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Kopenhafer L, Thompson A, Chang J, Sikirica S, Masters ET, Cappelleri JC, Peck EY, Maculaitis MC. Patient experience and unmet needs in high-risk nonmuscle-invasive bladder cancer: Insights from qualitative interviews and a cross-sectional survey. Urol Oncol 2024; 42:70.e1-70.e10. [PMID: 38272755 DOI: 10.1016/j.urolonc.2024.01.013] [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] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/04/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES To evaluate patient experience, unmet needs, and burden among patients with high-risk nonmuscle-invasive bladder cancer (HR-NMIBC) treated with Bacillus Calmette-Guérin (BCG). METHODS This cross-sectional study included HR-NMIBC patients who received BCG treatment in the past 3 years. The study, preceded by a focused literature review, was conducted in 2 phases: 1) qualitative interviews with 32 patients in the United States (US), France, Germany, and United Kingdom (UK) and 2) quantitative survey of 150 patients in the US. Both phases of the study assessed patient characteristics, treatment history, experience, and perceptions, as well as side effects, pain, discomfort, and time burden associated with BCG treatment. The quantitative survey included additional items related to BCG treatment satisfaction, health-related quality of life (HRQoL), productivity, and healthcare resource utilization. Descriptive statistics and bivariate subgroup comparisons were reported. RESULTS All patients in both study phases received transurethral resection of the bladder tumor (TURBT). Nearly all patients reported keeping their bladder/avoiding radical cystectomy (RC) was important (99%). Results from the quantitative survey reported a substantial impact to cancer-specific HRQoL of patients, with lower mean scores on physical (64.7), social (62.8), and role functioning (56.7) as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). Most patients (69%) were satisfied overall with BCG treatment, although satisfaction declined with increased number of side effects, higher numbers of BCG administrations, and greater discomfort (all P < 0.05). CONCLUSIONS Most HR-NMIBC patients were satisfied overall with BCG treatment. Approximately half of the patients had stopped BCG treatment, notably, most during the induction phase, suggesting nonadherence to guidelines which recommend maintenance treatment after induction. Future treatments should focus on delaying or avoiding recurrence and cystectomy while reducing patient discomfort and discontinuation prior to completing the recommended course of treatment.
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Batt NM, Rodrigues B, Bloom S, Sawhney R, George ES, Hodge A, Vootukuru N, McCrae C, Sood S, Roberts SK, Dev A, Bell S, Thompson A, Ryan MC, Kemp W, Gow PJ, Sood S, Nicoll AJ. Metabolic-associated fatty liver disease and hepatocellular carcinoma: a prospective study of characteristics and response to therapy. J Gastroenterol Hepatol 2024. [PMID: 38369382 DOI: 10.1111/jgh.16501] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/31/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND AIM The rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population. METHOD Multicenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period. RESULTS Three hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n = 77), MAFLD plus other liver disease (n = 57) (the "mixed" group), and non-MAFLD (n = 179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73 years vs 67 years vs 63 years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate. CONCLUSION Equal to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration.
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Affiliation(s)
- N M Batt
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
| | - B Rodrigues
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
| | - S Bloom
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - R Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - E S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - A Hodge
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - N Vootukuru
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
| | - C McCrae
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
| | - Surbhi Sood
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - S K Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - A Dev
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia
| | - S Bell
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Gastroenterology, Monash Health, Clayton, Victoria, Australia
| | - A Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - M C Ryan
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - W Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - P J Gow
- Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Siddharth Sood
- Department of Gastroenterology and Hepatology, Melbourne Health, Parkville, Victoria, Australia
| | - A J Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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El-Hage D, Gao CX, Bedi G, Guerin A, Francey S, Stavely H, Rickwood D, Telford N, McGorry P, Thompson A, Brown E. Correlates of substance use in a large naturalistic cohort of young people with early and emerging psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1447-1456. [PMID: 36808500 PMCID: PMC10460356 DOI: 10.1007/s00127-023-02436-w] [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: 07/29/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a first episode of psychosis (FEP), sample sizes have been small and less research assesses cohorts at ultrahigh risk of psychosis (UHR). METHODS This study uses data from a naturalistic cohort including UHR and FEP participants (N = 1252) to elucidate clinical correlates of use in the past 3 months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover, network analysis based on use of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed. RESULTS Young people with FEP used substances at significantly higher rates than those at UHR. High concurrence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group, participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not. CONCLUSION A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents the earliest opportunity to address substance use early to improve outcomes.
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Affiliation(s)
- D El-Hage
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - C X Gao
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - G Bedi
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - A Guerin
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - S Francey
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - H Stavely
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - D Rickwood
- Headspace National, Melbourne City, VIC, Australia
- University of Canberra, Bruce, ACT, Australia
| | - N Telford
- Headspace National, Melbourne City, VIC, Australia
| | - P McGorry
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - A Thompson
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, Australia
| | - Ellie Brown
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.
- Orygen, 35 Poplar Road, Parkville, VIC, Australia.
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Rieu R, Prestwich RJ, Paterson C, Vohra S, Swan A, Noble D, Srinivasan D, Dixon L, Chiu K, Scott A, Mendes R, Khan S, Pilar A, Thompson A, Nutting CM, McPartlin A. A Multicenter Study of Clinician and Patient Reported Acute and Late Toxicity after Radical (Chemo)Radiotherapy for Non-Endemic Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e619. [PMID: 37785855 DOI: 10.1016/j.ijrobp.2023.06.2001] [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] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Curative (chemo)radiotherapy ((CT)RT) for Nasopharyngeal cancers (NPC) achieves excellent disease control but is associated with significant late toxicities despite modern treatment delivery. Contemporary late toxicity data, including patient reported outcomes (PROs), is limited in the non-endemic population; we present a large contemporary series of toxicity outcomes and late PROs following treatment of non-endemic NPC. MATERIALS/METHODS Adult patients completing radical (CT)RT for primary NPC between February 2016 and 2020 at 7 large UK cancer centers were identified on institutional databases. Patients were excluded if they had prior head and neck cancer or prior therapeutic head and neck surgery (except neck dissection). Patients with an active other cancer were excluded from PRO assessment. Demographic, treatment, acute toxicity and outcome data were collected retrospectively from patient records. Disease-free patients were invited to complete an M.D. Anderson Dysphagia Index (MDADI) and University of Washington (UoW) Quality of Life (QoL) PROs questionnaires. RESULTS A total of 180 eligible patients were identified: 68% male, median age 54 years, 11% ≥70 years. EBV status was positive in 61% (unknown 12%). Patients had stage I (5%), II (22%), III (37%), IV (36%) disease; 95% were performance status ≤1 at baseline. Median follow-up was 31.2 months (range 0-68). A total of 54% received 70Gy in 33-35# and 43% received 65-66 Gy in 30-33#. 66% received induction and 65% received concurrent chemotherapy. 9.5% had residual disease at the first follow-up scan. Subsequent locoregional or distant recurrence occurred in 5% and 12% respectively. At last assessment, 84% patients were alive, 16% had died (of which 70% had active disease). Acute treatment toxicity included: 63% of patients required enteral support (median duration 98 days) with 9% a feeding tube at 1 year post treatment. 18% G3 dermatitis, 53% G3 mucositis. 82% requiring opioids and 40% admitted for symptom management. 90 patients completed the PROs (76% response rate) at a median of 37.8 months post treatment (Table 1). These demonstrate significant QoL detriment: 28% report significant pain, 24% require regular analgesia, and 59% report significant impact on daily activity. This was found to persist at different timepoints (not shown). CONCLUSION Excellent cancer survival outcomes are seen in a non-selected, non-endemic NPC population. However significant acute and late toxicity following radical treatment is identified which can profoundly negatively impact QoL in a relatively young cohort. This highlights the importance of ongoing efforts to reduce toxicity and supports the prospective evaluation of potential toxicity sparing technologies, such as proton beam radiotherapy.
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Affiliation(s)
- R Rieu
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R J Prestwich
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - C Paterson
- Beatson West of Scotland Cancer Centre, Radiation Oncology Department, Glasgow, United Kingdom
| | - S Vohra
- Beaton West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - D Noble
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, United Kingdom
| | - D Srinivasan
- Western General Hospital, Edinburgh, United Kingdom
| | - L Dixon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, Sheffield, United Kingdom
| | - K Chiu
- Mount Vernon Cancer Centre, Department of Clinical Oncology, Northwood, United Kingdom
| | - A Scott
- Mount Vernon Hospital, Department of Clinical Oncology, Northwood, United Kingdom
| | - R Mendes
- University College London Hospital, London, United Kingdom
| | - S Khan
- University College London Hospital, London, United Kingdom
| | - A Pilar
- University College London Hospital, London, United Kingdom
| | - A Thompson
- North Middlesex University Hospital, Cambridge CB2 8AP, United Kingdom
| | - C M Nutting
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A McPartlin
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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5
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Henderson DAG, Donaghy E, Dozier M, Guthrie B, Huang H, Pickersgill M, Stewart E, Thompson A, Wang HHX, Mercer SW. Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China. BMC Med 2023; 21:319. [PMID: 37620865 PMCID: PMC10463288 DOI: 10.1186/s12916-023-03033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe major policy changes including key 'components', impacts of new models of care, and barriers and facilitators to PCT implementation. METHODS We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym ). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened the titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed. RESULTS A total of 107 studies from 15 countries were included. The most frequently employed component of PCT was the expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with < 20% measuring patient views or satisfaction. Only three studies evaluated the effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes. CONCLUSIONS Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation and mixed findings on impacts. Only a minority of studies described the impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.
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Affiliation(s)
- D A G Henderson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Donaghy
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M Dozier
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - B Guthrie
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - H Huang
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M Pickersgill
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Stewart
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - A Thompson
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - H H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - S W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
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6
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Simon MW, Bataille R, Caldwell NS, Gessner BD, Jodar L, Lamberth E, Peng Y, Scott DA, Lei L, Giardina PC, Gruber WC, Jansen KU, Thompson A, Watson W. Safety and immunogenicity of a multivalent pneumococcal conjugate vaccine given with 13-valent pneumococcal conjugate vaccine in healthy infants: A phase 2 randomized trial. Hum Vaccin Immunother 2023; 19:2245727. [PMID: 37927075 PMCID: PMC10629427 DOI: 10.1080/21645515.2023.2245727] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/01/2023] [Indexed: 11/07/2023] Open
Abstract
Use of pneumococcal conjugate vaccines (PCVs) has led to substantial reductions in the global burden of pediatric pneumococcal disease. Expansion of serotype coverage has been achieved by increasing PCV valency, but this may carry the potential risk of antibody interference. A complementary 7-valent PCV (cPCV7) including polysaccharide conjugates from 7 non-13-valent (PCV13) serotypes was developed to potentially complement PCV13-mediated protection and expand serotype coverage. This study evaluated cPCV7 and PCV13 coadministered in separate limbs or separated in time in infants. This phase 2, multicenter, open-label study included 512 infants randomized 1:1:1 to receive cPCV7 coadministered with PCV13 at ages 2, 4, 6, and 12 months (cPCV7 Coadministered); cPCV7 given at ages 3, 5, 7, and 13 months, 3‒5 weeks after PCV13 (cPCV7 Separated); or PCV13 at ages 2, 4, 6, and 12 months followed by a single supplemental dose of cPCV7 at 13 months (PCV13 Control). Safety evaluations included local reactions, systemic events, and adverse events. Serotype-specific immunoglobulin G concentrations and opsonophagocytic activity titers were assessed. The safety profile of cPCV7 was similar to that of PCV13. cPCV7 was well-tolerated in infants when coadministered with or given separately from PCV13. Robust and functional immune responses for all cPCV7 serotypes were observed in both cPCV7 groups. No immunologic interference was observed for either the cPCV7 or PCV13 serotypes with coadministration. A single cPCV7 dose induced immune responses in toddlers. These findings support potential coadministration of a complementary PCV to supplement protection provided by existing PCVs.Trial registration: ClinicalTrials.gov, NCT03550313.
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Affiliation(s)
- Michael W. Simon
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | | | | | - Bradford D. Gessner
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Luis Jodar
- Vaccines Medical Development and Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Erik Lamberth
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, New York, NY, USA
| | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Lanyu Lei
- Vaccine Research and Development, Pfizer Inc, New York, NY, USA
| | | | | | | | | | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
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7
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Smid CR, Ganesan K, Thompson A, Cañigueral R, Veselic S, Royer J, Kool W, Hauser TU, Bernhardt B, Steinbeis N. Neurocognitive basis of model-based decision making and its metacontrol in childhood. Dev Cogn Neurosci 2023; 62:101269. [PMID: 37352654 PMCID: PMC10329104 DOI: 10.1016/j.dcn.2023.101269] [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] [Received: 09/02/2022] [Revised: 04/16/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
Human behavior is supported by both goal-directed (model-based) and habitual (model-free) decision-making, each differing in its flexibility, accuracy, and computational cost. The arbitration between habitual and goal-directed systems is thought to be regulated by a process known as metacontrol. However, how these systems emerge and develop remains poorly understood. Recently, we found that while children between 5 and 11 years displayed robust signatures of model-based decision-making, which increased during this developmental period, there were substantial individual differences in the display of metacontrol. Here, we inspect the neurocognitive basis of model-based decision-making and metacontrol in childhood and focus this investigation on executive functions, fluid reasoning, and brain structure. A total of 69 participants between the ages of 6-13 completed a two-step decision-making task and an extensive behavioral test battery. A subset of 44 participants also completed a structural magnetic resonance imaging scan. We find that individual differences in metacontrol are specifically associated with performance on an inhibition task and individual differences in thickness of dorsolateral prefrontal, temporal, and superior-parietal cortices. These brain regions likely reflect the involvement of cognitive processes crucial to metacontrol, such as cognitive control and contextual processing.
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Affiliation(s)
- C R Smid
- Department of Psychology and Language Sciences, University College London, United Kingdom.
| | - K Ganesan
- Department of Psychology and Language Sciences, University College London, United Kingdom
| | - A Thompson
- Department of Psychology and Language Sciences, University College London, United Kingdom
| | - R Cañigueral
- Department of Psychology and Language Sciences, University College London, United Kingdom
| | - S Veselic
- Clinical and Movement Neurosciences, Department of Motor Neuroscience, University College London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, United Kingdom
| | - J Royer
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - W Kool
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States
| | - T U Hauser
- Wellcome Centre for Human Neuroimaging, University College London, United Kingdom; Max Planck University College London Centre for Computational Psychiatry and Ageing Research, United Kingdom
| | - B Bernhardt
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - N Steinbeis
- Department of Psychology and Language Sciences, University College London, United Kingdom
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8
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Green C, McGinley J, Sande C, Capone S, Makvandi-Nejad S, Vitelli A, Silva-Reyes L, Bibi S, Otasowie C, Sheerin D, Thompson A, Dold C, Klenerman P, Barnes E, Dorrell L, Rollier C, Pollard A, O’Connor D. Transcriptomic response and immunological responses to chimpanzee adenovirus- and MVA viral-vectored vaccines for RSV in healthy adults. Clin Exp Immunol 2023; 211:269-279. [PMID: 36622786 PMCID: PMC10038321 DOI: 10.1093/cei/uxad003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/30/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
Cohorts of healthy younger adults (18-50yrs) and healthy older adults (60-75yrs) were immunized intramuscularly or intranasally with an adenovirus-vectored RSV vaccine (PanAd3-RSV) as a prime dose and boosted with PanAd3-RSV or a poxvirus-vectored vaccine (MVA-RSV) encoding the same insert. Whole blood gene expression was measured at baseline, 3- and 7-days post vaccination. Intramuscular prime vaccination with PanAd3-RSV induced differential expression of 643 genes (DEGs, FDR < 0.05). Intranasal prime vaccination with PanAd3-RSV did not induce any differentially expressed genes (DEGs) in blood samples at 3 days post vaccination. Intranasally primed participants showed greater numbers of DEGS on boosting than intramuscularly primed participants. The most highly enriched biological processes related to DEGs after both prime and boost vaccination were type-1 interferon related pathways, lymphocytic and humoral immune responses.
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Affiliation(s)
- C Green
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Institute of Microbiology & Infection, University of Birmingham, Birmingham, UK
| | - J McGinley
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - C Sande
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - S Capone
- Experimental Vaccinology Department, ReiThera Srl, Roma, Italy
| | - S Makvandi-Nejad
- Nuffield Department of Medicine, University of Oxford NDM Research Building, Oxford, UK
| | - A Vitelli
- Experimental Vaccinology Department, ReiThera Srl, Roma, Italy
| | - L Silva-Reyes
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - S Bibi
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - C Otasowie
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - D Sheerin
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A Thompson
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - C Dold
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - P Klenerman
- Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - E Barnes
- Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - L Dorrell
- Nuffield Department of Medicine, University of Oxford NDM Research Building, Oxford, UK
| | - C Rollier
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A Pollard
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - D O’Connor
- Oxford Vaccine Group, Department of Paediatrics and the NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Cannon K, Cardona JF, Yacisin K, Thompson A, Belanger TJ, Lee DY, Peng Y, Moyer L, Ginis J, Gruber WC, Scott DA, Watson W. Safety and immunogenicity of a 20-valent pneumococcal conjugate vaccine coadministered with quadrivalent influenza vaccine: A phase 3 randomized trial. Vaccine 2023; 41:2137-2146. [PMID: 36828719 DOI: 10.1016/j.vaccine.2022.11.046] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Older adults are at increased risk of adverse outcomes from pneumococcal disease and influenza infections. Vaccination is an established strategy for preventing both illnesses. This study evaluated coadministration of 20-valent pneumococcal conjugate vaccine (PCV20) and an adjuvanted quadrivalent inactivated influenza vaccine (QIV). METHODS This phase 3, randomized, double-blind, multicenter study included 1796 US adults ≥ 65 years of age randomized 1:1 to receive either PCV20 and QIV followed 1 month later by saline (Coadministration group) or QIV and saline followed 1 month later by PCV20 (Separate Administration group). Primary immunogenicity objectives were to show noninferiority of PCV20 and QIV coadministration compared with separate administration of either vaccine based on serotype-specific opsonophagocytic activity (OPA) titers for PCV20 and strain-specific hemagglutination inhibition assay (HAI) titers for QIV. Safety endpoints included local reactions, systemic events, and adverse events (AEs). RESULTS Noninferiority for pneumococcal and influenza antibody responses (lower bound 95 % CI of the OPA and HAI geometric mean ratios of > 0.5 and > 0.67, respectively) was shown for the Coadministration group compared with the Separate Administration group for all 20 pneumococcal serotypes and all 4 influenza vaccine strains. Local reactions and systemic events were mostly mild or moderate in severity across groups; injection site pain was the most frequent local reaction, and fatigue was the most frequent systemic event. Mild and moderate fatigue were reported more frequently after PCV20 and QIV coadministration compared with separate administration (mild, 20.0 % vs 10.8 %-12.6 %; moderate, 12.3 % vs 8.4 %-9.6 %); this was not considered clinically significant. AE reporting rates were similar across groups, and no serious AEs were considered vaccination-related. CONCLUSIONS Immune responses after coadministration of PCV20 and QIV were noninferior to separate administration of either vaccine. The PCV20 safety profile was similar when given together with or after QIV. These findings support PCV20 and QIV coadministration. TRIAL REGISTRATION ClinicalTrials.gov, NCT04526574.
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Affiliation(s)
- Kevin Cannon
- PMG Research of Wilmington, LLC, 1202 Medical Center Dr, Wilmington, NC 28401, USA.
| | - Jose F Cardona
- Indago Research & Health Center, Inc., 3700 W 12th Ave, Suite 300, Hialeah, FL 33012, USA
| | - Kari Yacisin
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Allison Thompson
- Vaccine Research and Development, Pfizer Inc, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Todd J Belanger
- Vaccine Research and Development, Pfizer Inc, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Dung-Yang Lee
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Lisa Moyer
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - John Ginis
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, 401 North Middletown Rd, Pearl River, NY 10965, USA
| | - Daniel A Scott
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
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Thompson A, Hynicka LM, Shere-Wolfe KD. A Comprehensive Review of Herbal Supplements Used for Persistent Symptoms Attributed to Lyme Disease. Integr Med (Encinitas) 2023; 22:30-38. [PMID: 37101730 PMCID: PMC10124234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Context Lyme disease is the most common, tick-borne disease in the USA. While most patients successfully recover with antibiotics, some patients experience persistent symptoms for months to years. Patients who attribute chronic symptoms to Lyme disease commonly use herbal supplements. The complexity, variability in dose and formulation, and lack of data for these herbal compounds make it difficult to assess their efficacy and safety. Objective This review examines the evidence for the antimicrobial activity, safety, and drug-drug interactions of 18 herbal supplements that patients commonly use for treatment of persistent symptoms attributed to Lyme disease. Design The research team performed a narrative review by searching the PubMed, Embase, Scopus, Natural Medicines databases, and NCCIH website. The search used the keywords for 18 herbal compounds: (1) andrographis (Andrographis paniculate), (2) astragalus (Astragalus propinquus), (3) berberine, (4) cat's claw bark (Uncaria tomentosa), (5) cordyceps (Cordyceps sinensis), (6) cryptolepis (Cryptolepis sanguinolenta), (7) Chinese skullcap (Scutellaria baicalensis), (8) garlic (Allium sativum), (9) Japanese knotwood (Polygonum cuspidatum), (10) reishi mushrooms (Ganoderma lucidum), (11) sarsaparilla (Smilax medica), (12) Siberian ginseng (Eleutherococcus senticosus), (13) sweet wormwood (Artemisia annua), (14) teasle root (Dipsacus fullonum), (15) lemon balm (Melissa officinalis), (16) oil of oregano (Origanum vulgare), (17) peppermint (Mentha x piperita), and (18) thyme (Thymus vulgaris). The team also searched for terms related to protocols, including Dr. Rawls' protocol and the Buhner protocol. Setting University of Maryland Medical Center, Baltimore MD. Results Seven of the 18 herbs reviewed had evidence for in-vitro activity against B. burgdorferi. These compounds included: (1) cat's claw (2) cryptolepis, (3) Chinese skullcap, (4) Japanese knotweed, (5) sweet wormwood, (6) thyme, and (7) oil of oregano. With the exception of oil of oregano these compounds also have anti-inflammatory activity. In vivo data and clinical trials are lacking. Clinicians should be cautious as many of the identified compounds have drug interactions and additive effects that could lead to increased risks for bleeding, hypotension, and hypoglycemia. Conclusions Many of the herbs that alternative and integrative practitioners use to treat Lyme disease have anti-inflammatory effects that may contribute to patients' perceptions of symptomatic improvement. Some herbs have limited demonstrated anti-borrelial activity in vitro, but in-vivo data and clinical trial data is lacking. Further research is required to determine the efficacy, safety and appropriate use of these herbs for this patient population.
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Affiliation(s)
| | - Lauren M. Hynicka
- Associate professor of Pharmacotherapy Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Kalpana D. Shere-Wolfe
- Assistant Professor of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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11
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Petrilla AA, Silverstein AR, Eccleston A, Thompson A, Brinkmann J, Bello T, Chang J, Cappelleri JC, Chandrasekar S, Schroeder AL. Time to event following bacillus Calmette-Guerin therapy initiation in Medicare beneficiaries with intermediate- to high-risk non-muscle invasive bladder cancer, 2010-2019. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.473] [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] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
473 Background: For patients with intermediate- to high-risk non-muscle invasive bladder cancer (NMIBC), standard of care includes transurethral resection (TURBT) followed by induction and maintenance intravesical immunotherapy with Bacillus Calmette-Guerin (BCG). This study describes characteristics and clinical outcomes of Medicare beneficiaries newly diagnosed with NMIBC who initiated BCG therapy following TURBT. Methods: Retrospective cohort study using Centers for Medicare and Medicaid-sourced Medicare Fee-for-Service medical/pharmacy claims (100% sample). Patient selection criteria: ≥1 bladder cancer diagnosis 2010-2019, no prior radiotherapy, systemic therapy, cystectomy, or metastasis in 6 months post-diagnosis, continuously enrolled in Medicare ≥12 months pre- and post-index (or death). Index date = date of first BCG instillation. A literature-based definition for adequate maintenance BCG defined adequate (≥7 instillations of BCG within 274 days of BCG initiation) and inadequate (remainder) BCG therapy for patient stratification. Events: time to BCG discontinuation, radical cystectomy, systemic therapy, radiation, and metastasis. Provider access to BCG (due to supply shortage), patient tolerability, and NMIBC risk status are not captured in claims data. Results: Of 46,052 BCG-treated patients eligible for analysis, 19,859 (43.1%) received adequate BCG therapy. The two cohorts had similar baseline characteristics (Table) and median duration of follow up (46 months). Median (interquartile range [IQR]) time from NMIBC diagnosis to BCG initiation was 2.8 (8.2) months for adequate, 3.7 (14.4) months for inadequate BCG. Time from BCG initiation to discontinuation, radical cystectomy, systemic therapy, radiation, and metastasis are reported in the table. Conclusions: Between 2010 and 2019, 57% of Medicare patients initiating BCG following diagnosis of NMIBC and TURBT may not have received adequate BCG therapy. Patients with inadequate BCG therapy had numerically shorter time to radical cystectomy, systemic therapy, radiation, and metastasis than those with adequate BCG therapy. Characteristics & Outcomes by Cohort. [Table: see text]
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12
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Clark O, Sarmento T, Eccleston A, Brinkmann J, Picoli R, Daliparthi V, Voss J, Chandrasekar S, Thompson A, Chang J. Economic impact of bladder cancer (BC) in the United States (US). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.479] [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] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
479 Background: Incidence and mortality for BC has changed very little over the past 20 years. Approximately 40% of patients with high-risk non-muscle invasive BC eventually recur/progress. It is important to understand the economic impact of disease recurrence/progression in BC. Methods: An economic model was constructed to calculate the number of patients receiving each treatment modality at every stage of disease and their respective costs. Epidemiological data was based on the CancerMPact Patient Metrics (PM) database, and treatment modality data retrieved from CMP Treatment Architecture (TA), 2021 version. Resource utilization and costs were obtained from the medical literature and public data sources. Only direct costs were considered. Results: There were an estimated 83,532 newly diagnosed BC patients of all stages in 2021 with a projected total cost of treatment of $2,584,783,728. Average cost per patient varied from $19,521 (stage 0a) to $169,533 (metastatic disease) (Table). Cost profile differed substantially among the stages of disease. For the 75,760 patients that were expected to have a recurrence in 2021, an additional cost of $3,953,096,316 was estimated at an average cost per patient of $52,179. The expected total cost to treat newly diagnosed and newly recurrent patients is reported in this model, with the total cost in 2021 estimated to exceed $6.5 billion. Conclusions: Treatment and resource costs increase for BC as the disease recurs/progresses. More effective treatments earlier in the disease setting to delay recurrence/progression may reduce the economic burden associated with BC. [Table: see text]
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Pineda D, Bingham RE, Thompson A, Gates A, Stansfield B. Acid/base balance in fortified human milk. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00653-5] [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: 01/28/2023]
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14
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Alsaidi Y, Thompson A, Spilchuk V, House RA, Adisesh A. Cryoglobulins and cold agglutinins for hand arm vibration syndrome. Occup Med (Lond) 2022; 72:609-613. [PMID: 36179074 DOI: 10.1093/occmed/kqac083] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hand arm vibration syndrome (HAVS) is a condition caused by hand transmitted vibration from the use of hand-held vibrating tools or workpieces. The disease affects the vascular, neurological and musculoskeletal systems. The vascular component of HAVS is a form of secondary Raynaud's phenomenon. Other causes of disease must be excluded before attributing the cause to hand transmitted vibration. AIMS To evaluate the prevalence, and utility of testing for, cryoglobulins and cold agglutinins in patients with HAVS symptoms. METHODS A retrospective cohort study of 1183 patients referred for HAVS clinical assessment at St. Michael's Hospital, Toronto, Canada, between 2014 and 2020. The standard operating procedure at the clinic includes a detailed clinical and exposure history, physical examination, objective investigations and blood tests. Data were retrieved from patient chart review and laboratory investigation results for all cases with cryoglobulin and cold agglutinin testing. RESULTS A total of 1183 patients had a serum cryoglobulin measurement. Eleven patients (1%) were positive. Seven positive results were 'low titre' (1% positive) and the other four results were 2%, 6%, 9% and 18%. The patient with a 9% positive cryoglobulin titre had previously diagnosed Sjögren's syndrome. There were no positive cold agglutinin tests in the 795 patients tested. CONCLUSIONS Routine testing for cryoglobulins and cold agglutinins in patients with HAVS symptoms is not recommended because test positivity rates are negligible. Testing may be considered if the clinical history or routine blood investigations suggest evidence of underlying cryoglobulinaemia or cold agglutinin disease.
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Affiliation(s)
- Y Alsaidi
- Division of Occupational Medicine, Department of Medicine, University of Toronto and St. Michael's Hospital, Toronto, Canada
| | - A Thompson
- Division of Occupational Medicine, Department of Medicine, University of Toronto and St. Michael's Hospital, Toronto, Canada
| | - V Spilchuk
- Division of Occupational Medicine, Department of Medicine, University of Toronto and St. Michael's Hospital, Toronto, Canada
| | - R A House
- Division of Occupational Medicine, Department of Medicine, University of Toronto and St. Michael's Hospital, Toronto, Canada
| | - A Adisesh
- Division of Occupational Medicine, Department of Medicine, University of Toronto and St. Michael's Hospital, Toronto, Canada
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Seneviratne D, DeWees T, Buras M, Beuerlein W, Chumsri S, Thompson A, Thorpe C, Vallow L, Pockaj B, Cronin P, Halyard M, Vern-Gross T, McGee L, Mclaughlin S, Zot P, Vargas C. Assessing the Relationship between Residual Cancer Burden and the Tumor Immune-Microenvironment in Early-Stage, Hormone Receptor-Positive Breast Cancer Following Preoperative Radiation Therapy in MC1732 Clinical Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.697] [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: 10/31/2022]
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16
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Connor C, Yap MBH, Warwick J, Birchwood M, De Valliere N, Madan J, Melvin GA, Padfeld E, Patterson P, Petrou S, Raynes K, Stewart-Brown S, Thompson A. Correction: An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol. Trials 2022; 23:919. [PMID: 36316757 PMCID: PMC9620662 DOI: 10.1186/s13063-022-06870-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C. Connor
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - M. B. H. Yap
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - J. Warwick
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - M. Birchwood
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - N. De Valliere
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - J. Madan
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - G. A. Melvin
- grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - E. Padfeld
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - P. Patterson
- grid.498025.20000 0004 0376 6175Birmingham Women’s & Children’s NHS Foundation Trust, Birmingham, UK
| | - S. Petrou
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - K. Raynes
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - S. Stewart-Brown
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - A. Thompson
- grid.7372.10000 0000 8809 1613University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
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Ridley J, Huff M, Thompson A, Masood A, Vela E. 303 Improving Obstetrical Trauma Care Using a Standardized Protocol. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.331] [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: 11/17/2022]
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18
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Hafeez S, Koh M, Jones K, El Ghzal A, D'Arcy J, Kumar P, Khoo V, Lalondrelle S, McDonald F, Thompson A, Scurr E, Sohaib A, Huddart R. Assessing Bladder Radiotherapy Response With Quantitative Diffusion-Weighted Magnetic Resonance Imaging Analysis. Clin Oncol (R Coll Radiol) 2022; 34:630-641. [PMID: 35534398 DOI: 10.1016/j.clon.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
AIMS Radiotherapy with radiosensitisation offers opportunity for cure with organ preservation in muscle-invasive bladder cancer (MIBC). Treatment response assessment and follow-up are reliant on regular endoscopic evaluation of the retained bladder. In this study we aim to determine the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) analysis to assess bladder radiotherapy response. MATERIALS AND METHODS Patients with T2-T4aN0-3M0 MIBC suitable for radical radiotherapy were recruited prospectively to an ethics approved protocol. Following transurethral resection of the bladder tumour and prior to any treatment, magnetic resonance imaging including DWI was performed on a 1.5T system using b values of 0, 100, 150, 250, 500, 750 s/mm2. DWI was repeated 3 months after completing radiotherapy. Cystoscopy and tumour site biopsy were undertaken following this. The response was dichotomised into response ( RESULTS Thirty-four patients were evaluated. Response was associated with a significant increase in ΔADC mean compared with poor response at ΔADCall (0.57 × 10-3 mm2/s versus -0.01 × 10-3 mm2/s; P < 0.0001) and ΔADCb100 (0.58 × 10-3 mm2/s versus -0.10 x 10-3 mm2/s; P = 0.007). A 48.50% increase in %ΔADCall mean was seen in response compared with a 1.37% decrease in poor response (P < 0.0001). This corresponded to a %ΔADCb100 mean increase of 50.34% in response versus a 7.36% decrease for poor response (P < 0.0001). Significant area under the curve (AUC) values predictive of radiotherapy response were identified at ΔADC and %ΔADC for ADCall and ADCb100 mean, 10th, 25th, 50th, 75th and 90th percentiles (AUC >0.9, P < 0.01). ΔADCall mean of 0.16 × 10-3 mm2/s and ΔADCb100 mean 0.12 × 10-3 mm2/s predicted radiotherapy response with sensitivity/specificity/positive predictive value/negative predictive value of 92.9%/100.0%/100.0%/75.0% and 89.3%/100.0%/100.0%/66.7%, respectively. CONCLUSIONS Quantitative DWI analysis can successfully provide non-invasive assessment of bladder radiotherapy response. Multicentre validation is required before prospective testing to inform MIBC radiotherapy follow-up schedules and decision making.
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Affiliation(s)
- S Hafeez
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - M Koh
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - K Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - A El Ghzal
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - J D'Arcy
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - P Kumar
- The Royal Marsden NHS Foundation Trust, London, UK
| | - V Khoo
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Lalondrelle
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - F McDonald
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - A Thompson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Scurr
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A Sohaib
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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Nigrovic L, Neville D, Chapman L, Kharbanda A, Balamuth F, Levas M, Thompson A, Gerstbrein D, Buchan B. 5EMF Frequency of Tick-borne Coinfections in Children With Suspected Lyme Disease. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.027] [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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20
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Meyer C, Zeidan A, Beshara G, Cortes J, Tibbetts C, Tracy BM, Jayaraman Muralidharan V, Sola R, Hernandez Irizarry R, Williams K, Thompson A, Todd S, Sciarretta J, Smith R. Characterizing injury patterns and outcomes in hospitalized trauma patients with non-English Language Preferences. Am J Surg 2022; 225:948-952. [DOI: 10.1016/j.amjsurg.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/27/2022]
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Mullan K, Ferris K, Thompson A, Loughran C. ALLERGIC CONTACT DERMATITIS TO A COMMON TOPICAL ACNE TREATMENT - AN UNFAMILIAR MIMIC OF ANGIOEDEMA. Ulster Med J 2022; 91:167-169. [PMID: 36474842 PMCID: PMC9720594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- K Mullan
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
| | - K Ferris
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland,Centre for Medical Education, Queens University Belfast
| | - A Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland,Corresponding Author- Dr.Andrew Thompson ()
| | - C Loughran
- Department of Paediatrics, Royal Belfast Hospital for Sick Children (RBHSC), Belfast, N. Ireland
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Thompson A, Chavas L, Isabet T, Jamme F, Montaville P, Perez J, Pineau B, Susini J, Lassalle B, Eric L, Pierre-Damien C. New opportunities for integrated structural biology at fourth-generation synchrotron sources. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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23
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Connor C, Mbh Y, Warwick J, Birchwood M, De Valliere N, Madan J, Melvin GA, Padfield E, Patterson P, Petrou S, Raynes K, Stewart-Brown S, Thompson A. An online parenting intervention to prevent affective disorders in high-risk adolescents: the PIPA trial protocol. Trials 2022; 23:655. [PMID: 35971178 PMCID: PMC9376903 DOI: 10.1186/s13063-022-06563-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent depression can place a young person at high risk of recurrence and a range of psychosocial and vocational impairments in adult life, highlighting the importance of early recognition and prevention. Parents/carers are well placed to notice changes in their child's emotional wellbeing which may indicate risk, and there is increasing evidence that modifiable factors exist within the family system that may help reduce the risk of depression and anxiety in an adolescent. A randomised controlled trial (RCT) of the online personalised 'Partners in Parenting' programme developed in Australia, focused on improving parenting skills, knowledge and awareness, showed that it helped reduce depressive symptoms in adolescents who had elevated symptom levels at baseline. We have adapted this programme and will conduct an RCT in a UK setting. METHODS In total, 433 family dyads (parents/carers and children aged 11-15) will be recruited through schools, social media and parenting/family groups in the UK. Following completion of screening measures of their adolescent's depressive symptoms, parents/carers of those with elevated scores will be randomised to receive either the online personalised parenting programme or a series of online factsheets about adolescent development and wellbeing. The primary objective will be to test whether the personalised parenting intervention reduces depressive symptoms in adolescents deemed at high risk, using the parent-reported Short Mood & Feelings Questionnaire. Follow-up assessments will be undertaken at 6 and 15 months and a process evaluation will examine context, implementation and impact of the intervention. An economic evaluation will also be incorporated with cost-effectiveness of the parenting intervention expressed in terms of incremental cost per quality-adjusted life year gained. DISCUSSION Half of mental health problems emerge before mid-adolescence and approximately three-quarters by mid-20s, highlighting the need for effective preventative strategies. However, few early interventions are family focused and delivered online. We aim to conduct a National Institute for Health and Care Research (NIHR) funded RCT of the online personalised 'Partners in Parenting' programme, proven effective in Australia, targeting adolescents at risk of depression to evaluate its effectiveness, cost-effectiveness and usability in a UK setting. TRIAL REGISTRATION {2A}: ISRCTN63358736 . Registered 18 September 2019.
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Affiliation(s)
- C Connor
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - Yap Mbh
- Monash University, Melbourne, Australia
| | - J Warwick
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - M Birchwood
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - N De Valliere
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - J Madan
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | | | - E Padfield
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - P Patterson
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - S Petrou
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - K Raynes
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - S Stewart-Brown
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - A Thompson
- University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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Papaluca T, Craigie A, McDonald L, Edwards A, Winter R, Hoang A, Pappas A, Waldron A, McCoy K, Stoove M, Doyle J, Hellard M, Holmes J, MacIsaac M, Desmond P, Iser D, Thompson A. Care navigation increases initiation of hepatitis C treatment following release from prison in a prospective randomised controlled trial: The C-LINK Study. Open Forum Infect Dis 2022; 9:ofac350. [PMID: 35949401 PMCID: PMC9356682 DOI: 10.1093/ofid/ofac350] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prison-based hepatitis C treatment is safe and effective; however, many individuals are released untreated due to time or resource constraints. On community re-entry, individuals face a number of immediate competing priorities, and in this context, linkage to hepatitis C care is low. Interventions targeted at improving healthcare continuity after prison release have yielded positive outcomes for other health diagnoses; however, data regarding hepatitis C transitional care are limited. Methods We conducted a prospective randomized controlled trial comparing a hepatitis C care navigator intervention with standard of care for individuals released from prison with untreated hepatitis C infection. The primary outcome was prescription of hepatitis C direct-acting antivirals (DAA) within 6 months of release. Results Forty-six participants were randomized. The median age was 36 years and 59% were male. Ninety percent (n = 36 of 40) had injected drugs within 6 months before incarceration. Twenty-two were randomized to care navigation and 24 were randomized to standard of care. Individuals randomized to the intervention were more likely to commence hepatitis C DAAs within 6 months of release (73%, n = 16 of 22 vs 33% n = 8 of 24, P < .01), and the median time between re-entry and DAA prescription was significantly shorter (21 days [interquartile range {IQR}, 11–42] vs 82 days [IQR, 44–99], P = .049). Conclusions Care navigation increased hepatitis C treatment uptake among untreated individuals released from prison. Public policy should support similar models of care to promote treatment in this high-risk population. Such an approach will help achieve hepatitis C elimination as a public health threat.
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Affiliation(s)
- T Papaluca
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Craigie
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - L McDonald
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Edwards
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - R Winter
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
- Burnet Institute , Melbourne, Victoria , Australia
| | - A Hoang
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Pappas
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Waldron
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - K McCoy
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - M Stoove
- Burnet Institute , Melbourne, Victoria , Australia
- Department of Epidemiology and Preventative Medicine, Monash University , Victoria , Australia
| | - J Doyle
- Burnet Institute , Melbourne, Victoria , Australia
- Department of Epidemiology and Preventative Medicine, Monash University , Victoria , Australia
- Department of Infectious Diseases, The Alfred and Monash University , Melbourne, Victoria , Australia
| | - M Hellard
- Burnet Institute , Melbourne, Victoria , Australia
- Department of Epidemiology and Preventative Medicine, Monash University , Victoria , Australia
- Department of Infectious Diseases, The Alfred and Monash University , Melbourne, Victoria , Australia
| | - J Holmes
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - M MacIsaac
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - P Desmond
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - D Iser
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
| | - A Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne , Victoria , Australia
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25
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Hao L, Kuttel MM, Ravenscroft N, Thompson A, Prasad AK, Gangolli S, Tan C, Cooper D, Watson W, Liberator P, Pride MW, Jansen KU, Anderson AS, Scully IL. Streptococcus pneumoniae serotype 15B polysaccharide conjugate elicits a cross-functional immune response against serotype 15C but not 15A. Vaccine 2022; 40:4872-4880. [PMID: 35810060 DOI: 10.1016/j.vaccine.2022.06.041] [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] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Protection conferred by pneumococcal polysaccharide conjugate vaccines (PCVs) is associated with PCV-induced antibodies against vaccine-covered serotypes that exhibit functional opsonophagocytic activity (OPA). Structural similarity between capsular polysaccharides of closely related serotypes may result in induction of cross-reactive antibodies with or without a cross-functional activity against a serotype not covered by a PCV, with the former providing an additional protective clinical benefit. Serotypes 15B, 15A, and 15C, in the serogroup 15, are among the most prevalent Streptococcus pneumoniae serotypes associated with invasive pneumococcal disease following the implementation of a 13-valent PCV; in addition, 15B contributes significantly to acute otitis media. Serological discrimination between closely related serotypes such as 15B and 15C is complicated; here, we implemented an algorithm to quickly differentiate 15B from its closely related serotypes 15C and 15A directly from whole-genome sequencing data. In addition, molecular dynamics simulations of serotypes 15A, 15B, and 15C polysaccharides demonstrated that while 15B and 15C polysaccharides assume rigid branched conformation, 15A polysaccharide assumes a flexible linear conformation. A serotype 15B conjugate, included in a 20-valent PCV (PCV20), induced cross-functional OPA serum antibody responses against the structurally similar serotype 15C but not against serotype 15A, both not included in PCV20. In PCV20-vaccinated adults (18-49 years), robust OPA antibody titers were detected against both serotypes 15B (the geometric mean titer [GMT] of 19,334) and 15C (GMTs of 1692 and 2747 for strains PFE344340 and PFE1160, respectively), but were negligible against serotype 15A (GMTs of 10 and 30 for strains PFE593551 and PFE647449, respectively). Cross-functional 15B/C responses were also confirmed using sera from a larger group of older adults (60-64 years).
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Affiliation(s)
- Li Hao
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Michelle M Kuttel
- Department of Computer Science, University of Cape Town, Rondebosch 7701, South Africa
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
| | - Allison Thompson
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - A Krishna Prasad
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Seema Gangolli
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Charles Tan
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - David Cooper
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Wendy Watson
- Pfizer Vaccine Clinical Research & Development, 500 Arcola Rd, Collegeville, PA 19422, USA
| | - Paul Liberator
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Michael W Pride
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Annaliesa S Anderson
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Ingrid L Scully
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA.
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, Vijay Sukhnani M, Brown L, Desai B, Elzanati H, Godhaniya J, Kavanagh E, Kent J, Kishor A, Liu A, Norwood M, Shaari N, Wood C, Wood M, Brown A, Chellapuri A, Ferriman A, Ghosh I, Kulkarni N, Noton T, Pinto A, Rajesh S, Varghese B, Wenban C, Aly R, Barciela C, Brookes T, Corrin E, Goldsworthy M, Mohamed Azhar MS, Moore J, Nakhuda S, Ng D, Pillay S, Port S, Abdullah M, Akinyemi J, Islam S, Kale A, Lewis A, Manjunath T, McCabe H, Misra S, Stubley T, Tam JP, Waraich N, Chaora T, Ford C, Osinkolu I, Pong G, Rai J, Risquet R, Ainsworth J, Ayandokun P, Barham E, Barrett G, Barry J, Bisson E, Bridges I, Burke D, Cann J, Cloney M, Coates S, Cripps P, Davies C, Francis N, Green S, Handley G, Hathaway D, Hurt L, Jenkins S, Johnston C, Khadka A, McGee U, Morris D, Murray R, Norbury C, Pierrepont Z, Richards C, Ross O, Ruddy A, Salmon C, Shield M, Soanes K, Spencer N, Taverner S, Williams C, Wills-Wood W, Woodward S, Chow J, Fan J, Guest O, Hunter I, Moon WY, Arthur-Quarm S, Edwards P, Hamlyn V, McEneaney L, N D G, Pranoy S, Ting M, Abada S, Alawattegama LH, Ashok A, Carey C, Gogna A, Haglund C, Hurley P, Leelo N, Liu B, Mannan F, Paramjothy K, Ramlogan K, Raymond-Hayling O, Shanmugarajah A, Solichan D, Wilkinson B, Ahmad NA, Allan D, Amin A, Bakina C, Burns F, Cameron F, Campbell A, Cavanagh S, Chan SMZ, Chapman S, Chong V, Edelsten E, Ekpete O, El Sheikh M, Ghose R, Hassane A, Henderson C, Hilton-Christie S, Husain M, Hussain H, Javid Z, Johnson-Ogbuneke J, Johnston A, Khalil M, Leung TCC, Makin I, Muralidharan V, Naeem M, Patil P, Ravichandran S, Saraeva D, Shankey-Smith W, Sharma N, Swan R, Waudby-West R, Wilkinson A, Wright K, Balasubramanian A, Bhatti S, Chalkley M, Chou WK, Dixon M, Evans L, Fisher K, Gandhi P, Ho S, Lau YB, Lowe S, Meechan C, Murali N, Musonda C, Njoku P, Ochieng L, Pervez MU, Seebah K, Shaikh I, Sikder MA, Vanker R, Alom J, Bajaj V, Coleman O, Finch G, Goss J, Jenkins C, Kontothanassis A, Liew MS, Ng K, Outram M, Shakeel MM, Tawn J, Zuhairy S, Chapple K, Cinnamond A, Coleman S, George HA, Goulder L, Hare N, Hawksley J, Kret A, Luesley A, Mecia L, Porter H, Puddy E, Richardson G, Sohail B, Srikaran V, Tadross D, Tobin J, Tokidis E, Young L, Ashdown T, Bratsos S, Koomson A, Kufuor A, Lim MQ, Shah S, Thorne EPC, Warusavitarne J, Xu S, Abigail S, Ahmed A, Ahmed J, Akmal A, Al-Khafaji M, Amini B, Arshad M, Bogie E, Brazkiewicz M, Carroll M, Chandegra A, Cirelli C, Deng A, Fairclough S, Fung YJ, Gornell C, Green RL, Green SV, Gulamhussein AHM, Isaac AG, Jan R, Jegatheeswaran L, Knee M, Kotecha J, Kotecha S, Maxwell-Armstrong C, McIntyre C, Mendis N, Naing TKP, Oberman J, Ong ZX, Ramalingam A, Saeed Adam A, Tan LL, Towell S, Yadav J, Anandampillai R, Chung S, Hounat A, Ibrahim B, Jeyakumar G, Khalil A, Khan UA, Nair G, Owusu-Ayim M, Wilson M, Kanani A, Kilkelly B, Ogunmwonyi I, Ong L, Samra B, Schomerus L, Shea J, Turner O, Yang Y, Amin M, Blott N, Clark A, Feather A, Forrest M, Hague S, Hamilton K, Higginbotham G, Hope E, Karimian S, Loveday K, Malik H, McKenna O, Noor A, Onsiong C, Patel B, Radcliffe N, Shah P, Tye L, Verma K, Walford R, Yusufi U, Zachariah M, Casey A, Doré C, Fludder V, Fortescue L, Kalapu SS, Karel E, Khera G, Smith C, Appleton B, Ashaye A, Boggon E, Evans A, Faris Mahmood H, Hinchcliffe Z, Marei O, Silva I, Spooner C, Thomas G, Timlin M, Wellington J, Yao SL, Abdelrazek M, Abdelrazik Y, Bee F, Joseph A, Mounce A, Parry G, Vignarajah N, Biddles D, Creissen A, Kolhe S, K T, Lea A, Ledda V, O'Loughlin P, Scanlon J, Shetty N, Weller C, Abdalla M, Adeoye A, Bhatti M, Chadda KR, Chu J, Elhakim H, Foster-Davies H, Rabie M, Tailor B, Webb S, Abdelrahim ASA, Choo SY, Jiwa A, Mangam S, Murray S, Shandramohan A, Aghanenu O, Budd W, Hayre J, Khanom S, Liew ZY, McKinney R, Moody N, Muhammad-Kamal H, Odogwu J, Patel D, Roy C, Sattar Z, Shahrokhi N, Sinha I, Thomson E, Wonga L, Bain J, Khan J, Ricardo D, Bevis R, Cherry C, Darkwa S, Drew W, Griffiths E, Konda N, Madani D, Mak JKC, Meda B, Odunukwe U, Preest G, Raheel F, Rajaseharan A, Ramgopal A, Risbrooke C, Selvaratnam K, Sethunath G, Tabassum R, Taylor J, Thakker A, Wijesingha N, Wybrew R, Yasin T, Ahmed Osman A, Alfadhel S, Carberry E, Chen JY, Drake I, Glen P, Jayasuriya N, Kawar L, Myatt R, Sinan LOH, Siu SSY, Tjen V, Adeboyejo O, Bacon H, Barnes R, Birnie C, D'Cunha Kamath A, Hughes E, Middleton S, Owen R, Schofield E, Short C, Smith R, Wang H, Willett M, Zimmerman M, Balfour J, Chadwick T, Coombe-Jones M, Do Le HP, Faulkner G, Hobson K, Shehata Z, Beattie M, Chmielewski G, Chong C, Donnelly B, Drusch B, Ellis J, Farrelly C, Feyi-Waboso J, Hibell I, Hoade L, Ho C, Jones H, Kodiatt B, Lidder P, Ni Cheallaigh L, Norman R, Patabendi I, Penfold H, Playfair M, Pomeroy S, Ralph C, Rottenburg H, Sebastian J, Sheehan M, Stanley V, Welchman J, Ajdarpasic D, Antypas A, Azouaghe O, Basi S, Bettoli G, Bhattarai S, Bommireddy L, Bourne K, Budding J, Cookey-Bresi R, Cummins T, Davies G, Fabelurin C, Gwilliam R, Hanley J, Hird A, Kruczynska A, Langhorne B, Lund J, Lutchman I, McGuinness R, Neary M, Pampapathi S, Pang E, Podbicanin S, Rai N, Redhouse White G, Sujith J, Thomas P, Walker I, Winterton R, Anderson P, Barrington M, Bhadra K, Clark G, Fowler G, Gibson C, Hudson S, Kaminskaite V, Lawday S, Longshaw A, MacKrill E, McLachlan F, Murdeshwar A, Nieuwoudt R, Parker P, Randall R, Rawlins E, Reeves SA, Rye D, Sirkis T, Sykes B, Ventress N, Wosinska N, Akram B, Burton L, Coombs A, Long R, Magowan D, Ong C, Sethi M, Williams G, Chan C, Chan LH, Fernando D, Gaba F, Khor Z, Les JW, Mak R, Moin S, Ng Kee Kwong KC, Paterson-Brown S, Tew YY, Bardon A, Burrell K, Coldwell C, Costa I, Dexter E, Hardy A, Khojani M, Mazurek J, Raymond T, Reddy V, Reynolds J, Soma A, Agiotakis S, Alsusa H, Desai N, Peristerakis I, Adcock A, Ayub H, Bennett T, Bibi F, Brenac S, Chapman T, Clarke G, Clark F, Galvin C, Gwyn-Jones A, Henry-Blake C, Kerner S, Kiandee M, Lovett A, Pilecka A, Ravindran R, Siddique H, Sikand T, Treadwell K, Akmal K, Apata A, Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Crozier I, Haqqani H, Kotschet E, Shaw D, Prabhu A, Roubos J, Alison J, Melton I, Denman R, Lin T, Almeida A, Thompson A, Lande J, Liang S, O’donnell D. Three-year chronic follow-up from the pilot study of a substernal extravascular implantable cardioverter defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.467] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
The investigational Extravascular Implantable Cardioverter-Defibrillator (EV ICD) uses a substernal lead and delivers defibrillation and pacing therapies, including antitachycardia pacing (ATP).
Objective
To characterize EV ICD system performance through 3 years.
Methods
The prospective, first-in-human EV ICD Pilot study was conducted at 4 sites in Australia and New Zealand. ICD-indicated patients were enrolled July-December of 2018. Defibrillation testing was conducted for all patients at implant, and chronically per physician discretion. Electrical testing was conducted at pre-hospital discharge, 2 weeks, 4-6 weeks and 3 months post-implant, and every 6 months thereafter. Posture effects on pacing and sensing were evaluated through 3 months.
Results
Of 26 patients enrolled, 21 underwent the EV ICD implant procedure. There were no intraprocedural complications. After successful implantation and testing, 17 of 21 patients entered chronic follow-up. 14 patients continue follow up, representing 523 patient-months. Eight elective chronic defibrillation tests converted 7 of 7 patients with ≤ 40 J (maximum energy). Five episodes of spontaneous ventricular tachycardia (VT) were detected in 1 patient and either self-terminated or successfully defibrillated with appropriate shock.
Over the total course of follow-up, 3 patients received an inappropriate shock due to; lead tip displacement with subsequent P-wave oversensing; Electromagnetic interference (EMI) in a ungrounded hot-tub; and EMI while doing plumbing work on unearthed electrical pipes, resulting in an annualized inappropriate shock rate of 6.9%.
Pacing capture thresholds remained stable across time (5.1 ± 2.0 V at implant and 5.5 ± 2.7 V at 3 years); similarly, R-wave amplitudes were stable across time (3.4 ±2.0 mV at implant and 4.2 ± 2.7 mV at 3 years). Pacing thresholds tended to be lowest with the patient lying on the right side and pacing threshold often increased relative to supine position for left-side, prone or bending postures. R-wave amplitude tended to be greater when bending forward.
There were 10 system or procedure-related adverse events in 8 patients through 3 years, including 3 elective system removals for: a single inappropriate shock (1), chronic defibrillation testing showing no safety margin in a patient with arrhythmogenic right ventricular dysplasia (1), intolerance to ATP (1 - high pacing threshold and frequent VT). Other than the lead tip displacement within the first 3 months, no additional clinically significant lead displacements have been observed through 3 years.
Conclusion
The EV ICD is a novel platform for delivering high-voltage therapy. There were no procedure and system related complications observed after the first year post-implant. Lead position and chronic system performance have generally remained stable through 3 years with a low rate of adverse events.
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Affiliation(s)
- I Crozier
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - H Haqqani
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - E Kotschet
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - D Shaw
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - A Prabhu
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - J Roubos
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - J Alison
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - I Melton
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - R Denman
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - T Lin
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - A Almeida
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - A Thompson
- Medtronic, Inc., Minneapolis, United States of America
| | - J Lande
- Medtronic, Inc., Minneapolis, United States of America
| | - S Liang
- Medtronic, Inc., Minneapolis, United States of America
| | - D O’donnell
- Austin Health, Department of Cardiology, Heidelberg, Australia
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Thompson A, Irving SY, Hales R, Quinn R, Chittams J, Himebauch A, Nishisaki A. Simulation-Facilitated Education for Pediatric Critical Care Nurse Practitioners' Airway Management Skills: A 10-Year Experience. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1745832] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractThis study aimed to describe the process of the development and implementation with report of our 10-year experience with a simulation-facilitated airway management curriculum for pediatric acute care nurse practitioners in a large academic pediatric intensive care unit. This is a retrospective observational study. The study was conducted at a single-center quaternary noncardiac pediatric intensive care unit in an urban children's hospital in the United States. A pediatric critical care airway management curriculum for nurse practitioners consisting 4 hours of combined didactic and simulation-facilitated education followed by hands-on experience in the operating room. Tracheal intubations performed by nurse practitioners in the pediatric intensive care unit were tracked by a local quality improvement database, NEAR4KIDS from January 2009 to December 2018. Since curriculum initiation, 39 nurse practitioners completed the program. Nurse practitioners functioned as the first provider to attempt intubation in 473 of 3,128 intubations (15%). Also, 309 of 473 (65%) were successful at first attempt. Implementation of a simulation-facilitated pediatric airway management curriculum successfully supported the ongoing airway management participation and first attempt intubation success by nurse practitioners in the pediatric intensive care unit over the 10-year period.
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Affiliation(s)
- Allison Thompson
- Division of Critical Care Medicine, Nemours Children's Hospital, Delaware, Wilmington, Delaware, United States
| | - Sharon Y. Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
- Division of Critical Care Medicine, Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Roberta Hales
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Ryan Quinn
- Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Jesse Chittams
- Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Adam Himebauch
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Akira Nishisaki
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Connor C, De Valliere N, Warwick J, Stewart-Brown S, Thompson A. The COV-ED Survey: exploring the impact of learning and teaching from home on parent/carers' and teachers' mental health and wellbeing during COVID-19 lockdown. BMC Public Health 2022; 22:889. [PMID: 35509002 PMCID: PMC9066392 DOI: 10.1186/s12889-022-13305-7] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Following the emergence of COVID-19 in the UK, on March 18th 2020 the majority of schools in England closed and families and teachers were tasked with providing educational support for children and adolescents within the home environment. Little is known, however, regarding the impact of remote teaching and learning on the mental wellbeing of parents/carers and teaching staff. METHODS The Coronavirus Education (COV-ED) online survey explored the practicalities of learning and teaching from home for 329 parents/carers and 117 teachers of 11-15 year old adolescents in England, during June/July 2020, and the associated impact on their mental wellbeing. Participants were recruited through schools and via University of Warwick social media channels. Data was analysed using a series of Multiple Linear and Multivariate Regressions. RESULTS Despite coping well with the challenges of remote learning, a third of teachers reported below average mental wellbeing on the Warwick-Edinburgh Mental Wellbeing Scale. Multivariate regression revealed that wellbeing was associated with access to resources and confidence to teach from home. Almost half of parents/carers surveyed reported below average wellbeing. Multivariate regression revealed that poor wellbeing was more common in those who were also working from home and who lacked support for their own mental health. Concerns about their child's mental health and lack of access to electronic devices and workspace were also significantly associated with the mental wellbeing of parents/carers. CONCLUSIONS Whilst young people's mental health and wellbeing has, and continues to be a national priority, the mental health and wellbeing of the families and teachers supporting them has not previously been explored. Our survey population was of predominantly white British heritage, female and living in the West Midlands UK, therefore, findings should be treated with caution. Findings provide a snapshot of factors that may be of significance to families and schools in supporting the mental wellbeing of those tasked with learning from home. They will help i) increase knowledge and awareness with regard to future support of families and teachers during similar crises; ii) enable the design and development of practical solutions in the delivery of remote teaching and learning; and, iii) help address the mental wellbeing needs of those tasked with supporting adolescents.
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Affiliation(s)
- C Connor
- Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England.
| | - N De Valliere
- Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England
| | - J Warwick
- Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England
| | - S Stewart-Brown
- Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England
| | - A Thompson
- Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England
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Nikou P, Nisbet A, Thompson A, Gulliford S, McClelland J. PO-1492 Characterising anatomical changes of head and neck cancer patients during radiotherapy treatment. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03456-9] [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: 10/18/2022]
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Miller GD, Maxwell JD, Thompson A, Cable NT, Low DA, George KP, Jones H. The effects of exercise training in the cold on cerebral blood flow and cerebrovascular function in young healthy individuals. Auton Neurosci 2022; 238:102945. [PMID: 35176639 DOI: 10.1016/j.autneu.2022.102945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/12/2021] [Revised: 11/09/2021] [Accepted: 01/16/2022] [Indexed: 11/17/2022]
Abstract
Exercise elicits acute increases in cerebral blood flow velocity (CBFv) and provokes long-term beneficial effects on CBFv, thereby reducing cerebrovascular risk. Acute exposure to a cold stimulus also increases CBFv. We compared the impact of exercise training in cold and thermoneutral environments on CFBv, cerebrovascular function and peripheral endothelial function. Twenty-one (16 males, 22 ± 5 years) individuals were randomly allocated to either a cold (5 °C) or thermoneutral (15 °C) exercise intervention. Exercise consisted of 50-min cycling at 70% heart rate max, three times per week for eight weeks. Transcranial Doppler was used to determine pre and post intervention CBFv, dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity (CVRCO2). Conduit endothelial function, microvascular function and cardiorespiratory fitness were also assessed. Cardiorespiratory fitness improved (2.91 ml.min.kg-1, 95%CI 0.49, 5.3; P = 0.02), regardless of exercise setting. Neither intervention had an impact on CBFv, CVRCO2, FMD or microvascular function (P > 0.05). There was a significant interaction between time and condition for dCA normalised gain with evidence of a decrease by 0.192%cm.s-1.%mmHg-1 (95%CI -0.318, -0.065) following training in the cold and increase (0.129%cm.s-1.%mmHg-1, 95%CI 0.011, 0.248) following training in the thermoneutral environment (P = 0.001). This was also evident for dCA phase with evidence of an increase by 0.072 rad (95%CI -0.007, 0.152) following training in the cold and decrease by 0.065 (95%CI -0.144, 0.014) radians following training in the thermoneutral environment (P = 0.02). Both training interventions improved fitness but CBFv, CVRCO2 and peripheral endothelial function were unaltered. Exercise training in the cold improved dCA whereas thermoneutral negated dCA.
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Affiliation(s)
- G D Miller
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J D Maxwell
- Manchester University NHS Foundation Trust, Manchester, UK
| | - A Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - N T Cable
- The Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - D A Low
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - K P George
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - H Jones
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
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Kim C, Thompson A, Kim G, Marcum Z, Keller M, Sorensen A, Brandt N. Understanding Global Deprescribing Policy: Opportunities and Challenges. Innov Aging 2021. [PMCID: PMC8681753 DOI: 10.1093/geroni/igab046.3034] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The landscape of deprescribing, the planned process of dose reduction or stoppage for medications which are no longer of benefit, has been rapidly expanding with global efforts and the formation of regional and national deprescribing networks. The purpose of this qualitative study is to describe successes and challenges about deprescribing from thought-leaders across the world to inform future policy initiatives. We aim to conduct at least 15 key informant (KI) interviews; we have completed 13 to date. Codes were constructed to identify themes that depict the perspectives regarding deprescribing policy across the globe. The KIs primarily represent the fields of pharmacy and medicine from four global regions with years of deprescribing experience ranging from 5 to > 20. We identified two emerging overarching themes through our qualitative analysis: Regional Organization Support and Evidence & Knowledge gaps. Within these overarching themes, we further identified sub-themes and their representative quotes: Network Structure: “idea of the network was threefold: 1) To try and figure out what we need to activate healthcare providers to deprescribe; 2) To do work with community-dwelling seniors to motivate them and give them opportunities to deprescribe; 3) ...getting pharmacists to provide the education to the patients.” Cost-effectiveness: “If we can show that it is cost-effective to deprescribe, that there is actually a return here, not just in health terms but in monetary terms, I think that would really push it along.” This research will help to advance global efforts to optimize medication management.
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Affiliation(s)
- Catherine Kim
- University of Maryland School of Pharmacy, BALTIMORE, Maryland, United States
| | - Allison Thompson
- University of Maryland School of Pharmacy, University of Maryland School of Pharmacy, Maryland, United States
| | - Grace Kim
- University of Maryland School of Pharmacy, University of Maryland School of Pharmacy, Maryland, United States
| | - Zachary Marcum
- University of Washington, Seattle, Washington, United States
| | | | | | - Nicole Brandt
- University of Maryland School of Pharmacy, University of Maryland School of Pharmacy, Maryland, United States
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Parzen J, Almahariq M, Quinn T, Siddiqui Z, Thompson A, Guerrero T, Lee K, Stevens C, Grills I. Assessing the Benefit of Higher Biologically Effective Dose in Patients With Squamous Cell Carcinoma of the Lung Treated With Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1264] [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: 10/20/2022]
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Jones D, Park N, Thompson A. M101 JOINT PAIN: A RARE SYMPTOM IN PATIENTS WITH HEREDITARY ANGIOEDEMA WITH NORMAL C1-INH. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.255] [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: 11/16/2022]
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Smith A, Thompson A, Stanier P, Rooker J, Lowdon I. 1700 Using Intra-Operative Imaging as A Tool to Provide Peer Review, Scoring, Feedback and Education for Hand and Wrist Trauma Cases - A Quality Improvement Project. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.923] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
To improve the efficiency of intraoperative hand trauma x-ray review, introduce a scoring system for quality of fixation achieved and use this as an education and feedback tool for trainees.
Method
A large QI project in 2019 demonstrated that intra-operative images taken using the mini C-arm were not being reviewed. In March 2020 the first QI cycle introduced an Access database to ensure that as cases were removed from the trauma board, they were added to a review list. Each x-ray was also scored in the trauma meeting (good, acceptable, poor) to assess the radiographic quality of fixation. The second QI cycle identified the named surgeon for each case, allowing surgeon specific feedback. Finally, we trained all qualified users of the mini C-arm to upload their own images after each case, reducing the mean time to upload.
Results
This QI project has improved the review rate of mini C-arm images from 30% to 100% and every x-ray is scored. The mean time to review images has reduced from 4 days to less than 24 hours. All trainees can access their scores for imaged hand and wrist trauma and receive written constructive feedback.
Conclusions
This project ensures appropriate and prompt review of all hand and wrist trauma cases allowing early identification of any concerns. All x-rays are scored, and this process acts as an educational prompt in the trauma meeting. A final report can be printed for each trainee which can be uploaded to their portfolio to document their surgical progress.
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Affiliation(s)
- A Smith
- Great Western Hospital, Swindon, United Kingdom
| | - A Thompson
- Great Western Hospital, Swindon, United Kingdom
| | - P Stanier
- Great Western Hospital, Swindon, United Kingdom
| | - J Rooker
- Great Western Hospital, Swindon, United Kingdom
| | - I Lowdon
- Great Western Hospital, Swindon, United Kingdom
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Senders S, Klein NP, Lamberth E, Thompson A, Drozd J, Trammel J, Peng Y, Giardina PC, Jansen KU, Gruber WC, Scott DA, Watson W. Safety and Immunogenicity of a 20-valent Pneumococcal Conjugate Vaccine in Healthy Infants in the United States. Pediatr Infect Dis J 2021; 40:944-951. [PMID: 34525007 PMCID: PMC8443440 DOI: 10.1097/inf.0000000000003277] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND The development and widespread use of pneumococcal conjugate vaccines (PCVs) substantially reduced the global burden of pneumococcal disease. Expanding the serotypes covered by PCVs may further reduce disease burden. A 20-valent PCV (PCV20) has been developed to add coverage for 7 additional serotypes (8, 10A, 11A, 12F, 15B, 22F and 33F) to those in the existing 13-valent PCV (PCV13). This phase 2 study evaluated the safety, tolerability and immunogenicity of PCV20 in healthy US infants. METHODS In this randomized, active-controlled, double-blind study, 460 infants were randomized 1:1 to receive a 4-dose series of either PCV20 or PCV13 at 2, 4, 6 and 12 months of age. Solicited local reactions and systemic events, adverse events (AEs) and serious AEs were recorded. Immunogenicity was assessed by measuring serotype-specific IgG concentrations and opsonophagocytic activity titers at 1 month after Dose 3, before Dose 4 and 1 month after Dose 4. RESULTS Of 460 infants, 82.8% completed the 1-month visit after Dose 4. Local reactions and systemic events were mostly mild to moderate in severity and similar between the PCV20 and PCV13 groups. Treatment-related AEs were uncommon, with no related serious AEs or deaths reported. IgG and opsonophagocytic activity responses elicited by PCV20 were robust and demonstrated a booster response after Dose 4. CONCLUSIONS Administration of PCV20 in US infants was well tolerated, with a safety profile similar to PCV13, and induced robust serotype-specific immune responses. These findings support continued development of PCV20 in the pediatric population.
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Affiliation(s)
| | | | - Erik Lamberth
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Allison Thompson
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Jelena Drozd
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - James Trammel
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | | | | | | | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
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Schmid P, Gomez-Pardo P, Wheatley D, Roy P, Krabisch P, Thill M, Ledwidge S, Thompson A, Macaskill E, Viehstädt N, Purushotham A, Gluz O, Stefek A, Ackerman C, Prendergast A, Mousa K, Jones L, Viale G, Cortés J, Kümmel S. 208P ARB: Phase II window of opportunity study of preoperative treatment with enzalutamide in ER+ve and TNBC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.490] [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: 10/20/2022] Open
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Bertolini M, Vazquez Munoz R, Archambault L, Shah S, Souza JGS, Costa RC, Thompson A, Zhou Y, Sobue T, Dongari-Bagtzoglou A. Mucosal Bacteria Modulate Candida albicans Virulence in Oropharyngeal Candidiasis. mBio 2021; 12:e0193721. [PMID: 34399623 PMCID: PMC8406182 DOI: 10.1128/mbio.01937-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 01/12/2023] Open
Abstract
Oropharyngeal candidiasis (OPC) is the most prevalent oral infection in immunocompromised patients, primarily associated with Candida albicans. Increasing evidence points to a significant role of mucosal bacteria on the transition of C. albicans from commensal to pathogenic. In this work, we hypothesized that changes in the abundance or composition of the mucosal bacterial microbiota induced by dietary sucrose during the development of OPC can modulate C. albicans virulence. C. albicans burdens and mucosal lesions were evaluated in a mouse cortisone immunosuppression model amended with sucrose. We also analyzed the mucosal bacterial composition using 16S rRNA gene sequencing and culture methods. In immunocompetent mice, sucrose significantly increased total bacterial burdens and reduced alpha diversity, by increasing the relative abundance of mitis group streptococci. In immunocompromised mice, C. albicans infection was associated with a significantly reduced bacterial alpha diversity due to an increase in the relative abundance of enterococci. When exposed to dietary sucrose, these mice had reduced C. albicans burdens and reduced bacterial alpha diversity, associated with an increase in the relative abundance of Lactobacillus. SparCC correlation networks showed a significant negative correlation between Lactobacillus and Enterococcus in all Candida-infected mice. Depletion of lactobacilli with antibiotic treatment partially restored C. albicans burdens in mice receiving sucrose. In coculture in vitro experiments, mouse oral Lactobacillus johnsonii isolates inhibited growth of Enterococcus faecalis isolates and C. albicans. These results support the hypothesis that the sucrose-induced attenuation of C. albicans virulence was a result of changes in the mucosal bacterial microbiome characterized by a reduction in enterococci and an increase in lactobacilli. IMPORTANCE By comparing Candida albicans virulence and the mucosal bacterial composition in a mouse oral infection model, we were able to dissect the effects of the host environment (immunosuppression), infection with C. albicans, and local modulating factors (availability of sucrose as a carbon source) on the mucosal bacterial microbiome and its role on fungal virulence. We showed that changes in endogenous microbial communities in response to sucrose can lead to attenuation of fungal disease. We also showed that Lactobacillus johnsonii may curtail Candida virulence both by inhibiting its growth and by inhibiting the growth of potentially synergistic bacteria such as enterococci. Our results support the concept that Candida pathogenesis should be viewed in the contexts of both a susceptible host and a mucosal bacterial microbiota conducive to virulence.
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Affiliation(s)
- M. Bertolini
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - R. Vazquez Munoz
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - L. Archambault
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - S. Shah
- Department of Computer Science and Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - J. G. S. Souza
- Dental Research Division, Guarulhos University, Guarulhos, SP, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas [FCO]), Montes Claros, MG, Brazil
| | - R. C. Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - A. Thompson
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - Y. Zhou
- Department of Medicine, UConn Health, Connecticut, Farmington, Connecticut, USA
| | - T. Sobue
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
| | - A. Dongari-Bagtzoglou
- Department of Oral Health and Diagnostic Sciences, UConn Health, Farmington, Connecticut, USA
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Jerusalem G, Farah S, Courtois A, Chirgwin J, Aebi S, Karlsson P, Neven P, Hitre E, Graas MP, Simoncini E, Abdi E, Kamby C, Thompson A, Loibl S, Gavilá J, Kuroi K, Marth C, Müller B, O'Reilly S, Gombos A, Ruhstaller T, Burstein HJ, Rabaglio M, Ruepp B, Ribi K, Viale G, Gelber RD, Coates AS, Loi S, Goldhirsch A, Regan MM, Colleoni M. Continuous versus intermittent extended adjuvant letrozole for breast cancer: final results of randomized phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy. Ann Oncol 2021; 32:1256-1266. [PMID: 34384882 DOI: 10.1016/j.annonc.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n = 2425 in the intermittent and n = 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n = 78 in the intermittent and n = 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.
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Affiliation(s)
- G Jerusalem
- International Breast Cancer Study Group, Bern, Switzerland; Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium.
| | - S Farah
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA
| | - A Courtois
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium
| | - J Chirgwin
- Breast Cancer Trials-Australia and New Zealand, University of Newcastle, Callaghan, Australia; Box Hill and Maroondah Hospitals, Monash University, Clayton, Australia
| | - S Aebi
- Division of Medical Oncology, Cancer Center, Lucerne Cantonal Hospital, Lucerne, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - E Hitre
- Department of Medical Oncology and Clinical Pharmacology "B", National Institute of Oncology, Budapest, Hungary
| | | | - E Simoncini
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Abdi
- The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - C Kamby
- Danish Breast Cancer Group and Rigshospitalet, Copenhagen, Denmark
| | - A Thompson
- Scottish Cancer Trials Breast Group and Division of Surgical Oncology, Baylor College of Medicine, Houston, USA
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - J Gavilá
- SOLTI Group and Fundación Instituto Valenciano de Oncologia, Valencia, Spain
| | - K Kuroi
- Japan Breast Cancer Research Group and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - C Marth
- Austrian Breast & Colorectal Cancer Study Group and Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Providencia, Santiago, Chile
| | - S O'Reilly
- Cancer Trials Ireland, Dublin, Ireland; University College Cork, Cork University Hospital, Cork, Ireland
| | - A Gombos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - T Ruhstaller
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Breast Center St. Gallen, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - H J Burstein
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium; Harvard Medical School, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Rabaglio
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Ruepp
- International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- International Breast Cancer Study Group, Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA; Frontier Science Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Loi
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group, Bern, Switzerland; IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Colleoni
- International Breast Cancer Study Group, Bern, Switzerland; Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Burkhardt E, Berger M, Yolken RH, Lin A, Yuen HP, Wood SJ, Francey SM, Thompson A, McGorry PD, Nelson B, Yung AR, Amminger GP. Toxoplasma gondii, Herpesviridae and long-term risk of transition to first-episode psychosis in an ultra high-risk sample. Schizophr Res 2021; 233:24-30. [PMID: 34225023 DOI: 10.1016/j.schres.2021.06.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ultra high-risk (UHR) criteria were introduced to identify people at imminent risk of developing psychosis. To improve prognostic accuracy, additional clinical and biological risk factors have been researched. Associations between psychotic disorders and infections with Toxoplasma gondii and Herpesviridae have been found. It is unknown if exposure to those pathogens increases the risk of transition to psychosis in UHR cohorts. METHODS We conducted a long-term follow-up of 96 people meeting UHR criteria, previously seen at the Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service in Melbourne, Australia. Transition to psychosis was assessed using the Comprehensive Assessment of the At-Risk Mental State (CAARMS) and state public mental health records. The relationship between IgG antibodies to Herpesviridae (HSV-1, HSV-2, CMV, EBV, VZV) and Toxoplasma gondii and risk for transition was examined with Cox regression models. RESULTS Mean follow-up duration was 6.46 (±3.65) years. Participants who transitioned to psychosis (n = 14) had significantly higher antibody titers for Toxoplasma gondii compared to those who did not develop psychosis (p = 0.03). After adjusting for age, gender and year of baseline assessment, seropositivity for Toxoplasma gondii was associated with a 3.6-fold increase in transition hazard in multivariate Cox regression models (HR = 3.6; p = 0.036). No significant association was found between serostatus for Herpesviridae and risk of transition. CONCLUSIONS Exposure to Toxoplasma gondii may contribute to the manifestation of positive psychotic symptoms and increase the risk of transitioning to psychosis in UHR individuals.
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Affiliation(s)
- E Burkhardt
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - M Berger
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - R H Yolken
- John Hopkins University School of Medicine, Stanley Division of Developmental Neurovirology, Baltimore, USA
| | - A Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - H P Yuen
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S J Wood
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S M Francey
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A Thompson
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK
| | - P D McGorry
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - B Nelson
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - A R Yung
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Health Sciences, University of Manchester, UK
| | - G P Amminger
- Orygen, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Pachchigar R, Blackwell N, Webb L, Francis K, Pahor K, Thompson A, Cornmell G, Anstey C, Ziegenfuss M, Shekar K. Development and implementation of a clinical information system-based protocol to improve nurse satisfaction of end-of-life care in a single intensive care unit. Aust Crit Care 2021; 35:273-278. [PMID: 34148763 DOI: 10.1016/j.aucc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/14/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patients treated in Australian intensive care units (ICUs) have an overall mortality rate of 5.05%. This is due to the critical nature of their disease, the increasing proportion of patients with multiple comorbidities, and advanced age. This has made treating patients during the end of life an integral part of intensive care practice and requires a high quality of care. With the increased use of electronic clinical information systems, a standardised protocol encompassing end-of-life care may provide an efficient method for documentation, communication, and timely delivery of comfort care. OBJECTIVE The aim of the study was to determine if an electronic clinical information system-based end-of-life care protocol improved nurses' satisfaction with the practice of end-of-life care for patients in the ICU. DESIGN This is a prospective single-centre observational study. SETTING The study was carried out at a 20-bed cardiothoracic and general ICU between 2015 and 2017. PARTICIPANTS The study participants were ICU nurses. INTERVENTION Electronic clinical information-based end-of-life care protocol was used in the study. OUTCOME The primary outcome was nurse satisfaction obtained by a survey. RESULTS The number of respondents for the before survey and after survey was 58 (29%) and 64 (32%), respectively. There was a significant difference between the before survey and the after survey with regard to feeling comfortable in transitioning from curative treatment (median = 2 [interquartile range {IQR} = 2, 3] vs 3 [IQR = 2, 3], p = 0.03), feeling involved in the decision to move from curative treatment to end-of-life care (median = 2 [IQR = 2, 2] vs 2 [IQR 2, 3], p = 0.049), and feeling religious beliefs/rituals should be respected during the end-of-life process (median = 4 [IQR = 3, 4] vs. 4 [IQR = 4, 4], p = 0.02). There were some practices that had a low satisfaction rate on both the before survey and after survey. However, a high proportion of nurses were satisfied with many of the end-of-life care practices. CONCLUSION The nurses were highly satisfied with many aspects of end-of-life care practices in this unit. The use of an electronic clinical information system-based protocol improved nurse satisfaction and perception of quality of end-of-life care practices for three survey questions.
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Affiliation(s)
- R Pachchigar
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - N Blackwell
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - L Webb
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia
| | - K Francis
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia
| | - K Pahor
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia
| | - A Thompson
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia
| | - G Cornmell
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia
| | - C Anstey
- Faculty of Medicine, University of Queensland, Brisbane, Australia; School of Medicine, Griffith University, Sunshine Coast Campus, Birtinya, Australia
| | - M Ziegenfuss
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - K Shekar
- Department of Intensive Care Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
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Castro M, Butler M, Thompson A, Gee S, Posporelis S. Management of acute disturbance: The intravenous route. Eur Psychiatry 2021. [PMCID: PMC9476064 DOI: 10.1192/j.eurpsy.2021.977] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction The intravenous (IV) is one of the main parenteral routes for drug administration. Rapid onset of action, precise titration, patient-specific dosing and bypass of liver metabolism are a few of its advantages, while hypersensitivity reactions, adverse effects, infection risk and a higher overall cost some of its most debated downsides. Unlike other areas of Medicine, IV has been significantly under-utilized in Psychiatry. Objectives This systematic review analyzed the evidence for effectiveness and safety behind the use of IV medication used for the management of acute disturbance. Methods APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible studies. Studies were included if they used IV medication to treat acute disturbance, in English language, had participants aged >18. The quality of the included studies was assessed using the National Institutes of Health quality checklist. Results 17 studies were deemed eligible. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly between each study. Findings showed strong evidence for efficacy and safety of dexmedetomidine, droperidol, midazolam, and olanzapine. These medications displayed a short time to sedation, reduction in agitation levels, or large percentage of patients adequately sedated with a low number of adverse events. Results did not provide enough evidence for the use of IV ketamine, haloperidol, diazepam, lorazepam, and promethazine. Conclusions This review supports dexmedetomidine, droperidol, midazolam, and olanzapine as safe and efficacious options for managing acute disturbance via the intravenous route, particularly in special clinical settings where trained staff, optimal monitoring, resuscitation equipment and ventilators are all at hand.
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Tambakis G, Lee T, Shah R, Wright E, Connell W, Miller A, Demediuk B, Ryan M, Howell J, Tsoi E, Lust M, Basnayake C, Ding N, Croagh C, Hong T, Kamm M, Farrell A, Papaluca T, MacIsaac M, Iser D, Mahady S, Holt B, Thompson A, Holmes J. Low failure to attend rates and increased clinic capacity with Telehealth: A highly effective outpatient model that should continue beyond the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1136-1137. [PMID: 33338284 DOI: 10.1111/jgh.15379] [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] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/09/2022]
Affiliation(s)
- G Tambakis
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Lee
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - R Shah
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Wright
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Miller
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Demediuk
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Ryan
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Howell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Tsoi
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Lust
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Basnayake
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - N Ding
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Croagh
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Hong
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Farrell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Papaluca
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M MacIsaac
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - D Iser
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Mahady
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Holt
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Holmes
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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Pankhania M, Rees J, Thompson A, Richards S. Tonsillitis, tonsillectomy, and deep neck space infections in England: the case for a new guideline for surgical and non-surgical management. Ann R Coll Surg Engl 2021; 103:208-217. [PMID: 33645267 DOI: 10.1308/rcsann.2020.7030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
INTRODUCTION Tonsillectomy is a common surgical procedure performed chiefly for recurrent tonsillitis. The Scottish Intercollegiate Guidance Network (SIGN) introduced guidelines in 1998 to improve patient selection for tonsillectomy and reduce the potential harm to patients from surgical complications such as haemorrhage. Since the introduction of the guidance, the number of admissions for tonsillitis and its complications has increased. National Hospital Episode Statistics over a 20-year period were analysed to assess the trends in tonsillectomy, post-tonsillectomy haemorrhage, tonsillitis and its complications with reference to the guidance, procedures of limited clinical value and the associated costs and benefits. MATERIALS AND METHODS A literature search was conducted via PubMed and the Cochrane Library to identify relevant research. Hospital Episode Statistics data were interrogated and relevant data compared over time to assess trends related to the implementation of national guidance. RESULTS Over the period analysed, the incidence of deep neck space infections has increased almost five-fold, mediastinitis ten-fold and peritonsillar abscess by 1.7-fold compared with prior to SIGN guidance. Following procedures of limited clinical value implementation, the incidence of deep neck space infections has increased 2.4-fold, mediastinitis 4.1-fold and peritonsillar abscess 1.4-fold compared with immediately prior to clinical commissioning group rationing. The rate of tonsillectomy and associated haemorrhage (1-2%) has remained relatively constant at 46,299 (1999) compared with 49,447 (2009) and 49,141 (2016), despite an increase in the population of England by seven million over the 20-year period. DISCUSSION The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to be around £73 million. The cost of tonsillectomy and treating post-tonsillectomy haemorrhage is £56 million by comparison. The total cost per annum for tonsillectomy prior to the introduction of SIGN guidance was estimated at £71 million with tonsillitis and its complications accounting for a further £8 million.
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Affiliation(s)
- M Pankhania
- The Rotherham Foundation Trust, Moorgate Road, Rotherham
| | - J Rees
- The Rotherham Foundation Trust, Moorgate Road, Rotherham
| | - A Thompson
- Sheffield Teaching Hospitals, Glossop Road, Sheffield
| | - S Richards
- The Rotherham Foundation Trust, Moorgate Road, Rotherham
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Kurosu A, Osman F, Daggett S, Peña-Chávez R, Thompson A, Myers SM, VanKampen P, Koenig SS, Ciucci M, Mahoney J, Rogus-Pulia N. Factors Associated with Self-Reported Dysphagia in Older Adults Receiving Meal Support. J Nutr Health Aging 2021; 25:1145-1153. [PMID: 34866141 PMCID: PMC8653989 DOI: 10.1007/s12603-021-1700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Dysphagia is common in older adults. However, there are no current estimates of dysphagia in community-dwelling older adults those receiving meal support. It is unknown whether dysphagia is associated with other measures of physical function (activities of daily living [ADL] ability or nutrition status). The study purposes were to determine the prevalence of self-reported dysphagia and to identify factors associated with self-reported dysphagia in community-dwelling older adults receiving meal support. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS 476 community-dwelling older adults (78.5±0.51 years) across five Elder Nutrition Program meal services in Wisconsin participated in the study. MEASUREMENTS Data were collected through administration of validated ADL and nutrition questionnaires (nutritional status, functional status with ADLs, chewing ability, dental conditions, and prior diagnoses of dysphagia, pneumonia, and dementia). For self-reported dysphagia, the validated 10-item eating assessment tool (EAT-10) was used. RESULTS The prevalence of self-reported dysphagia (EAT-10 score of ≥ 3) was 20.4%. Multivariate logistic regression results indicated that poor nutritional status (OR=3.1, p=0.04), difficulty chewing (OR=2.2, p=0.03), prior dysphagia diagnosis (OR=34.8, p<0.001), prior pneumonia diagnosis (OR=2.1, p=0.04), and meal service site (OR=2.68, p=0.02) were associated with self-reported dysphagia. CONCLUSION Approximately one in five community-dwelling older adults receiving meal support had self-reported dysphagia. Increased risk for poor nutrition, reduced chewing ability, prior dysphagia and pneumonia diagnosis, and meal service site were identified as factors associated with dysphagia on the EAT-10. Results highlight the need for further studies across more sites to identify dysphagia risk indicators in community-dwelling older adults receiving meal support state-wide.
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Affiliation(s)
- A Kurosu
- Nicole Rogus-Pulia, Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA,
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Senders S, Klein NP, Lamberth E, Thompson A, Drozd J, Trammel J, Peng Y, Giardina P, Jansen KU, Gruber WC, Scott D, Watson W. 1236. Safety and Immunogenicity of a 20-Valent Pneumococcal Conjugate Vaccine (PCV20) in Healthy Infants in the United States. Open Forum Infect Dis 2020. [PMCID: PMC7777493 DOI: 10.1093/ofid/ofaa439.1421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A 20-valent pneumococcal conjugate vaccine (PCV20) is being developed to extend protection against pneumococcal disease beyond that of the 13-valent pneumococcal vaccine (PCV13). This is the first safety and immunogenicity study of PCV20 in healthy infants. Methods This randomized, double-blind study enrolled and randomized (1:1) healthy infants ≥ 42 to ≤ 98 days of age to receive a 4-dose series of either PCV20 or PCV13 (control) at 2, 4, 6, and 12 months of age. Local reactions and systemic events were assessed for 7 days after each vaccination; adverse events (AEs) and serious AEs (SAEs) were collected throughout the study. PCV20 immune responses (serotype-specific immunoglobulin G [IgG] and opsonophagocytic activity [OPA]) were measured in sera 1 month after the third infant dose and the fourth dose at 12 months of age. Results There were 460 subjects enrolled, with 416 and 391 subjects receiving 3 and 4 doses, respectively. Local reactions and systemic events were predominantly mild to moderate in severity and similar among vaccine groups. There were no related SAEs or deaths reported. PCV20 elicited IgG responses 1 month after the third dose with boosting after a fourth dose. OPA responses were also observed. Conclusion PCV20 was well tolerated with a safety profile similar to PCV13. PCV20 elicited immune responses to all 20 vaccine serotypes. Disclosures Shelly Senders, MD, Pfizer (Grant/Research Support) Nicola P. Klein, MD, PhD, GSK group of companies (Research Grant or Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Protein Science (now SP) (Grant/Research Support)Sanofi Pasteur (Grant/Research Support) Erik Lamberth, MD, Pfizer (Employee) Allison Thompson, MD, Pfizer (Employee) Jelena Drozd, MS, Pfizer (Employee) James Trammel, MS, Pfizer (Employee) Yahong Peng, PhD, Pfizer (Employee, Shareholder) Peter Giardina, PhD, Pfizer (Employee) Kathrin U. Jansen, PhD, Pfizer (Employee, Shareholder) William C. Gruber, MD, Pfizer (Employee, Shareholder) Daniel Scott, MD, Pfizer (Employee, Shareholder) Wendy Watson, MD, Pfizer (Employee, Shareholder)
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Affiliation(s)
- Shelly Senders
- Senders Pediatrics, Cleveland, Ohio, United States, Euclid, Ohio
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California, United States, Oakland, California
| | | | | | | | | | | | - Peter Giardina
- Pfizer Vaccine Research and Development, Pearl River, NY
| | | | | | | | - Wendy Watson
- Pfizer Vaccine Research and Development, Pearl River, NY
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Pollaers K, Thompson A, Kuthubutheen J. Cochlear nerve anomalies in paediatric single-sided deafness - prevalence and implications for cochlear implantation strategies. J Laryngol Otol 2020; 134:1-4. [PMID: 33280620 DOI: 10.1017/s002221512000225x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/05/2022]
Abstract
OBJECTIVE To determine the prevalence of cochlear nerve anomalies on magnetic resonance imaging in patients with unilateral or bilateral sensorineural hearing loss. METHODS A retrospective case series was conducted at a tertiary referral centre. The inclusion criteria were paediatric patients with bilateral or unilateral sensorineural hearing loss, investigated with magnetic resonance imaging. The primary outcome measure was the rate of cochlear nerve hypoplasia or aplasia. RESULTS Of the 72 patients with unilateral sensorineural hearing loss, 39 per cent (28 cases) had absent or hypoplastic cochlear nerves on the affected side. Fifteen per cent (11 cases) had other abnormal findings on magnetic resonance imaging. Eighty-four patients had bilateral sensorineural hearing loss, of which cochlear nerve hypoplasia or aplasia was identified only in 5 per cent (four cases). Other abnormal findings were identified in 14 per cent (12 cases). CONCLUSION Paediatric patients with unilateral sensorineural hearing loss are more likely to have cochlear nerve anomalies than those patients with bilateral sensorineural hearing loss. This has important implications regarding cochlear implantation for patients with single-sided deafness.
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Affiliation(s)
- K Pollaers
- Department of ENT, Perth Children's Hospital, Nedlands, Australia
| | - A Thompson
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, Australia
| | - J Kuthubutheen
- Department of ENT, Perth Children's Hospital, Nedlands, Australia
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Australia
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Turner RM, de Koning EM, Fontana V, Thompson A, Pirmohamed M. Multimorbidity, polypharmacy, and drug-drug-gene interactions following a non-ST elevation acute coronary syndrome: analysis of a multicentre observational study. BMC Med 2020; 18:367. [PMID: 33234119 PMCID: PMC7687685 DOI: 10.1186/s12916-020-01827-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 06/30/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The number of patients living with co-existing diseases is growing. This study aimed to assess the extent of multimorbidity, medication use, and drug- and gene-based interactions in patients following a non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS In 1456 patients discharged from hospital for a NSTE-ACS, comorbidities and multimorbidity (≥ 2 chronic conditions) were assessed. Of these, 698 had complete drug use recorded at discharge, and 652 (the 'interaction' cohort) had drug use and actionable genotypes available for CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5, DPYD, F5, SLCO1B1, TPMT, UGT1A1, and VKORC1. The following drug interactions were investigated: pharmacokinetic drug-drug (DDIs) involving CYPs (CYPs above, plus CYP1A2, CYP2C8, CYP3A4), SLCO1B1, and P-glycoprotein; drug-gene (DGIs); drug-drug-gene (DDGIs); and drug-gene-gene (DGGIs). Interactions predicted to be 'substantial' were defined as follows: DDIs due to strong inhibitors/inducers, DGIs due to variant homozygous/compound heterozygous genotypes, and DDGIs/DGGIs where the constituent DDI/DGI(s) both influenced the victim drug in the same direction. RESULTS In the whole cohort, 727 (49.9%) patients had multimorbidity. Non-linear relationships between age and increasing comorbidities and decreasing coronary intervention were observed. There were 98.1% and 39.8% patients on ≥ 5 and ≥ 10 drugs, respectively (from n = 698); women received more non-cardiovascular drugs than men (median (IQR) 3 (1-5) vs 2 (1-4), p = 0.014). Overall, 98.7% patients had at least one actionable genotype. Within the interaction cohort, 882 interactions were identified in 503 patients (77.1%), of which 346 in 252 patients (38.7%) were substantial: 59.2%, 11.6%, 26.3%, and 2.9% substantial interactions were DDIs, DGIs, DDGIs, and DGGIs, respectively. CYP2C19 (49.5% of all interactions) and SLCO1B1 (18.4%) were involved in the largest number of interactions. Multimorbidity (p = 0.019) and number of drugs (p = 9.8 × 10-10) were both associated with patients having ≥ 1 substantial interaction. Multimorbidity (HR 1.76, 95% CI 1.10-2.82, p = 0.019), number of drugs (HR 1.10, 95% CI 1.04-1.16, p = 1.2 × 10-3), and age (HR 1.05, 95% CI 1.03-1.07, p = 8.9 × 10-7), but not drug interactions, were associated with increased subsequent major adverse cardiovascular events. CONCLUSIONS Multimorbidity, polypharmacy, and drug interactions are common after a NSTE-ACS. Replication of results is required; however, the high prevalence of DDGIs suggests integrating co-medications with genetic data will improve medicines optimisation.
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Affiliation(s)
- R M Turner
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, L69 3GL, UK.
| | - E M de Koning
- Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - V Fontana
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, L69 3GL, UK
| | - A Thompson
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, L69 3GL, UK
| | - M Pirmohamed
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, L69 3GL, UK
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Snyder MD, Priestley MA, Weiss M, Hoegg CL, Plachter N, Ardire S, Thompson A. Preventing Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit. Crit Care Nurse 2020; 40:e12-e17. [PMID: 32006039 DOI: 10.4037/ccn2020438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections are common health care-associated infections and have been associated with increased mortality, morbidity, length of stay, and cost. Prevention strategies are grouped into bundles focused on reducing unnecessary catheter use and promptly removing urinary catheters. Before intervention in the study institution, no urinary catheters were unnecessarily used and compliance with the catheter-associated urinary tract infection bundle was 84%. OBJECTIVE To increase bundle compliance by using targeted rounds specifically focused on eliminating dependent loops in drainage tubing and ensuring appropriate catheter use to reduce the incidence of catheter-associated urinary tract infections. METHODS A multidisciplinary team was formed to identify misperceptions, highlight best practices, and eliminate barriers to success over 1 year in a single pediatric intensive care unit. The team completed a quality improvement project of daily targeted rounding for patients with an indwelling urinary catheter. The goals were to assess appropriateness of catheterization, increase bundle compliance, and decrease catheter-associated urinary tract infection risk. Targeted rounds were conducted in addition to the medical team rounds. RESULTS Bundle compliance supported by targeted rounding increased from 84% to 93% and helped reduce the overall catheter-associated urinary tract infection rate from 2.7 infections per 1000 catheter-days at baseline to 0. This change was sustained for 1 year. CONCLUSION Targeted rounding for pediatric patients with an indwelling urinary catheter is an effective and sustainable strategy to reduce catheter-associated urinary tract infections. The ease of implementation for this intervention lends itself to generalizability to other patient populations.
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Affiliation(s)
- Megan D Snyder
- Megan D. Snyder is the Director of Nursing Professional Practice at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret A Priestley
- Margaret A. Priestley is an associate professor of clinical anesthesiology and critical care medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,medical director of the pediatric intensive care unit at the Children's Hospital of Philadelphia
| | - Michelle Weiss
- Michelle Weiss is a case management specialist at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cindy L Hoegg
- Cindy L. Hoegg is the Senior Infection Preventionist in the Infection Prevention and Control Department at the Children's Hospital of Philadelphia
| | - Natalie Plachter
- Natalie Plachter is a primary care nurse practitioner at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah Ardire
- Sarah Ardire is a clinical nurse expert in the pediatric intensive care unit at the Children's Hospital of Philadelphia
| | - Allison Thompson
- Allison Thompson is the advanced practice provider manager for the critical care, sedation/radiology, and surgical subspecialty teams at the Children's Hospital of Philadelphia
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Hancock S, Inglis L, Laurence M, Miller D, Thompson A. Facial action units, activity and time spent with dam are effective measures of pain in response to mulesing of Merino lambs. Aust Vet J 2020; 99:61-65. [PMID: 33145759 DOI: 10.1111/avj.13038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/11/2020] [Revised: 09/01/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022]
Abstract
Repeatable measures of pain in ruminants following husbandry procedures are required to validate responses to pain relief. This study tested the hypotheses that facial action units, activity and time spent with dam can be used to assess the efficacy of pain relief in lambs following mulesing. Merino lambs (n = 120) were allocated to one of six treatments implemented at mulesing: (1) lambs that were not mulesed or lambs that were mulesed and administered (2) no pain relief, (3) meloxicam 15 min before mulesing, (4) Tri-Solfen®, (5) a combination of meloxicam 15 min before mulesing and Tri-Solfen after mulesing and (6) meloxicam at mulesing. Facial action units detected a difference in pain between mulesed and non-mulesed lambs at 1 and 5 h post-mulesing (P = 0.005 and <0.001) but not at 26 h post-mulesing. Lambs that were not mulesed were more active and spent more time with their dams than mulesed lambs (P < 0.001). No differences were observed between lambs that were mulesed with or without pain relief. Therefore, facial action units, activity of the lamb and time spent with dam can detect pain in response to mulesing in Merino lambs but cannot detect any changes associated with pain relief.
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Affiliation(s)
- S Hancock
- College of Science, Health, Engineering and Education, Agricultural Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - L Inglis
- College of Science, Health, Engineering and Education, Agricultural Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - M Laurence
- College of Science, Health, Engineering and Education, Veterinary College, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - D Miller
- College of Science, Health, Engineering and Education, Agricultural Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - A Thompson
- College of Science, Health, Engineering and Education, Agricultural Sciences, Murdoch University, Murdoch, Western Australia, 6150, Australia
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