ≥180 days of follow-up was created. Poisson regression was conducted in each NOAC-warfarin matched cohort to compare time at home and time at home without external AF-related care.
Results
After matching, a total of 100,977 apixaban-warfarin, 36,990 dabigatran-warfarin, and 125,068 rivaroxaban-warfarin patient pairs were selected. Of those patients, 38–46% had 180 days of follow-up available. Across treatment cohorts, approximately 75% of patients were at home for the 180-day follow-up. Apixaban, dabigatran, and rivaroxaban patients had 1.3, 0.9, and 0.8 more days at home, respectively, compared to warfarin patients. Patients treated with apixaban had 13.4 more days at home without AF-related care compared to warfarin, while dabigatran and rivaroxaban had 11.6 and 11.7 more days at home without AF-related care compared to warfarin. A greater proportion of warfarin patients than NOAC patients had an INR test (81–82% vs 14–21%), and days with INR testing were the main driver for external AF-related care for warfarin patients.
Conclusion
Among NVAF patients treated with OACs, NOACs were associated with a longer time at home and time at home without external AF-related care compared to warfarin. These results can help inform healthcare providers and patients regarding the impact of NOAC treatment in NVAF patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.
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Affiliation(s)
- S Deitelzweig
- Ochsner Clinic Foundation, New Orleans, United States of America
| | - A Keshishian
- STATinMED Research, Ann Arbor, United States of America
| | - A Kang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - N Atreja
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - P Schuler
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - J Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, United States of America
| | - K Lovett
- STATinMED Research, Ann Arbor, United States of America
| | - H Yuce
- City University of New York, New York, United States of America
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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13
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Rojas-Villabona A, Magnaye L, Jenkins A, Surash S. Two cases of asymptomatic Teflon granulomas following microvascular decompression mimicking cerebellopontine angle tumours: lessons learnt in the neuro-oncology multidisciplinary team. Ann R Coll Surg Engl 2021; 103:e324-e326. [PMID: 34414772 DOI: 10.1308/rcsann.2021.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present the cases of two patients with asymptomatic Teflon granulomas which were incidentally found years after microvascular decompression and presented to the neuro-oncology multidisciplinary team as possible cerebellopontine angle tumours. Teflon granulomas can be asymptomatic and they can radiologically resemble cerebellopontine angle tumours. It is important that all relevant information is available to the neuro-oncology multidisciplinary team for adequate assessment and appropriate treatment recommendations.
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Affiliation(s)
| | - L Magnaye
- University of Newcastle, Newcastle Upon Tyne, UK
| | - A Jenkins
- Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - S Surash
- Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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14
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Halvorsen S, Johnsen SP, Madsen M, Linder M, Sulo G, Ghanima W, Gislason G, Hohnloser SH, Jenkins A, Al-Khalili F, Tell GS, Ehrenstein V. Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation: a Scandinavian population-based cohort study. Eur Heart J Qual Care Clin Outcomes 2021; 8:577-587. [PMID: 34244745 PMCID: PMC9382660 DOI: 10.1093/ehjqcco/qcab048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 12/29/2022]
Abstract
AIMS Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in anticoagulation-naïve patients with atrial fibrillation (AF). METHODS AND RESULTS This historical cohort study included 219 545 AF patients [median age 74 years; 43% women; mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischaemic attack, vascular disease, age 65-74 years, sex category) score 3.3] initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden (1 January 2013 to 31 December 2016). The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9-21.5) months for stroke/SE and 9.6 (3.8-21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA2DS2-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban-warfarin (n = 111 162), dabigatran-warfarin (n = 56 856), and rivaroxaban-warfarin (n = 61 198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 [95% confidence interval (CI): 0.87-1.06] for apixaban, 0.89 (95% CI: 0.80-1.00) for dabigatran, and 1.03 (95% CI: 0.92-1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI: 0.67-0.78) for apixaban, 0.89 (95% CI: 0.82-0.97) for dabigatran, and 1.15 (95% CI: 1.07-1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dose-defined subgroups. CONCLUSION In this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE to patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin.
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Affiliation(s)
- Sigrun Halvorsen
- Corresponding author. Tel: +47 91317460, Fax: +47 22119181, E-mail:
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Linder
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Sulo
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Waleed Ghanima
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Østfold Hospital Trust, Kalnes, Norway
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, 2900 Hellerup, Denmark
| | | | | | - Faris Al-Khalili
- Heart, Lung and Allergy Clinic, Sophiahemmet Hospital, Stockholm, Sweden
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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15
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Ige TA, Jenkins A, Burt G, Angal-Kalinin D, McIntosh P, Coleman CN, Pistenmaa DA, O'Brien D, Dosanjh M. Surveying the Challenges to Improve Linear Accelerator-based Radiation Therapy in Africa: a Unique Collaborative Platform of All 28 African Countries Offering Such Treatment. Clin Oncol (R Coll Radiol) 2021; 33:e521-e529. [PMID: 34116903 DOI: 10.1016/j.clon.2021.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/22/2021] [Accepted: 05/19/2021] [Indexed: 12/24/2022]
Abstract
Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate and service, especially for low- and middle-income countries (LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime. A global initiative was launched in 2016 to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognised that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries. This report presents the method used to conduct this multilevel study of the macro- and microenvironments, the organisation of departments, the technology, the training and the service models that will provide input into the design of a LINAC prototype for a LINAC-based radiation therapy system that will improve access to radiation therapy and thus improve cancer treatment outcomes. It is important to note that new technology should be introduced in a contextual manner so as not to disrupt existing health systems inadvertently, especially with regards to existing staffing, infrastructure and socioeconomic issues. A detailed analysis of data is underway and will be presented in a follow-up report. Selected preliminary results of the study are the observation that LINAC-based facilities in LMICs experience downtime associated with failures in multileaf collimators and vacuum pumps, as well as power instability. Also, that there is a strong association of gross national product per capita with the number of LINACs per population.
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Affiliation(s)
- T A Ige
- National Hospital Abuja, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | | | - G Burt
- University of Lancaster, Lancaster, UK
| | | | - P McIntosh
- STFC Daresbury Laboratory, Warrington, UK
| | - C N Coleman
- International Cancer Expert Corps, Washington, DC, USA
| | - D A Pistenmaa
- International Cancer Expert Corps, Washington, DC, USA
| | - D O'Brien
- International Cancer Expert Corps, Washington, DC, USA
| | - M Dosanjh
- University of Oxford, Oxford, UK; International Cancer Expert Corps, Washington, DC, USA; CERN, Geneva, Switzerland.
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16
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Connelly A, Thwaites V, Turnbull H, Neil J, Walker K, Short A, Keast T, Sweeney L, Jenkins A. P.29 Predicting post-delivery anaemia: Development of the MABL table. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Hemphill K, Varma U, Curl C, Raaijmakers H, Bernasochi G, Mellor K, Jenkins A, Delbridge L. Molecular Mechanisms of Cardio-Protection Conferred By Metformin in Type 1 Diabetes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Wang J, Bose S, Frenk CS, Gao L, Jenkins A, Springel V, White SDM. Universal structure of dark matter haloes over a mass range of 20 orders of magnitude. Nature 2020; 585:39-42. [PMID: 32879500 DOI: 10.1038/s41586-020-2642-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 06/23/2020] [Indexed: 11/09/2022]
Abstract
Cosmological models in which dark matter consists of cold elementary particles predict that the dark halo population should extend to masses many orders of magnitude below those at which galaxies can form1-3. Here we report a cosmological simulation of the formation of present-day haloes over the full range of observed halo masses (20 orders of magnitude) when dark matter is assumed to be in the form of weakly interacting massive particles of mass approximately 100 gigaelectronvolts. The simulation has a full dynamic range of 30 orders of magnitude in mass and resolves the internal structure of hundreds of Earth-mass haloes in as much detail as it does for hundreds of rich galaxy clusters. We find that halo density profiles are universal over the entire mass range and are well described by simple two-parameter fitting formulae4,5. Halo mass and concentration are tightly related in a way that depends on cosmology and on the nature of the dark matter. For a fixed mass, the concentration is independent of the local environment for haloes less massive than those of typical galaxies. Haloes over the mass range of 10-3 to 1011 solar masses contribute about equally (per logarithmic interval) to the luminosity produced by dark matter annihilation, which we find to be smaller than all previous estimates by factors ranging up to one thousand3.
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Affiliation(s)
- J Wang
- Key Laboratory for Computational Astrophysics, National Astronomical Observatories, Chinese Academy of Sciences, Beijing, China. .,School of Astronomy and Space Science, University of Chinese Academy of Sciences, Beijing, China.
| | - S Bose
- Center for Astrophysics
- Harvard and Smithsonian, Cambridge, MA, USA
| | - C S Frenk
- Institute for Computational Cosmology, Department of Physics, Durham University, Durham, UK.
| | - L Gao
- Key Laboratory for Computational Astrophysics, National Astronomical Observatories, Chinese Academy of Sciences, Beijing, China.,School of Astronomy and Space Science, University of Chinese Academy of Sciences, Beijing, China
| | - A Jenkins
- Institute for Computational Cosmology, Department of Physics, Durham University, Durham, UK
| | - V Springel
- Max-Planck-Institut für Astrophysik, Garching, Germany
| | - S D M White
- Max-Planck-Institut für Astrophysik, Garching, Germany.
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19
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Jenkins A, Jupiter SD, Capon A, Horwitz P, Negin J. Nested ecology and emergence in pandemics. Lancet Planet Health 2020; 4:e302-e303. [PMID: 32800145 PMCID: PMC7423328 DOI: 10.1016/s2542-5196(20)30165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Aaron Jenkins
- School of Public Health, University of Sydney, Westmead, NSW, Australia; Centre for Ecosystem Management, Edith Cowan University, Joondalup 6027, Australia.
| | - Stacy D Jupiter
- Wildlife Conservation Society, Melanesia Program, Suva, Fiji
| | - Anthony Capon
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Pierre Horwitz
- Centre for Ecosystem Management, Edith Cowan University, Joondalup 6027, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Westmead, NSW, Australia
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20
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Kohsaka S, Katada J, Saito K, Jenkins A, Li B, Mardekian J, Terayama Y. Safety and effectiveness of non-vitamin K oral anticoagulants versus warfarin in real-world patients with non-valvular atrial fibrillation: a retrospective analysis of contemporary Japanese administrative claims data. Open Heart 2020; 7:e001232. [PMID: 32341789 PMCID: PMC7174060 DOI: 10.1136/openhrt-2019-001232] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 01/02/2023] Open
Abstract
Objective To assess the safety (ie, risk of bleeding) and effectiveness (ie, risk of stroke/systemic embolism (SE)) separately for four non-vitamin K oral anticoagulants (NOACs; apixaban, dabigatran, edoxaban and rivaroxaban) versus warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF), including those at high risk of bleeding and treated with reduced doses of NOACs. Methods We conducted a retrospective analysis of electronic health records and claims data from 372 acute care hospitals in Japan for patients with NVAF newly initiated on NOACs or warfarin. Baseline characteristics were balanced using inverse probability of treatment weighting with stabilised weights (s-IPTW). Bleeding risk and stroke/SE risk were expressed as HRs with 95% CIs. Two sensitivity analyses were conducted. Results A total of 73 989 patients were eligible for analysis. Notably, 52.8%-81.9% of patients received reduced doses of NOACs. After applying s-IPTW, patient characteristics were well balanced across warfarin/NOAC cohorts. The mean within-cohort age, CHADS2 score and CHA2DS2-VASc score were 76 years, 2.2-2.3 and 3.8, respectively. In all age categories, the majority of the HRs for major bleeding, any bleeding and stroke/SE were equal to or below 1 for all NOACs versus warfarin. Apixaban was the only NOAC associated with a significantly lower risk of any bleeding. There was a trend towards increased risk reduction with NOACs versus warfarin in patients with body weight ≥60 kg. In patients with renal disease, the HRs for apixaban versus warfarin were below 1 for major bleeding, any bleeding and stroke/SE, with statistical significance observed for the risk reduction in stroke/SE versus warfarin. In the sensitivity analysis, there were no large differences in HRs between the two observational periods. Conclusions In patients with NVAF primarily treated with reduced-dose NOACs, the risks of stroke/SE and major bleeding were significantly lower with NOACs versus warfarin.
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Katada
- Internal Medicine Medical Affairs, Pfizer Japan Inc, Tokyo, Japan
| | - Kumiko Saito
- Cardiovascular Medical Department, Bristol-Myers Squibb K.K, Tokyo, Japan
| | - Aaron Jenkins
- Department of Patient & Health Impact, Pfizer Inc, New York, New York, USA
| | - Benjamin Li
- Global Biometrics & Data Management, Pfizer Inc, New York, New York, USA
| | - Jack Mardekian
- Global Biometrics & Data Management, Pfizer Inc, New York, New York, USA
| | - Yasuo Terayama
- Neurological Institute, Shonan Keiiku Hospital, Kanagawa, Japan
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Allan V, Ramagopalan SV, Mardekian J, Jenkins A, Li X, Pan X, Luo X. Propensity score matching and inverse probability of treatment weighting to address confounding by indication in comparative effectiveness research of oral anticoagulants. J Comp Eff Res 2020; 9:603-614. [PMID: 32186922 DOI: 10.2217/cer-2020-0013] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
After decades of warfarin being the only oral anticoagulant (OAC) widely available for stroke prevention in atrial fibrillation, four direct OACs (apixaban, dabigatran, edoxaban and rivaroxaban) were approved after demonstrating noninferior efficacy and safety versus warfarin in randomized controlled trials. Comparative effectiveness research of OACs based on real-world data provides complementary information to randomized controlled trials. Propensity score matching and inverse probability of treatment weighting are increasingly popular methods used to address confounding by indication potentially arising in comparative effectiveness research due to a lack of randomization in treatment assignment. This review describes the fundamentals of propensity score matching and inverse probability of treatment weighting, appraises differences between them and presents applied examples to elevate understanding of these methods within the atrial fibrillation field.
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Affiliation(s)
- Victoria Allan
- Centre for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UK
| | - Sreeram V Ramagopalan
- Centre for Observational Research & Data Sciences, Bristol-Myers Squibb, Uxbridge, UK
| | - Jack Mardekian
- Statistics, Global Biometrics and Data Management, Pfizer Inc., New York City, NY, USA
| | - Aaron Jenkins
- Patient Health & Impact, Outcomes & Evidence, Pfizer Ltd, Tadworth, UK
| | - Xiaoyan Li
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Lawrenceville, NJ, USA
| | - Xianying Pan
- Pharmacoepidemiology, Bristol-Myers Squibb, Lawrenceville, NJ, USA
| | - Xuemei Luo
- Patient Health & Impact, Outcomes & Evidence, Pfizer Inc., Groton, CT, USA
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Hvidsten D, Frafjord K, Gray JS, Henningsson AJ, Jenkins A, Kristiansen BE, Lager M, Rognerud B, Slåtsve AM, Stordal F, Stuen S, Wilhelmsson P. The distribution limit of the common tick, Ixodes ricinus, and some associated pathogens in north-western Europe. Ticks Tick Borne Dis 2020; 11:101388. [PMID: 32122808 DOI: 10.1016/j.ttbdis.2020.101388] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/30/2022]
Abstract
In north-western Europe, the common tick, Ixodes ricinus, is widely established, its distribution appears to be increasing and the spread of tick-borne diseases is of increasing concern. The project 'Flått i Nord' (Ticks in northern Norway) commenced in spring 2009 with the intention of studying the tick's distribution and that of its pathogens in northern Norway. Several methods were used: cloth-dragging, collecting from trapped small mammals, and collecting from pets. Since 2010, the occurrence of ticks in the region of northern Norway was determined directly by cloth-dragging 167 times in 109 separate locations between the latitudes of 64 °N and 70 °N (included seven locations in the northern part of Trøndelag County). The northernmost location of a permanent I. ricinus population was found to be Nordøyvågen (66.2204 °N, 12.59 °E) on the Island of Dønna. In a sample of 518 nymphal and adult ticks, the Borrelia prevalence collected close to this distribution limit varied but was low (1-15 %) compared with the locations in Trøndelag, south of the study area (15-27 %). Five specimens (1 %) were positive for Rickettsia helvetica. The length of the vegetation growing season (GSL) can be used as an approximate index for the presence of established populations of I. ricinus. The present study suggests that the threshold GSL for tick establishment is about 170 days, because the median GSL from 1991 to 2015 was 174-184 days at sites with permanent tick populations, showing a clear increase compared with the period 1961-1990. This apparent manifestation of climate change could explain the northward extension of the range of I. ricinus.
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Affiliation(s)
- D Hvidsten
- University Hospital of North Norway, Department of Microbiology and Infection Control, Tromsø, Norway; Nordland Hospital, Division of Diagnostic Services, Department of Microbiology, Bodø, Norway.
| | - K Frafjord
- UiT The Arctic University of Norway, Tromsø University Museum, Tromsø, Norway
| | - J S Gray
- University College Dublin, Dublin, Ireland
| | - A J Henningsson
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - A Jenkins
- University of South-Eastern Norway, Department of Natural Science and Environmental Health, Bø, Norway
| | | | - M Lager
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Rognerud
- University of Oslo, Department of Geosciences, Oslo, Norway
| | - A M Slåtsve
- Nordland Hospital, Division of Diagnostic Services, Department of Microbiology, Bodø, Norway
| | - F Stordal
- University of Oslo, Department of Geosciences, Oslo, Norway
| | - S Stuen
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Section for Small Ruminants Research, Sandnes, Norway
| | - P Wilhelmsson
- Department of Clinical Microbiology, Jönköping, Region Jönköping County, AND Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Xu D, Jenkins A, Ryan C, Keech A, Brown A, Boffa J, O'Dea K, Bursell SE, Brazionis L. Health-related behaviours in a remote Indigenous population with Type 2 diabetes: a Central Australian primary care survey in the Telehealth Eye and Associated Medical Services Network [TEAMSnet] project. Diabet Med 2019; 36:1659-1670. [PMID: 31385331 DOI: 10.1111/dme.14099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2019] [Indexed: 12/01/2022]
Abstract
AIM There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. METHODS We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well-being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. RESULTS At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 - 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high-risk or likely-dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate-severe depressive symptoms. CONCLUSIONS Our SNAPE survey tool results present a high-risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long-term health.
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Affiliation(s)
- D Xu
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
| | - A Jenkins
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
| | - C Ryan
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - A Keech
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, SA
| | - J Boffa
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - K O'Dea
- The University of Melbourne, Melbourne, VIC
| | - S E Bursell
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, NSW
- The University of Melbourne, Melbourne, VIC
- Telehealth Research Institute, University of Hawaii, Hawaii, HI, USA
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Johnsen S, Madsen M, Linder M, Sulo G, Ghanima W, Gislason G, Halvorsen S, Hohnloser SH, Jenkins A, Al-Khalili F, Tell GS, Ehrenstein V. P3470Comparative effectiveness and safety of non-vitamin K oral anticoagulants and warfarin in non-valvular atrial fibrillation - a cohort study in 3 Nordic countries. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-vitamin K oral anticoagulants (NOACs) are an alternative to warfarin in the prevention of stroke in non-valvular atrial fibrillation (NVAF). Nordic countries have high quality of warfarin treatment, making them an especially suitable setting for assessing effectiveness and safety of NOACs against warfarin.
Purpose
The BEYOND Pooled (BEnefit of NOACs studY of nOn-valvular AF patieNts in NorDic countries) study compared risks of ischaemic or haemorrhagic stroke/systemic embolism (S/SE), and risk of bleeding with acute hospitalisation with an overnight stay (bleeding) in NVAF patients treated with apixaban, dabigatran or rivaroxaban, each compared with warfarin treatment.
Methods
A cohort study of treatment-naïve adult NVAF patients dispensed apixaban, dabigatran, rivaroxaban or warfarin was identified from 01 Jan 2013 to 31 Dec 2016. The population and study variables were identified from national registries in Denmark, Norway and Sweden. After 1:1 propensity score (PS) matching for each NOAC-warfarin comparison, individual-level data were pooled across the countries. Cox proportional-hazards regression was used to estimate adjusted hazard ratios (aHRs) of the endpoints.
Results
PS matched NOAC cohort sizes were: apixaban (55,696) dabigatran (28,526) and rivaroxaban (30,701), and the total follow-up in the PS-matched population was 291,171 years (mean 1.3 years). During the follow-up, 35,450 oral anticoagulation (OAC) patients had a S/SE and 38,620 OAC patients had bleeding. Adjusted HRs for the two endpoints are presented in the table. PH assumption has not been formally tested but cum incidence curves did not indicate substantial differences in the effects over time.
Table 1. Adjusted hazard ratios (aHR) of stroke/systemic embolism and bleeding for non-vitamin K oral anticoagulants versus warfarin Endpoint Apixaban vs Warfarin: aHR (95% CI) Dabigatran vs Warfarin: aHR (95% CI) Rivaroxaban vs Warfarin: aHR (95% CI) Stroke/SE 0.93 (0.85–1.03) 0.89 (0.80–1.00) 0.97 (0.88–1.08) Bleeding 0.72 (0.67–0.77) 0.87 (0.80–0.95) 1.12 (1.04–1.20)
Conclusions
Relative to warfarin, apixaban and dabigatran were associated with lower rates of bleeding whereas rivaroxaban was associated with a higher rate. The three NOACs had comparable rates of stroke and systemic embolism relative to warfarin.
Acknowledgement/Funding
This study was funded by the Pfizer/Bristol-Myers Squibb Alliance.
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Affiliation(s)
- S Johnsen
- Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M Linder
- Karolinska Institute, Centre for Pharmacoepidemiology, Stockholm, Sweden
| | - G Sulo
- Norwegian Institute of Public Health, Centre for Disease Burden, Bergen, Norway
| | - W Ghanima
- Oestfold Hospital Trust, Department of Hematology, Fredrikstad, Norway
| | - G Gislason
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - S Halvorsen
- Ulleval University Hospital, Department of Cardiology, Oslo, Norway
| | - S H Hohnloser
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - A Jenkins
- Pfizer Ltd, Tadworth, United Kingdom
| | - F Al-Khalili
- Sophiahemmets Hospital, Heart, Lung and Allergy Clinic, Stockholm, Sweden
| | - G S Tell
- University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
| | - V Ehrenstein
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
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Moore J, Raine T, Jenkins A, Livens F, Law K, Morris K, Law G, Yeates S. Decontamination of caesium and strontium from stainless steel surfaces using hydrogels. REACT FUNCT POLYM 2019. [DOI: 10.1016/j.reactfunctpolym.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Jenkins A, Bhuva AN, Hughes AD, Manisty CH, Moon JC, Treibel TA. P432aortic stenosis. the role of aortoseptal angulation as a predictive factor for asymmetrical septal hypertrophy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Jenkins
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A N Bhuva
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A D Hughes
- University College London, London, United Kingdom of Great Britain & Northern Ireland
| | - C H Manisty
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J C Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - T A Treibel
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
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27
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Pitsika M, Nissen J, Jenkins A, Mitchell P. P4 Spinal cord haemangioblastomas: surgical management and clinical outcome. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesSpinal haemangioblastomas are rare tumours that can be either sporadic or as part of the CNS expression of Von Hippel Lindau syndrome (VHL). The aim of this study was to identify the characteristics of the haemangioblastomas both in sporadic and in VHL cases and to assess the outcome of the surgical management.MethodsWe retrospectively reviewed all spinal haemangioblastomas that were operated between 2004 and 2017 including clinical letters, MRIs and pathology reports.ResultsA total of 14 patients underwent excision of a spinal haemangioblastoma. Average follow up time was 50 months (range 4–164 months). The location was: medulla n=3, cervical region n=4, thoracic region n=5 and conus n=2. Six patients had VHL (42%) and from those n=5 had more than one lesion. A syrinx was present in n=9 cases (VHL n=6, multiple lesions n=5) and 2 had a syringoperitoneal shunt inserted followed by excision of the haemangioblastoma. In all but one case a total excision was achieved and the syrinx disappeared or improved in 6 cases. A clinical improvement was seen in n=10 patients, in n=2 a deterioration was seen post-operatively and in n=2 new symptoms developed during their follow up from the other lesions. None of the haemangioblastomas that were removed recurred.ConclusionsTotal excision of spinal haemangioblastomas offers a good outcome with possible cure in cases of a single lesion. Patients with VHL present more commonly with multiple lesions and large syrinxes which pose a challenge to the surgical management.
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Cao J, Waldman B, O’Connell R, Sullivan D, Gebski V, Marschner I, Scott R, Taskinen M, Simes J, McGill N, Jenkins A, Keech A. Baseline and Short-Term Change in Plasma Uric Acid on Fenofibrate Predict Cardiovascular Risk: A Post Hoc Analysis of FIELD. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sivashanmugarajah A, Fulcher J, Sullivan D, Jenkins A, Keech A. A Suggested Clinical Approach for the Diagnosis and Management of ‘Statin Intolerance’. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jenkins A, Capon A, Negin J, Marais B, Sorrell T, Parkes M, Horwitz P. Watersheds in planetary health research and action. Lancet Planet Health 2018; 2:e510-e511. [PMID: 30526933 DOI: 10.1016/s2542-5196(18)30228-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Aaron Jenkins
- School of Public Health, University of Sydney, Westmead, NSW 2145, Australia; Centre for Ecosystem Management, Edith Cowan University, Joondalup, Australia.
| | - Anthony Capon
- School of Public Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Joel Negin
- School of Public Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Ben Marais
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Tania Sorrell
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Margot Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Pierre Horwitz
- Centre for Ecosystem Management, Edith Cowan University, Joondalup, Australia
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Finnigan-Fox G, Allen L, Matlock D, Jenkins A. THE COST CONUNDRUM: NAVIGATING DISCUSSIONS AROUND COST FOR HEART FAILURE MEDICATIONS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - L Allen
- University of Colorado Denver
| | - D Matlock
- University of Colorado School of Medicine
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Farrell LJ, Lo R, Wanford JJ, Jenkins A, Maxwell A, Piddock LJV. Revitalizing the drug pipeline: AntibioticDB, an open access database to aid antibacterial research and development. J Antimicrob Chemother 2018; 73:2284-2297. [DOI: 10.1093/jac/dky208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L J Farrell
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - R Lo
- School of Biological Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- Department of Biological Chemistry, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
| | - J J Wanford
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - A Jenkins
- British Society for Antimicrobial Chemotherapy, Griffin House, 53 Regent Place, Birmingham B1 3NJ, UK
| | - A Maxwell
- Department of Biological Chemistry, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, UK
| | - L J V Piddock
- Institute of Microbiology & Infection, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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34
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Brazionis L, Jenkins A, Keech A, Ryan C, Brown A, Boffa J, Bursell S. Diabetic retinopathy in a remote Indigenous primary healthcare population: a Central Australian diabetic retinopathy screening study in the Telehealth Eye and Associated Medical Services Network project. Diabet Med 2018; 35:630-639. [PMID: 29405370 DOI: 10.1111/dme.13596] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 01/29/2023]
Abstract
AIM To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. METHODS A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy. RESULTS Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19-86) years and known diabetes duration 9.0 (0-24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases. CONCLUSIONS A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of 'any' diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404.
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Affiliation(s)
- L Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - A Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Australia
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - A Keech
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - C Ryan
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - A Brown
- SAHMRI, University of South Australia, Adelaide, Australia
| | - J Boffa
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - S Bursell
- National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia
- Telehealth Research Unit, University of Hawaii, HI, USA
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35
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Smith JA, Andersen TJ, Shortt M, Gaffney AM, Truffer M, Stanton TP, Bindschadler R, Dutrieux P, Jenkins A, Hillenbrand CD, Ehrmann W, Corr HFJ, Farley N, Crowhurst S, Vaughan DG. Erratum: Corrigendum: Sub-ice-shelf sediments record history of twentieth-century retreat of Pine Island Glacier. Nature 2017; 549:292. [DOI: 10.1038/nature23650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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36
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Kolb I, Stoy WA, Rousseau EB, Moody OA, Jenkins A, Forest CR. Cleaning patch-clamp pipettes for immediate reuse. Sci Rep 2016; 6:35001. [PMID: 27725751 PMCID: PMC5057089 DOI: 10.1038/srep35001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/22/2016] [Indexed: 01/19/2023] Open
Abstract
Patch-clamp recording has enabled single-cell electrical, morphological and genetic studies at unparalleled resolution. Yet it remains a laborious and low-throughput technique, making it largely impractical for large-scale measurements such as cell type and connectivity characterization of neurons in the brain. Specifically, the technique is critically limited by the ubiquitous practice of manually replacing patch-clamp pipettes after each recording. To circumvent this limitation, we developed a simple, fast, and automated method for cleaning glass pipette electrodes that enables their reuse within one minute. By immersing pipette tips into Alconox, a commercially-available detergent, followed by rinsing, we were able to reuse pipettes 10 times with no degradation in signal fidelity, in experimental preparations ranging from human embryonic kidney cells to neurons in culture, slices, and in vivo. Undetectable trace amounts of Alconox remaining in the pipette after cleaning did not affect ion channel pharmacology. We demonstrate the utility of pipette cleaning by developing the first robot to perform sequential patch-clamp recordings in cell culture and in vivo without a human operator.
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Affiliation(s)
- I Kolb
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - W A Stoy
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 USA
| | - E B Rousseau
- Colleges of Nanoscale Science and Engineering, SUNY Polytechnic Institute, Albany, NY, 12203 USA
| | - O A Moody
- Neuroscience Graduate Program, GDBBS, Emory University, Atlanta, GA, 30322 USA
| | - A Jenkins
- Department of Pharmacology, Emory University School of Medicine, Atlanta, GA, 30322 USA.,Department of Anesthesiology, Emory University, Atlanta, GA, 30322 USA
| | - C R Forest
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta GA, 30332 USA
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37
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Royer P, Weber L, Jenkins A, Sanders J, Gawron L, Turok D. Family planning knowledge and contraceptive use among resettled African refugee women. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Royer P, Jenkins A, Weber L, Jackson B, Sanders J, Turok D. Group versus individual contraceptive counseling for resettled African refugee women: a pilot randomized controlled trial. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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39
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Abstract
Deep brain stimulation for movement disorders is becoming a commonly used procedure. In this article we describe a complication which has not been described previously. Post op intra-cranial air must be considered as a possible complication of DBS insertion and should be on the list of differentials if a patient presents with post operative neurological deficit.
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Affiliation(s)
- M A Hussain
- a Royal Victoria Infirmary , Newcastle Upon Tyne , UK
| | - A Jenkins
- a Royal Victoria Infirmary , Newcastle Upon Tyne , UK
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40
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King E, Yuan J, Kong S, Dunn L, Stocker R, Keech A, Jenkins A, Ng M. Hypoxia Tolerance in Diabetes Mellitus: The Role of Fenofibrate in Facilitating Protective Metabolic Reprogramming. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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41
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Jenkins A, Archer SN, von Schantz M. Expansion during Primate Radiation of a Variable Number Tandem Repeat in the Coding Region of the Circadian Clock Gene Period3. J Biol Rhythms 2016; 20:470-2. [PMID: 16267386 DOI: 10.1177/0748730405278442] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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42
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Manski-Nankervis J, Yates CJ, Blackberry I, Furler J, Ginnivan L, Cohen N, Jenkins A, Vasanthakumar S, Gorelik A, Young D, Best J, O'Neal D. Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study. Diabet Med 2016; 33:803-11. [PMID: 26435033 DOI: 10.1111/dme.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 01/13/2023]
Abstract
AIM To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare. METHODS We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change. RESULTS Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction (r = -0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia. CONCLUSION Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.
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Affiliation(s)
- J Manski-Nankervis
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - C J Yates
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - I Blackberry
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
- La Trobe University, Wodonga, Vic., Australia
| | - J Furler
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - L Ginnivan
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - N Cohen
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - A Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Vasanthakumar
- Monash Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia
| | - A Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - D Young
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - J Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - D O'Neal
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Vic., Australia
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43
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De Ron P, Dremier S, Winlow P, Jenkins A, Hanon E, Nogueira da Costa A. Correlating behaviour and gene expression endpoints in the dopaminergic system after modafinil administration in mouse. Eur Neuropsychopharmacol 2016; 26:729-40. [PMID: 26875113 DOI: 10.1016/j.euroneuro.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
The mechanisms of action of modafinil continue to be poorly characterised and its potential for abuse in preclinical models remains controverted. The aim of this study was to further elucidate the mechanism of action of modafinil, through a potential behavioural and molecular association in the mouse. A conditioned place preference (CPP) paradigm was implemented to investigate the rewarding properties of modafinil. Whole genome expression and qRT-PCR analysis were performed on the ventral tegmental area (VTA), nucleus accumbens (NAC) and prefrontal cortex (PFC) of modafinil-treated and control animals. Modafinil administration (65 mg/kg) induced an increase in locomotor activity, an increase in the change of preference for the drug paired side after a conditioning period as well as changes to gene expression profiles in the VTA (120 genes), NAC (23 genes) and PFC (19 genes). A molecular signature consisting of twelve up-regulated genes was identified as common to the three brain regions. Multiple linear correlation analysis showed a strong correlation (R(2)>0.70) between the behavioural and molecular endpoints in the three brain regions. We show that modafinil had a concomitant effect on CPP, locomotor activity, and up-regulation of interferon-γ (IFN-γ) regulated genes (Gbp2, Gbp3, Gbp10, Cd274, Igtp), while correlating the latter set of genes with behaviour changes evaluated through the CPP. A potential association can be proposed based on the dysregulation of p47 family genes and Gbp family of IFN-γ induced GTPases. In conclusion, these findings suggest a link between the behavioural and molecular events in the context of modafinil administration.
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Affiliation(s)
- P De Ron
- Non-Clinical Development, UCB Biopharma SPRL, Belgium
| | - S Dremier
- Non-Clinical Development, UCB Biopharma SPRL, Belgium
| | - P Winlow
- Non-Clinical Development, UCB Biopharma SPRL, Belgium
| | - A Jenkins
- Non-Clinical Development, UCB Biopharma SPRL, Belgium
| | - E Hanon
- CNS Research, UCB Biopharma SPRL, Belgium
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Ridha E, Donaldson R, Lefevre C, Ramagopalan S, Lister S, Jenkins A, Evans D, Minns I, Lacoin L. ANTICOAGULATION CONTROL IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION TREATED WITH VITAMIN K ANTAGONIST THERAPY FOR 12 MONTHS OR MORE IN PRIMARY CARE IN THE UK. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kingsley J, Patrick R, Horwitz P, Parkes M, Jenkins A, Massy C, Henderson-Wilson C, Arabena K. Exploring Ecosystems and Health by Shifting to a Regional Focus: Perspectives from the Oceania EcoHealth Chapter. Int J Environ Res Public Health 2015; 12:12706-22. [PMID: 26473903 PMCID: PMC4626995 DOI: 10.3390/ijerph121012706] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/20/2015] [Accepted: 10/09/2015] [Indexed: 11/18/2022]
Abstract
This article highlights contributions that can be made to the public health field by incorporating "ecosystem approaches to health" to tackle future environmental and health challenges at a regional level. This qualitative research reviews attitudes and understandings of the relationship between public health and the environment and the priorities, aspirations and challenges of a newly established group (the Oceania EcoHealth Chapter) who are attempting to promote these principles. Ten semi-structured interviews with Oceania EcoHealth Chapter members highlighted the important role such groups can play in informing organisations working in the Oceania region to improve both public health and environmental outcomes simultaneously. Participants of this study emphasise the need to elevate Indigenous knowledge in Oceania and the role regional groups play in this regard. They also emphasis that regional advocacy and ecosystem approaches to health could bypass silos in knowledge and disciplinary divides, with groups like the Oceania EcoHealth Chapter acting as a mechanism for knowledge exchange, engagement, and action at a regional level with its ability to bridge the gap between environmental stewardship and public health.
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Affiliation(s)
- Jonathan Kingsley
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3010, Australia.
| | - Rebecca Patrick
- School of Health & Social Development, Deakin University, Melbourne 3125, Australia.
| | - Pierre Horwitz
- School of Natural Sciences, Edith Cowan University, Joondalup 6027, Australia.
| | - Margot Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George V2N4Z9, Canada.
| | - Aaron Jenkins
- School of Natural Sciences, Edith Cowan University, Joondalup 6027, Australia.
| | - Charles Massy
- Fenner School for Environment and Society, Australian National University, Canberra 2601, Australia.
| | | | - Kerry Arabena
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3010, Australia.
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Xu S, Alexander K, Bryant W, Cohen N, Craig ME, Forbes M, Fulcher G, Greenaway T, Harrison N, Holmes-Walker DJ, Howard G, Jackson J, Jenkins A, Kamp M, Kaye J, Sinha A, Stranks S, O'Neal D, Colman P. Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia. Intern Med J 2015; 45:86-93. [PMID: 25370368 DOI: 10.1111/imj.12619] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/22/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Healthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care. AIM This study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery. METHODS Twenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT. RESULTS Data on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 ± 6.4 weeks for 895 patients; age 35.4 ± 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 ± 2.8, dietitians 0.4 ± 0.2 and doctors 1.0 ± 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 ± 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively. CONCLUSIONS IPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.
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Affiliation(s)
- S Xu
- St Vincent's Hospital, Melbourne, Victoria, Australia
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Argyropulo-Palmer M, Jenkins A, Theti DS, Larkin J, Montgomery D. Sunitinib in Metastatic Renal Cell Carcinoma: A Systematic Review of UK Real World Data. Front Oncol 2015; 5:195. [PMID: 26380224 PMCID: PMC4548684 DOI: 10.3389/fonc.2015.00195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/11/2015] [Indexed: 12/03/2022] Open
Abstract
Background Real world data (RWD) are increasingly used to inform drug reimbursement decisions, but it is unclear how well outcomes from real world studies compare to those of clinical trials. This systematic review seeks to compare outcomes for sunitinib in routine UK clinical practice with the sunitinib registrational and expanded-access program clinical trials. Method Systematic review of the real world published literature was undertaken. UK observational studies recording first- or second-line sunitinib efficacy were included. A qualitative summary of the results and comparison to the controlled clinical trials was conducted. Fifteen real world studies were included, 14 of which were only available as posters/presentations. Results Real world study reporting quality was generally low, making comparisons with the clinical trials difficult. Practice relating to starting dose, dose modification, timing of therapy initiation, and other factors varied between centers. Median progression-free survival and adverse events were generally comparable to the clinical trial outcomes, but overall survival was not. Conclusion There are few published data on sunitinib use in UK clinical practice. Studies are characterized by lack of peer reviewed publication and heterogeneity in design, reporting, and analysis. For use of RWD in the reimbursement setting, data collection and reporting will need to improve. Highlights There are few published data on sunitinib use in UK clinical practice. Studies are characterized by lack of peer reviewed publication and heterogeneity in design, reporting, and analysis. Practice varies considerably between different UK centers. Median progression-free survival and adverse events are generally comparable to the clinical trial outcomes, but overall survival is not. For use of real world data in the reimbursement setting, data collection and reporting will need to improve.
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Affiliation(s)
| | | | | | - James Larkin
- Department of Medical Oncology, The Royal Marsden Hospital , London , UK
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Lebrun R, Jenkins A, Dussaux A, Locatelli N, Tsunegi S, Grimaldi E, Kubota H, Bortolotti P, Yakushiji K, Grollier J, Fukushima A, Yuasa S, Cros V. Understanding of Phase Noise Squeezing Under Fractional Synchronization of a Nonlinear Spin Transfer Vortex Oscillator. Phys Rev Lett 2015; 115:017201. [PMID: 26182117 DOI: 10.1103/physrevlett.115.017201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Indexed: 06/04/2023]
Abstract
We investigate experimentally the synchronization of vortex based spin transfer nano-oscillators to an external rf current whose frequency is at multiple integers, as well as at an integer fraction, of the oscillator frequency. Through a theoretical study of the locking mechanism, we highlight the crucial role of both the symmetries of the spin torques and the nonlinear properties of the oscillator in understanding the phase locking mechanism. In the locking regime, we report a phase noise reduction down to -90 dBc/Hz at 1 kHz offset frequency. Our demonstration that the phase noise of these nanoscale nonlinear oscillators can be tuned and eventually lessened, represents a key achievement for targeted radio frequency applications using spin torque devices.
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Affiliation(s)
- R Lebrun
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - A Jenkins
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - A Dussaux
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - N Locatelli
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - S Tsunegi
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - E Grimaldi
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - H Kubota
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - P Bortolotti
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - K Yakushiji
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - J Grollier
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
| | - A Fukushima
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - S Yuasa
- National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - V Cros
- Unité Mixte de Physique CNRS/Thales and Université Paris Sud, 1 Avenue Fresnel, 91767 Palaiseau, France
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Benedict A, Ishak J, Gal P, Proskorovsky I, Cappelleri J, Everiss T, Jones H, Hughes R, Jenkins A. THU0207 Comparative Analysis of the Effectiveness of anti-TNF Therapies in Non-Radiographic Axial Spondyloarthritis Using Novel Statistical Techniques: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rowley D, Jenkins A, Aucharaz K, Urquhart T, Demack S. Do community based activity days benefit childhood cancer patients? Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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