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Kastlunger G, Vijay S, Chen X, Sharma S, Peterson A. On the Thermodynamic Equivalence of Grand Canonical, Infinite-Size, and Capacitor-Based Models in First-Principle Electrochemistry. Chemphyschem 2024:e202300950. [PMID: 38511569 DOI: 10.1002/cphc.202300950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/27/2024] [Indexed: 03/22/2024]
Abstract
First principles-based computational and theoretical methods are constantly evolving trying to overcome the many obstacles towards a comprehensive understanding of electrochemical processes on an atomistic level. One of the major challenges has been the determination of reaction energetics under a constant potential. Here, a theoretical framework was proposed applying standard electronic structure methods and extrapolating to the infinite-cell size limit where reactions do not alter the potential. Today, electronically grand canonical modifications to electronic structure methods, holding the potential constant by varying the number of electrons in a finite simulation cell, become increasingly popular. In this perspective, we show that these two schemes are thermodynamically equivalent. Further, we link these methods to capacitive models of the interface, in the limit that the capacitance of the charging components (whether continuum or atomistic) are equal and invariant along the reaction pathway. We benchmark the three approaches with an example of alkali cation adsorption on Pt(111) showing that all three approaches converge in the cases of Li, Na and K. For Cs, however, strong deviation from the ideal conditions leads to a spread in the respective results. We discuss the latter by highlighting the cases of broken equivalence and assumptions among the approaches.
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Affiliation(s)
- Georg Kastlunger
- Catalysis Theory Center, Department of Physics, Technical University of Denmark, Fysikvej, 2800, Kongens Lyngby, Denmark
| | - Sudarshan Vijay
- Catalysis Theory Center, Department of Physics, Technical University of Denmark, Fysikvej, 2800, Kongens Lyngby, Denmark
| | - Xi Chen
- School of Engineering, Brown University, Hope Street, Providence, RI, USA
| | - Shubham Sharma
- School of Engineering, Brown University, Hope Street, Providence, RI, USA
| | - Andrew Peterson
- School of Engineering, Brown University, Hope Street, Providence, RI, USA
- Department of Energy Conversion and Storage, Technical University of Denmark, DK-2800 Kgs., Lyngby, Denmark
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Mortensen JJ, Larsen AH, Kuisma M, Ivanov AV, Taghizadeh A, Peterson A, Haldar A, Dohn AO, Schäfer C, Jónsson EÖ, Hermes ED, Nilsson FA, Kastlunger G, Levi G, Jónsson H, Häkkinen H, Fojt J, Kangsabanik J, Sødequist J, Lehtomäki J, Heske J, Enkovaara J, Winther KT, Dulak M, Melander MM, Ovesen M, Louhivuori M, Walter M, Gjerding M, Lopez-Acevedo O, Erhart P, Warmbier R, Würdemann R, Kaappa S, Latini S, Boland TM, Bligaard T, Skovhus T, Susi T, Maxson T, Rossi T, Chen X, Schmerwitz YLA, Schiøtz J, Olsen T, Jacobsen KW, Thygesen KS. GPAW: An open Python package for electronic structure calculations. J Chem Phys 2024; 160:092503. [PMID: 38450733 DOI: 10.1063/5.0182685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024] Open
Abstract
We review the GPAW open-source Python package for electronic structure calculations. GPAW is based on the projector-augmented wave method and can solve the self-consistent density functional theory (DFT) equations using three different wave-function representations, namely real-space grids, plane waves, and numerical atomic orbitals. The three representations are complementary and mutually independent and can be connected by transformations via the real-space grid. This multi-basis feature renders GPAW highly versatile and unique among similar codes. By virtue of its modular structure, the GPAW code constitutes an ideal platform for the implementation of new features and methodologies. Moreover, it is well integrated with the Atomic Simulation Environment (ASE), providing a flexible and dynamic user interface. In addition to ground-state DFT calculations, GPAW supports many-body GW band structures, optical excitations from the Bethe-Salpeter Equation, variational calculations of excited states in molecules and solids via direct optimization, and real-time propagation of the Kohn-Sham equations within time-dependent DFT. A range of more advanced methods to describe magnetic excitations and non-collinear magnetism in solids are also now available. In addition, GPAW can calculate non-linear optical tensors of solids, charged crystal point defects, and much more. Recently, support for graphics processing unit (GPU) acceleration has been achieved with minor modifications to the GPAW code thanks to the CuPy library. We end the review with an outlook, describing some future plans for GPAW.
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Affiliation(s)
- Jens Jørgen Mortensen
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Ask Hjorth Larsen
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Mikael Kuisma
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Aleksei V Ivanov
- Riverlane Ltd., St Andrews House, 59 St Andrews Street, Cambridge CB2 3BZ, United Kingdom
| | - Alireza Taghizadeh
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Andrew Peterson
- School of Engineering, Brown University, Providence, Rhode Island 02912, USA
| | - Anubhab Haldar
- Department of Electrical and Computer Engineering, Boston University, Boston, Massachusetts 02215, USA
| | - Asmus Ougaard Dohn
- Department of Physics, Technical University of Denmark, 2800 Lyngby, Denmark and Science Institute and Faculty of Physical Sciences, VR-III, University of Iceland, Reykjavík 107, Iceland
| | - Christian Schäfer
- Department of Physics, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Elvar Örn Jónsson
- Science Institute and Faculty of Physical Sciences, University of Iceland, VR-III, 107 Reykjavík, Iceland
| | - Eric D Hermes
- Quantum-Si, 29 Business Park Drive, Branford, Connecticut 06405, USA
| | | | - Georg Kastlunger
- CatTheory, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Gianluca Levi
- Science Institute and Faculty of Physical Sciences, University of Iceland, VR-III, 107 Reykjavík, Iceland
| | - Hannes Jónsson
- Science Institute and Faculty of Physical Sciences, University of Iceland, VR-III, 107 Reykjavík, Iceland
| | - Hannu Häkkinen
- Departments of Physics and Chemistry, Nanoscience Center, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Jakub Fojt
- Department of Physics, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Jiban Kangsabanik
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Joachim Sødequist
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Jouko Lehtomäki
- Department of Applied Physics, Aalto University, P.O. Box 11100, 00076 Aalto, Finland
| | - Julian Heske
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Jussi Enkovaara
- CSC-IT Center for Science Ltd., P.O. Box 405, FI-02101 Espoo, Finland
| | - Kirsten Trøstrup Winther
- SUNCAT Center for Interface Science and Catalysis, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - Marcin Dulak
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Marko M Melander
- Department of Chemistry, Nanoscience Center, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Martin Ovesen
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Martti Louhivuori
- CSC-IT Center for Science Ltd., P.O. Box 405, FI-02101 Espoo, Finland
| | - Michael Walter
- FIT Freiburg Centre for Interactive Materials and Bioinspired Technologies, University of Freiburg, Georges-Köhler-Allee 105, 79110 Freiburg, Germany
| | - Morten Gjerding
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Olga Lopez-Acevedo
- Biophysics of Tropical Diseases, Max Planck Tandem Group, University of Antioquia UdeA, 050010 Medellin, Colombia
| | - Paul Erhart
- Department of Physics, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Robert Warmbier
- School of Physics and Mandelstam Institute for Theoretical Physics, University of the Witwatersrand, 1 Jan Smuts Avenue, 2001 Johannesburg, South Africa
| | - Rolf Würdemann
- Freiburger Materialforschungszentrum, Universität Freiburg, Stefan-Meier-Straße 21, D-79104 Freiburg, Germany
| | - Sami Kaappa
- Computational Physics Laboratory, Tampere University, P.O. Box 692, FI-33014 Tampere, Finland
| | - Simone Latini
- Nanomade, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Tara Maria Boland
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Thomas Bligaard
- Department of Energy Conversion and Storage, Technical University of Denmark, DK-2800 Lyngby, Denmark
| | - Thorbjørn Skovhus
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Toma Susi
- Faculty of Physics, University of Vienna, Boltzmanngasse 5, 1090 Vienna, Austria
| | - Tristan Maxson
- Department of Chemical and Biological Engineering, The University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - Tuomas Rossi
- CSC-IT Center for Science Ltd., P.O. Box 405, FI-02101 Espoo, Finland
| | - Xi Chen
- School of Physical Science and Technology, Lanzhou University, Lanzhou, Gansu 730000, China
| | | | - Jakob Schiøtz
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - Thomas Olsen
- CAMD, Department of Physics, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
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Brown SFK, Nguyen H, Mzyk P, De Ieso ML, Unser AM, Brown I, Ramesh P, Afzaal H, Ahmed F, Torrejon KY, Nhan A, Markrush D, Daly T, Knecht E, McConaughy W, Halmos S, Liu ZL, Rennard R, Peterson A, Stamer WD. ANGPTL7 and Its Role in IOP and Glaucoma. Invest Ophthalmol Vis Sci 2024; 65:22. [PMID: 38497513 PMCID: PMC10950037 DOI: 10.1167/iovs.65.3.22] [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: 10/06/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Loss-of-function variants in the ANGPTL7 gene are associated with protection from glaucoma and reduced intraocular pressure (IOP). We investigated the role of ANGPTL7 in IOP homeostasis and its potential as a target for glaucoma therapeutics. Methods IOP, outflow facility, and outflow tissue morphology of Angptl7 knockout (KO) mice were assessed with and without dexamethasone (Dex). ANGPTL7 was quantified in conditioned media from human trabecular meshwork cells in response to Dex, in effluent from perfused human donor eyes, and in aqueous humor from human patients treated with steroids. Antibodies to ANGPTL7 were generated and tested in three-dimensional (3D) culture of outflow cells and perfused human donor eyes. Rabbits were injected intravitreally with a neutralizing antibody targeting ANGPTL7, and IOP was measured. Results IOP was significantly elevated, but outflow facility and outflow tissue morphology were not different between Angptl7 KO mice and littermates. When challenged with Dex, IOP increased in wild-type but not Angptl7 KO mice. In human samples, increased ANGPTL7 was seen in the aqueous humor of patients treated with steroids, regardless of glaucoma status. Using 3D culture, recombinant ANGPTL7 decreased, and ANGPTL7-blocking antibodies increased hydraulic conductivity. Significantly, outflow facility increased in human eyes treated ex vivo with ANGPTL7-blocking antibodies, and IOP decreased for 21 days in rabbits after a single injection of blocking antibodies. Conclusions Using multiple models, we have demonstrated that excess ANGPTL7 increases outflow resistance and IOP and that neutralizing ANGPTL7 has beneficial effects in both naïve and steroid-induced hypertensive eyes, thus motivating the development of ANGPTL7-targeting therapeutics for the treatment of glaucoma.
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Affiliation(s)
| | - Hien Nguyen
- Broadwing Bio, Waltham, Massachusetts, United States
| | - Philip Mzyk
- Duke University, Durham, North Carolina, United States
| | | | | | - Ian Brown
- Broadwing Bio, Waltham, Massachusetts, United States
| | | | - Hira Afzaal
- Humonix Biosciences, Albany, New York, United States
| | - Feryan Ahmed
- Humonix Biosciences, Albany, New York, United States
| | | | - Alan Nhan
- Alloy Therapeutics, Waltham, Massachusetts, United States
| | | | - Tom Daly
- Alloy Therapeutics, Waltham, Massachusetts, United States
| | - Ellie Knecht
- Alloy Therapeutics, Waltham, Massachusetts, United States
| | | | - Sara Halmos
- Alloy Therapeutics, Waltham, Massachusetts, United States
| | | | - Rachel Rennard
- Alloy Therapeutics, Waltham, Massachusetts, United States
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Kious BM, Peterson A, McGuire AL. Are Psychedelic Experiences Transformative? Can We Consent to Them? Perspect Biol Med 2024; 67:143-154. [PMID: 38662069 DOI: 10.1353/pbm.2024.a919716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Psychedelic substances have great promise for the treatment of many conditions, and they are the subject of intensive research. As with other medical treatments, both research and clinical use of psychedelics depend on our ability to ensure informed consent by patients and research participants. However, some have argued that informed consent for psychedelic use may be impossible, because psychedelic experiences can be transformative in the sense articulated by L. A. Paul (2014). For Paul, transformative experiences involve either the acquisition of knowledge that cannot be obtained in any other way or changes in the self. Either of these characteristics may appear to undermine informed consent. This article argues, however, that there is limited evidence that psychedelic experiences are transformative in Paul's sense, and that they may not differ in their transformative features from other common medical experiences for which informed consent is clearly possible. Further, even if psychedelic experiences can be transformative, informed consent is still possible. Because psychedelic experiences are importantly different in several respects from other medical experiences, this article closes with recommendations for how these differences should be reflected in informed consent processes.
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Karlawish J, Peterson A, Kleid M, Harkins K, Largent EA, Stites SD, Coykendall C, Clapp JT. Caregiver Accounts of Lucid Episodes in Persons with Advanced Dementia. Gerontologist 2023:gnad170. [PMID: 38134428 DOI: 10.1093/geront/gnad170] [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: 05/23/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Paradoxical lucidity is defined as an instance of unexpected lucid behavior in a person who is assumed to be noncommunicative due to a progressive and pathophysiologic dementing process. To inform studies of the prevalence, characteristics, and impact of these behaviors, this interview study examined caregivers' experiences of witnessing paradoxical lucidity. RESEARCH DESIGN AND METHODS Participants were family caregivers of persons living with advanced dementia caused by a neurodegenerative disease producing significant impairments in communication. Semi-structured interviews elicited the caregivers' experiences of plausible lucid episodes. Data analysis used a thematic analysis approach. RESULTS Most caregivers reported at least one episode of lucidity. Episodes were typically brief. Most involved utterances, but nonverbal behaviors were also common. The mental capacities associated with these behaviors included recognition, awareness of surroundings, recognizing others' emotions, and goal-directed behavior. Most caregivers' reactions were positive. Episodes did not lead to changes in major medical decisions but instead to efforts to either modify or reinforce daily caregiving efforts. DISCUSSION AND IMPLICATIONS Episodes of lucidity were common, a finding seen in other studies. If prevalence studies confirm this, the qualifier "paradoxical" should be eliminated. The caregivers' familiarity with the person living with dementia allowed them to attribute meaning to subtle behaviors that might not otherwise be detected or considered lucid. Clinicians who care for persons with advanced stage dementia should routinely ask caregivers about episodes of lucid communication and their emotional reactions.
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Affiliation(s)
- Jason Karlawish
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason, University, Fairfax, Virginia, USA
| | - Melanie Kleid
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Harkins
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shana D Stites
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cameron Coykendall
- Division of Geriatrics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin T Clapp
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, University, of Pennsylvania, Philadelphia, Pennsylvania, USA
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Largent EA, Peterson A, Harkins K, Coykendall C, Kleid M, Abera M, Stites SD, Karlawish J, Clapp JT. "A Raw Blessing" - Caregivers' Experiences Providing Care to Persons Living with Dementia in the COVID-19 Pandemic. J Law Med Ethics 2023; 51:626-640. [PMID: 38088630 PMCID: PMC10827343 DOI: 10.1017/jme.2023.99] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
The COVID-19 pandemic has been devastating for people living with dementia (PLWD) and their caregivers. While prior research has documented these effects, it has not delved into their specific causes or how they are modified by contextual variation in caregiving circumstances.
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Largent EA, Peterson A, Karlawish J. Supported decision making: Facilitating the self-determination of persons living with Alzheimer's and related diseases. J Am Geriatr Soc 2023; 71:3566-3573. [PMID: 37698156 PMCID: PMC10841214 DOI: 10.1111/jgs.18596] [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: 07/06/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
Decision-making capacity describes the ability to make a particular decision at a given time. People with Mild Cognitive Impairment (MCI) and mild stage dementia typically experience an associated erosion of their decisional abilities. Many could be said to have marginal capacity. These individuals are in a liminal space between adequate and inadequate capacity. Too often, marginal capacity is overlooked as a category: individuals are classified either as having capacity and being able to make decisions independently or as lacking capacity and needing a surrogate to make decisions for them. These approaches can, respectively, result in under- or overprotection of individuals with marginal capacity. A promising alternative approach is supported decision making. In supported decision making, a person with marginal capacity identifies a trusted person or network of persons to aid them in making their own decisions. Supported decision making is recognized by law in a growing number of states; it is important for geriatricians to be familiar with the concept, as they are increasingly likely to encounter it in their practice. Even in states where supported decision making is not formally recognized, it can be practiced informally, helping patients, care partners, and clinicians strike an appropriate balance between respecting autonomy and recognizing vulnerability. In this article, we describe supported decision making, discuss its ethical and legal foundations, and identify steps by which geriatricians can incorporate it into their practice.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University, Fairfax, Virginia, USA
| | - Jason Karlawish
- Department of Medicine, Department of Medical Ethics and Health Policy, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Judkins J, Moore B, Stone E, Welsh A, Carbon G, Rendell B, Peterson A. Pilot investigation of an activity-based approach to building hardiness. BMJ Mil Health 2023; 169:350-354. [PMID: 34413115 DOI: 10.1136/bmjmilitary-2020-001661] [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: 09/23/2020] [Accepted: 08/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The purpose was to describe an activity-based psychological hardiness training programme delivered by an occupational therapist and examine its acceptability and effectiveness in improving hardiness. METHOD Participants (N=28) completed the 6-hour programme, which included pre/post-programme completion of the Dispositional Resilience Scale-15 (DRS-15) and a Program Evaluation Form. Paired t-tests were used to determine differences between pre-training and post-training scores on the DRS-15. RESULTS Results showed a significant increase (p<0.05) in total hardiness, commitment, and control scores on the DRS-15 from pre-training to post-training and good-excellent ratings for all categories on the Program Evaluation Form. CONCLUSIONS This programme evaluation described an occupational therapist's role in providing an activity-based psychological hardiness training programme and provided preliminary support for the acceptability of an activity-based approach to training psychological hardiness for service members.
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Affiliation(s)
- Jason Judkins
- Military Performance Department, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - B Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia, USA
| | - E Stone
- 5-20 Infantry Battalion, 1-2 Stryker Brigade Combat Team, Joint Base Lewis-McChord, Washington, USA
| | - A Welsh
- US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - G Carbon
- Center for Army Analysis, Fort Belvior, Virginia, USA
| | - B Rendell
- AFROTC Detachment 842, University of Texas at San Antonio, San Antonio, Texas, USA
| | - A Peterson
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Anderson BJ, Wilz L, Peterson A. The Identification and Treatment of Common Skin Infections. J Athl Train 2023; 58:502-510. [PMID: 35984712 PMCID: PMC10496455 DOI: 10.4085/1062-6050-0142.22] [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: 11/09/2022]
Abstract
Skin conditions are a common problem addressed by medical providers. Up to 25% of individuals in the United States will seek attention for these conditions each year. The same problem occurs in the athletic training room, where athletes with infectious skin conditions can be seen. Most conditions are simple and can be treated without concern for spread to susceptible athletes. However, others can be quite serious and spread rapidly through a team and opponents during competition. Knowledge of the different types of skin infections is necessary to help treat these athletes and prevent spread to others. With proper diagnosis and treatment, certified athletic trainers can keep the athlete off the field of play for a minimum period and prevent transmission.
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Affiliation(s)
- B. J. Anderson
- Boynton Health Service, University of Minnesota, Minneapolis
- Medical Director of Sports Medicine, Augsburg University, Minneapolis, MN
| | - Logan Wilz
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City
| | - Andrew Peterson
- Carver College of Medicine, University of Iowa, Iowa City
- Stead Family Department of Pediatrics, University of Iowa, Iowa City
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City
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Premo H, Gordee A, Lee HJ, Scales CD, Moul JW, Peterson A. Disparities in Prostate Cancer Screening for Transgender Women: An Analysis of the MarketScan Database. Urology 2023; 176:237-242. [PMID: 36972765 PMCID: PMC10330039 DOI: 10.1016/j.urology.2023.03.016] [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: 08/10/2022] [Revised: 02/19/2023] [Accepted: 03/13/2023] [Indexed: 03/28/2023]
Abstract
OBJECTIVE To describe the prevalence of PSA screening amongst transgender women. A transgender individual is someone whose gender identity differs from their birth sex or the societal norms of that assigned sex. There are no formal guidelines regarding PSA screening in transgender women, even though they retain prostatic tissue throughout the gender-affirming process, and there is a lack of existing data to adequately inform clinical practice. METHODS We identified a cohort of transgender women in the IBM MarketScan dataset using ICD codes. The patient...s eligibility for inclusion was determined on an annual basis for the years 2013-2019. For each year, we required continuous enrollment, 3 months of post-transgender diagnosis follow-up, and aged 40-80 without a prior diagnosis of prostate malignancy. This cohort was compared to cisgender men with similar eligibility criteria. The proportions of individuals undergoing PSA screening were compared using log-binomial regression. RESULTS A group of 2957 transgender women met the inclusion criteria. We saw significantly lower PSA screening rates among transgender individuals for ages 40-54 and 55-69, but higher rates within the age group 70-80 (P.ß<.ß.001 for all). CONCLUSION This is the first study evaluating PSA screening rates for insured transgender women. While the rates for screening in transgender women over the age of 70 are higher, the overall rate of screening for all other age groups lags below the general population in this dataset. Further investigation is necessary to provide equitable care for the transgender community.
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Affiliation(s)
| | - Alexander Gordee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC; Surgery Center for Outcomes Research and Equity in Surgery, Duke University, Durham, NC
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC; Surgery Center for Outcomes Research and Equity in Surgery, Duke University, Durham, NC
| | - Charles D Scales
- Surgery Center for Outcomes Research and Equity in Surgery, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC; Department of Surgery, Division of Urology, Duke University, Durham, NC
| | - Judd W Moul
- Department of Surgery, Division of Urology, Duke University, Durham, NC; Duke Cancer Institute, Duke University, Durham, NC
| | - Andrew Peterson
- Department of Surgery, Division of Urology, Duke University, Durham, NC
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Peterson A. Editorial Comment. J Urol 2023:101097JU000000000000348802. [PMID: 37192274 DOI: 10.1097/ju.0000000000003488.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Andrew Peterson
- Department of Urology, Duke University, Durham, North Carolina
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Peterson A, Largent EA, Lynch HF, Karlawish J, Sisti D. Journeying to Ixtlan: Ethics of Psychedelic Medicine and Research for Alzheimer's Disease and Related Dementias. AJOB Neurosci 2023; 14:107-123. [PMID: 36476106 DOI: 10.1080/21507740.2022.2148771] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
In this paper, we examine the case of psychedelic medicine for Alzheimer's disease and related dementias (AD/ADRD). These "mind-altering" drugs are not currently offered as treatments to persons with AD/ADRD, though there is growing interest in their use to treat underlying causes and associated psychiatric symptoms. We present a research agenda for examining the ethics of psychedelic medicine and research involving persons living with AD/ADRD, and offer preliminary analyses of six ethical issues: the impact of psychedelics on autonomy and consent; the impact of "ego dissolution" on persons experiencing a pathology of self; how psychedelics might impact caregiving; the potential exploitation of patient desperation; institutional review boards' orientation to psychedelic research; and methods to mitigate inequity. These ethical issues are magnified for AD/ADRD but bear broader relevance to psychedelic medicine and research in other clinical populations.
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Affiliation(s)
| | | | | | | | - Dominic Sisti
- University of Pennsylvania Perelman School of Medicine
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13
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Wallum M, Whipple T, Peterson A. Wrestling with Heat Illness: Acquired Idiopathic Generalized Anhidrosis in the Pediatric Athlete. Curr Sports Med Rep 2023; 22:113-114. [PMID: 37036457 DOI: 10.1249/jsr.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- Michael Wallum
- Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Terese Whipple
- Department of Emergency Medicine, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Andrew Peterson
- Department of Pediatrics, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
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Diehl JN, Ray A, Collins LB, Peterson A, Alexander KC, Boutros JG, Ikonomidis JS, Akerman AW. A standardized method for plasma extracellular vesicle isolation and size distribution analysis. PLoS One 2023; 18:e0284875. [PMID: 37115777 PMCID: PMC10146456 DOI: 10.1371/journal.pone.0284875] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
The following protocol describes our workflow for isolation and quantification of plasma extracellular vesicles (EVs). It requires limited sample volume so that the scientific value of specimens is maximized. These steps include isolation of vesicles by automated size exclusion chromatography and quantification by tunable resistive pulse sensing. This workflow optimizes reproducibility by minimizing variations in processing, handling, and storage of EVs. EVs have significant diagnostic and therapeutic potential, but clinical application is limited by disparate methods of data collection. This standardized protocol is scalable and ensures efficient recovery of physiologically intact EVs that may be used in a variety of downstream biochemical and functional analyses. Simultaneous measurement quantifies EV concentration and size distribution absolutely. Absolute quantification corrects for variations in EV number and size, offering a novel method of standardization in downstream applications.
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Affiliation(s)
- J Nathaniel Diehl
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Amelia Ray
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Lauren B Collins
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Andrew Peterson
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Cardiothoracic Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kyle C Alexander
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Cardiothoracic Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jacob G Boutros
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, United States of America
| | - John S Ikonomidis
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Cardiothoracic Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Adam W Akerman
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Division of Cardiothoracic Surgery, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
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Peterson A, Clapp J, Harkins K, Kleid M, Largent E, Stites S, Karlawish J. IS THERE A DIFFERENCE BETWEEN TERMINAL LUCIDITY AND PARADOXICAL LUCIDITY? Innov Aging 2022. [PMCID: PMC9770271 DOI: 10.1093/geroni/igac059.354] [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: 12/24/2022] Open
Abstract
Recent arguments in aging and dementia research suggest that “terminal lucidity”—defined as unexpected communication or connectedness occurring shortly before death—is distinct from “paradoxical lucidity”—defined as an episode of communication or connectedness in a person who is assumed to have lost these capacities due to progressive neurodegeneration. We disagree with this distinction and argue that terminal lucidity is a special subtype of paradoxical lucidity. We suggest that specifying the relationship between terminal and paradoxical lucidity is important for investigating the underlying mechanism of lucidity in dementia.
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Affiliation(s)
| | - Justin Clapp
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Kristin Harkins
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Melanie Kleid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Emily Largent
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Shana Stites
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Jason Karlawish
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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16
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Largent EA, Clapp J, Blumenthal-Barby JS, Grady C, McGuire AL, Karlawish J, Grill JD, Stites SD, Peterson A. Deciding with Others: Interdependent Decision-Making. Hastings Cent Rep 2022; 52:23-32. [PMID: 36537275 PMCID: PMC9773484 DOI: 10.1002/hast.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Over the course of human life, health care decision-making is often interdependent. In this article, we use "interdependence" to refer to patients' engagement of nonclinicians-for example, family members or trusted friends-to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's decision-making capacity. In this article, we array various approaches to decision-making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span.
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17
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Campbell ML, Lenz AL, Peterson A, DeKeyser GJ, Haller J, O'Neill DC. Dual Approach to Talar Body Fractures Increases Talar Dome Access for Fracture Care without Osteotomy. Foot & Ankle Orthopaedics 2022. [DOI: 10.1177/2473011421s00605] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Category: Trauma; Ankle; Hindfoot Introduction/Purpose: No consensus surgical treatment algorithm exists for talar body fractures, with authors recommending both soft-tissue and osteotomy-based approaches. This study evaluated the utility of dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches, both with and without distraction. Methods: Ten cadaveric legs (5 matched pairs) were included. A mPM approach, between FHL and Achilles tendon, and an ATL approach, utilizing an anterolateral incision with transection of the ATFL and CFL fibular insertions, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4mm of tibiotalar distraction. Specimens were analyzed by micro-computed tomography. Primary outcome was total accessible DSA. Student's t-tests compared DSA accessed by different exposure methods. Results: An initial mPM approach allowed access to 25.6% and 33.6% of DSA without and with distraction (p=0.002). An initial ATL approach provided access to 47.0% and 58.1% of DSA without and with distraction, respectively (p=0.003). No significant difference in DSA accessibility were observed for either approach when they were performed second. Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (p=0.96 and 0.37, respectively). (Figure 1) Conclusion: Dual approaches provided access to greater than 70% and 85% of DSA without and with distraction. Order of approach did not change access. These results may promote soft-tissue only treatment strategies in talar body fracture care.
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Karlawish J, Peterson A, Clapp JT, Largent EA. A Case of Patient Abandonment, or an Abandonment of Patients? Am J Bioeth 2022; 22:86-87. [PMID: 35737506 PMCID: PMC9809500 DOI: 10.1080/15265161.2022.2075961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Roy A, Peterson A, Marchant N, Alvir J, Bhambri R, Bredl Z, Benjumea D, Kemner J, Parasuraman B. Baseline characteristics and secondary medication adherence among Medicare patients diagnosed with transthyretin amyloid cardiomyopathy and/or receiving tafamidis prescriptions: A retrospective analysis of a Medicare cohort. J Manag Care Spec Pharm 2022; 28:766-777. [PMID: 35737856 PMCID: PMC10372989 DOI: 10.18553/jmcp.2022.28.7.766] [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: 01/15/2023]
Abstract
BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed, life-threatening condition that mostly affects older persons. In May 2019, regulatory approval of tafamidis provided the first pharmacologic treatment of ATTR-CM. In the pivotal phase 3 Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT), 97.2% of patients were classified as adherent (defined as taking ≥ 80% of scheduled doses). Given its recent approval, there is limited real-world evidence examining patient adherence to tafamidis. OBJECTIVE: To evaluate adherence patterns, demographics, and clinical characteristics of patients in the United States receiving tafamidis prescriptions through Medicare. Secondarily, we aimed to evaluate concomitant medications filled by this patient population. METHODS: We conducted a retrospective cohort study of US Medicare claims data, limited by the Health Insurance Portability and Accountability Act of 1996, in adult patients with an adjudicated pharmacy claim for tafamidis (tafamidis free acid 61-mg capsule once daily or tafamidis meglumine four 20-mg capsules once daily) between May 1, 2019, and June 30, 2021. Gaps in therapy were measured using day gaps between prescription refills and continuous measure of medication gaps. Implementation adherence was assessed through modified medication possession ratio (MPRm), medication refill adherence (MRA), and proportion of days covered (PDC). Patients were grouped based on Medicare coverage. Patients were analyzed by subgroups based on age and at the zip code level, via distressed communities index quartiles and rural-urban tiers. RESULTS: A total of 3,558 patients who received a prescription fill of a tafamidis formulation were identified using Medicare Fee-for-Service (FFS) and Medicare Advantage (MA) claims data from May 1, 2019, to June 30, 2021. The characteristics of this patient population were consistent with published literature, as 98.6% were older than 65 years, 53.4% were between 75 years and 84 years, and 81.5% were male. In the patient population receiving tafamidis refills, adherence was high across all 3 measures, with mean MPRm greater than 90% and mean MRA greater than 80%, across all age groups. Mean PDC adherence rates were 79% or more across all age groups. Concomitant medications were generally indicated for heart failure and thrombosis. Among monotherapy groups with similar demographic makeup, adherence was significantly higher among users of tafamidis free acid vs tafamidis meglumine (P < 0.0001 across all mean adherence measures). CONCLUSIONS: Our results demonstrate that real-world adherence to tafamidis in the Medicare population is high, regardless of age, zip code-level socioeconomic quartile, or geography. Adherence was higher among patients receiving tafamidis free acid, suggesting that the enhanced convenience of a single capsule once daily may positively contribute to adherence among patients with ATTR-CM. DISCLOSURES: Darrin Benjumea is an employee of Genesis Research who has been contracted by Pfizer, Inc., for involvement in this study. Andrew Peterson is an employee of University of the Sciences who has been contracted by Pfizer, Inc., for involvement in this study. Zach Bredl is an employee of Care Journey who has been contracted by Pfizer, Inc., for involvement in this study. Anuja Roy, Nick Marchant, Jose Alvir, Rahul Bhambri, Jason Kemner, and Bhash Parasuraman are employees of Pfizer, Inc., and own stock and/or stock options. This study was supported by Pfizer, Inc.
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Affiliation(s)
| | - Andrew Peterson
- Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA
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20
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Fyfe S, Lanphier E, Peterson A. Neurorights for Incarcerated Persons: Should We Curb Inflation? AJOB Neurosci 2022; 13:165-168. [PMID: 35797127 DOI: 10.1080/21507740.2022.2082585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Elizabeth Lanphier
- Cincinnati Children's Hospital Medical Center.,University of Cincinnati College of Medicine
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21
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Singh N, Peterson A, Baraff A, Chung S, Bhatti P, Coffey D, Barton J, LI C, Smith N, Weiss N. POS1422 USE OF DISEASE MODIFYING ANTI-RHEUMATIC DRUGS AND RISK OF MULTIPLE MYELOMA IN PERSONS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2168] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundBiologic therapies used in the management of rheumatoid arthritis (RA) target several cytokines that have been implicated in the pathogenesis of multiple myeloma (MM). Yet little is known about the association between use of biologic or targeted synthetic disease modifying anti-rheumatic drugs (b or tsDMARDs) in RA and the incidence of MM.ObjectivesOur objective was to estimate the association between b/tsDMARD use and the risk of MM among persons with RA using Veterans Health Administration (VHA) data. We hypothesized that b-/tsDMARD use is associated with a lower incidence of MM compared with conventional synthetic DMARDs (csDMARDs).MethodsIn this retrospective cohort study, we identified patients >18 years of age diagnosed with RA in any United States VHA facility from 1/1/2002 and 12/31/2018. All patients met the following inclusion criteria: 1) two or more International Classification of Diseases Version 9 or 10 (ICD9 or ICD10) codes for RA at least 7 days apart but no more than 365 days apart 2) a prescription for a csDMARD within 90 days of the first RA diagnosis 3) one inpatient or outpatient visit 30 days to 2 years preceding first RA diagnosis (indicating a regular user of VHA). Medication data was derived from the outpatient prescription fills, bar coded medication administration (BCMA), and intravenous (IV) data domains. The csDMARDs included in these analyses were: methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine. The bDMARDs included were tumor necrosis factor inhibitors (TNFi) and non-TNFi biologics such as tocilizumab, rituximab, abatacept, and biosimilars; tsDMARD was tofacitinib. Patients with MM before the diagnosis of RA were excluded. Incident MM was determined by 1 or more ICD9/10 code or ICD-oncology codes. Multivariable Cox proportional hazards model were performed to estimate the hazard ratio for developing MM among those during and following the use of a b-/tsDMARD relative to b-/tsDMARD-naïve persons adjusting for age, gender, race, and ethnicity.Results27,540 veterans with RA met study eligibility criteria, of whom 8,322 (30%) had taken a b-/tsDMARD. Over the study period there were 77 incident MM over a total of 192,000 person years. There were 55 events in users of csDMARDs, an incidence rate (IR) of 0.40 (95% CI 0.30-0.52) per 1000 person-years and 22 in persons currently or formerly using b-/tsDMARDs (IR 0.41, 0.25-0.61 per 1000 person years). The unadjusted hazard ratio for MM following bDMARD use relative to csDMARD only use was 1.04 (0.63, 1.73), which increased to 1.28 (0.76, 2.16) after adjusting for demographic characteristics (Table 1).Table 1.Multivariable Cox proportional hazards model for association between use of disease modifying anti-rheumatic drugs and incident multiple myeloma.Clinical characteristicHazards ratio (95% CI)csDMARDReferenceb-/tsDMARD use1.28 (0.76-2.16)Age*1.04 (1.02-1.07)Female0.58 (0.20-1.62)RaceReferenceWhite2.11 (1.15-3.86)Black0.70 (0.10-5.08)OtherHispanic Ethnicity0.71 (0.17-2.92)Abbreviations: b-/tsDMARD- biologic or targeted synthetic disease modifying anti-rheumatic drug; CI: confidence interval*Hazards ratio reflects risk per every 1-year increase in ageModel adjusted for age, gender, race, and ethnicityConclusionIn this nationwide VA study, we did not observe an association between bDMARD use and the incidence of MM. Of note, the median interval from initiation of a bDMARD to the end of follow-up was approximately 5.8 years, which does not allow for an examination of a possible longer term influence.Disclosure of InterestsNone declared
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22
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Largent EA, Peterson A, Karlawish J, Lynch HF. Aspiring to Reasonableness in Accelerated Approval: Anticipating and Avoiding the Next Aducanumab. Drugs Aging 2022; 39:389-400. [PMID: 35696021 PMCID: PMC9247014 DOI: 10.1007/s40266-022-00949-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
The US Food and Drug Administration's decisions about drug approval-though guided by science, as well as relevant statutes, regulations, and guidance documents-reflect normative judgments about how the agency should exercise its discretion. This is particularly true in the context of the "accelerated approval" pathway, where the agency must balance speeding to market drugs for patients with unmet needs before they have been proven to work and ensuring confidence about the benefits and risks of those drugs. A key challenge in evaluating normative judgments such as these is that reasonable people can disagree, rendering it difficult to proclaim with certainty that a particular decision is right or wrong. Therefore, we propose that it is preferable to ask whether a decision is reasonable. A decision is reasonable when it transparently, comprehensively, and fairly balances the interests of affected parties, within the parameters of the decision maker's legal authority. If a decision achieves these three qualities, it can be viewed as legitimate and worthy of trust and confidence, regardless of whether one agrees with the particular outcome. We recommend that the Food and Drug Administration adopt procedural protections to promote reasonableness in four domains affecting accelerated approval decisions: pathway gatekeeping, endpoint selection, stakeholder engagement, and deliberation. This should aid the agency in minimizing controversies, such as that surrounding the 2021 approval of aducanumab (Aduhelm; Biogen).
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Blockley Hall, Room 1403, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | - Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University, Fairfax, VA, USA
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Blockley Hall, Room 1403, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Blockley Hall, Room 1403, 423 Guardian Drive, Philadelphia, PA, 19104, USA
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23
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Singh N, Peterson A, Baraff A, Bhatti P, Gopal A, Smith N, Barton J, Curtis J, LI C, Weiss N. POS1434 USE OF BIOLOGIC OR TARGETED SYNTHETIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS AND THE RISK OF LYMPHOMA IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3408] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEpidemiologic studies suggest that disease duration and degree of inflammatory activity of rheumatoid arthritis (RA) contribute to lymphoma development (1). Whether the decrease in inflammatory burden seen with use of biologic or targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs or tsDMARDs) translates into a lower risk of lymphoma in RA needs to be studied.ObjectivesThe objective of our study was to examine the effect of administration of b/tsDMARDS on the incidence of lymphoma relative to conventional synthetic DMARDs (csDMARDs) in an inception cohort of Veterans with RA.MethodsWe identified patients >18 years of age diagnosed with RA in any US Veterans Affairs (VA) facility from 1/1/2002 and 12/31/2018 using the VA Corporate Data Warehouse (CDW). To be included, each patient was required to meet the following criteria: 2+ RA diagnostic codes at least 7 days apart but no more than 365 days apart; 2) a prescription for a csDMARD within 90 days of the first RA diagnosis; and 3) an inpatient or outpatient visit 30 days to 2 years preceding first RA diagnosis (indicating they are a regular user of the VA). The csDMARDs included in these analyses were: methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine. The bDMARDs included were tumor necrosis factor inhibitors (TNFi) and non-TNFi biologics such as tocilizumab, rituximab, abatacept, and biosimilars; tsDMARD was tofacitinib. Patients with prevalent lymphoma were excluded. Lymphoma diagnoses were identified using International Classification of Diseases Version 9, 10 and Oncology (ICD9, ICD10, ICDO) codes.We used marginal structural models as described by Hernan et al (2) and time-varying Cox models to control for confounding by indication while evaluating this association. We adjusted for baseline demographics (age, sex, race, ethnicity, year of cohort entry, rheumatology visits), and time-varying CRP and time-varying Rheumatoid Disease Comorbidity Index (RDCI) (3) to control for confounding.Results27,421 Veterans with RA met our eligibility criteria. Most of the Veterans (56%) were in the age range 61-80 years old; 89% male, 76% White, 14% African American. 8,225 (30%) patients were treated with a b-/tsDMARD. The crude incidence rates were 1.71 (95% CI 1.5-1.94) per 1000 person-years for those only on csDMARDs and 1.78 (95% CI 1.44-2.18) for patients during or following use of a b/tsDMARDs. After adjustment with both time-fixed and time-varying covariates using marginal structural models, the incidence of lymphoma was not different between patients who did and did not use a b/tsDMARD (hazard ratio=1.06, 95% CI= 0.82-1.37) (Table 1).Table 1.Estimates of Effect of bDMARD or tsDMARD use on Lymphoma relative to use of csDMARDsMarginal Structural Models; adjusted for:@Demographics1.04(0.80, 1.34)#Demographics + CRP1.06(0.82, 1.37)* per 1000 person-years@Demographics = age, gender, race, ethnicity, rheumatology visits, and year of cohort entry#Adjusts for CRP, baseline rheumatology visits (yes/no) and RDCI.CRP = C-Reactive Protein, RDCI = Rhematic Disease Comorbidity Index, CI = Confidence Interval, b/tsDMARD = biologic or targeted synthetic DMARD, csDMARD = conventional synthetic DMARDConclusionIn this large study using the nationwide VA data, we did not observe an association between the use of b/ts DMARDs and an increased risk of lymphoma.References[1]Baecklund E, Iliadou A, Askling J, Ekbom A, Backlin C, Granath F, et al. Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis. Arthritis Rheum. 2006;54(3):692-701.[2]Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11(5):550-60.[3]England BR, Sayles H, Mikuls TR, Johnson DS, Michaud K. Validation of the rheumatic disease comorbidity index. Arthritis care & research. 2015;67(6):865-72.Disclosure of InterestsNone declared
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Flynn K, Grove S, Alsikafi N, Broghammer J, Buckley J, Elliott S, Myers J, Peterson A, Rourke K, Smith T, Vanni A, Zhao L, Erickson B. PD31-10 PATIENT AND STRICTURE VARIABLES ASSOCIATED WITH FAILURE AFTER URETHROPLASTY FOR BULBAR URETHRAL STRICTURES. J Urol 2022. [DOI: 10.1097/ju.0000000000002582.10] [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: 11/25/2022]
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25
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Peterson A, Young MJ, Fins JJ. Ethics and the 2018 Practice Guideline on Disorders of Consciousness: A Framework for Responsible Implementation. Neurology 2022; 98:712-718. [PMID: 35277446 PMCID: PMC9071367 DOI: 10.1212/wnl.0000000000200301] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 10/01/2021] [Accepted: 02/16/2022] [Indexed: 11/15/2022] Open
Abstract
The 2018 practice guideline on disorders of consciousness marks an important turning point in the care of patients with severe brain injury. As clinicians and health systems implement the guideline in practice, several ethical challenges will arise in assessing the benefits, harms, feasibility, and cost of recommended interventions. We provide guidance for clinicians when interpreting these recommendations and call on professional societies to develop an ethical framework to complement the guideline as it is implemented in clinical practice.
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Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Virginia.,Penn Program on Precision Medicine for the Brain, University of Pennsylvania, Pennsylvania
| | - Michael J Young
- Department of Neurology and Edmond J. Safra Center for Ethics, Harvard University, Massachusetts
| | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, Cornell University, New York.,Solomon Center for Health Law & Policy, Yale Law School, Connecticut
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Roghair J, Espe-Pfeifer P, Peterson A. Neuropsychological Profiles of Athletes and Views of Parents Choosing Flag Versus Tackle Football Participation. Orthop J Sports Med 2022; 10:23259671221079360. [PMID: 35295552 PMCID: PMC8918748 DOI: 10.1177/23259671221079360] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Previous studies have found that injury rates are slightly higher in children who play flag football versus tackle football. It is unclear if this difference is due to the way each type is played or taught or whether there are intrinsic differences in attitudes or neuropsychological characteristics in children and their parents. Purpose: To determine whether children who play flag football score differently from those who play tackle football on validated neuropsychological tests. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Each participating athlete (aged 8-12 years) was recruited in 2018 and 2019 by email through local youth football leagues and the local university. Each athlete was administered a 1-time multidimensional assessment battery. The battery included the Wechsler Abbreviated Scale of Intelligence-2nd Edition, the children’s version of the Trail Making Test, the Integrated Digit Span and Spatial Span subtests of the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV), and the Beck Self-Concept Inventory for Youth. The parent/guardian of each athlete completed the Achenbach Child Behavior Checklist-Parent Report Form, the Behavior Rating Inventory of Executive Function (BRIEF)-Parent Form, and a custom survey. These tests were used to determine IQ estimates and standardized scores, measuring verbal comprehension, matrix reasoning, mental set-shifting, attention, cognitive processing speed, working memory, spatial processing, perception of self-concept, behavioral regulation index, metacognition index, and global executive composite. Scores were compared between flag football and tackle football groups by 2-sample t test, with the Wilcoxon rank-sum test used for nonparametric data. Results: A total of 64 athletes (41 tackle football, 23 flag football) were enrolled from youth football leagues (grades 4-6). Flag players scored significantly higher on the WISC-IV Spatial Span-Backward subtest (scaled mean, 12.0 vs 10.6; P = .046), while tackle players had significantly higher BRIEF-Inhibit subscores (mean t-score, 45 vs 42; P = .026). There were no significant differences in any of the other tests, including socioeconomic status and perceived concussion risks. Conclusion: Concerns that injury epidemiologic studies comparing flag with tackle football could be confounded by intrinsic differences in the children who choose to play each type seem to be unfounded.
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Affiliation(s)
- Jasmine Roghair
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Patricia Espe-Pfeifer
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Andrew Peterson
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
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Peterson A, Clapp J, Harkins K, Kleid M, Largent EA, Stites SD, Karlawish J. Is there a difference between terminal lucidity and paradoxical lucidity? Alzheimers Dement 2022; 18:540-541. [PMID: 35102707 PMCID: PMC10911068 DOI: 10.1002/alz.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Fairfax, Virginia, USA
| | - Justin Clapp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin Harkins
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Kleid
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Largent
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shana D Stites
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason Karlawish
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Peterson A, Clapp J, Largent EA, Harkins K, Stites SD, Karlawish J. What is paradoxical lucidity? The answer begins with its definition. Alzheimers Dement 2022; 18:513-521. [PMID: 34338400 PMCID: PMC8807788 DOI: 10.1002/alz.12424] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022]
Abstract
Paradoxical lucidity in dementia is a clinically significant but understudied phenomenon. A provisional definition was proposed by the 2018 National Institute on Aging expert workshop and published in Alzheimer's and Dementia. However, several conceptual features of this definition remain vague, creating barriers to robust clinical research. Here, we critically analyze the provisional definition and present a refined definition that can be applied in clinical research. The refined definition is based on an analytic process our research group recently undertook to operationalize paradoxical lucidity for our own study protocol. Our goal is to facilitate debate and potentially harmonize interpretations of paradoxical lucidity among research groups.
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Affiliation(s)
- Andrew Peterson
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Philosophy, Institute for Philosophy and Public PolicyGeorge Mason UniversityFairfaxVirginiaUSA
| | - Justin Clapp
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Anesthesiology & Critical CarePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Emily A. Largent
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kristin Harkins
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Shana D. Stites
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of PsychiatryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jason Karlawish
- Penn Program on Precision Medicine for the BrainPenn Memory CenterUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Roy A, Peterson A, Marchant N, Alvir J, Bhambri R, Lynn J, Benjumea D, Prasad S, O’Brien A, Chen Y, Kemner J, Parasuraman B. Baseline Characteristics and Secondary Medication Adherence Patterns Among Patients Receiving Tafamidis Prescriptions: A Retrospective Analysis Using a National Specialty Pharmacy Dispensing Database. Patient Prefer Adherence 2022; 16:1115-1129. [PMID: 35517043 PMCID: PMC9064174 DOI: 10.2147/ppa.s352332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Transthyretin amyloid cardiomyopathy (ATTR-CM) is a serious, underrecognized condition, which leads to heart failure and early mortality if left untreated. Until recently, heart transplantation was the only treatment for ATTR-CM. Regulatory approval of tafamidis transformed treatment for patients. In the phase 3 Transthyretin Amyloidosis Cardiomyopathy Clinical Trial (ATTR-ACT), which established the safety and efficacy of tafamidis, medication adherence was high with 97.2% of patients taking ≥80% of scheduled doses. Evidence of real-world adherence to cardiology drugs demonstrates low adherence and suboptimal outcomes; however, real-world adherence to tafamidis has not been investigated. The main objective of this study was to describe adherence patterns of patients filling tafamidis in the Symphony Health database. METHODS This retrospective analysis of the Symphony Health Solutions claims database used secondary adherence measures, including modified medication possession ratio (MPRm), days between fills adherence rate, and compliance rate, to assess adherence patterns of 2020 patients filling tafamidis free acid 61-mg capsules or tafamidis meglumine 4x20-mg capsules from June 1, 2019 to August 31, 2020. RESULTS Patients receiving a tafamidis formulation had characteristics consistent with the expected patient population; 71.6% were aged 75-84 years, 83.2% were male, and the highest proportion resided in the Northeast region (30.5%) of the United States. Adherence for tafamidis was high, as 75% to 100% of the patients across subgroups met or exceeded the commonly defined adherence threshold of 80%. Median number of refills ordered and received was six refills per patient. Most patients received refills with no gap (n=1633) or a gap <30 days (n=1267/1317 patients). Adherence was high across follow-up time, sex, and age subgroups. Adherence varied by geographic region, with the Northeast being significantly higher than the Midwest (mean MPRm 94.41% vs 88.21%, p=0.0007). CONCLUSION These results provide evidence that real-world adherence to tafamidis in patients with ATTR-CM is high.
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Affiliation(s)
- Anuja Roy
- Global HEOR, Patient & Health Impact, Rare Diseases BU, Pfizer Inc, New York, NY, USA
- Correspondence: Anuja Roy, Global HEOR, Patient & Health Impact, Rare Diseases BU, Pfizer Inc, New York, NY, USA, Email
| | - Andrew Peterson
- Department of Pharmacy Practice/Pharmacy Administration, University of the Sciences, Philadelphia, PA, USA
| | - Nick Marchant
- Global HEOR, Patient & Health Impact, Rare Diseases BU, Pfizer Inc, New York, NY, USA
| | - Jose Alvir
- Statistical Research and Data Science Center Global Product Development, Pfizer Inc, New York, NY, USA
| | | | - Jason Lynn
- Medical Affairs, Pfizer Inc, New York, NY, USA
| | | | - Sapna Prasad
- Clarify Insights Services, Clarify Health Solutions, New York, NY, USA
| | - Alex O’Brien
- Clarify Insights Services, Clarify Health Solutions, New York, NY, USA
| | - Yong Chen
- Rare Disease, Pfizer Inc, Collegeville, PA, USA
| | - Jason Kemner
- Patient & Health Impact, Pfizer Inc, Collegeville, PA, USA
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Peterson A, Karlawish J, Largent EA. Supported Decision Making with People at the Margins of Autonomy: Response to Commentaries. Am J Bioeth 2022; 22:W1-W4. [PMID: 34962198 PMCID: PMC8803207 DOI: 10.1080/15265161.2021.1996660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Peterson A, Karlawish J. What Is Paradoxical Lucidity? Innov Aging 2021. [DOI: 10.1093/geroni/igab046.177] [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: 11/13/2022] Open
Abstract
Abstract
In this presentation, I provide a conceptual background from which the other symposium speakers can describe detailed methods for investigating paradoxical lucidity (PL) in dementia. First, I outline the clinical and ethical significance of studying PL. Second, I describes how PL is understudied and so difficult to measure. A working definition of PL has been formulated from case reports, but aspects of this definition remain vague. I argue that this vagueness challenges the measurement of PL and the generalizability of study results. I conclude by proposing ways to address these problems.
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Affiliation(s)
- Andrew Peterson
- George Mason University, George Mason University, Virginia, United States
| | - Jason Karlawish
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Andrew Peterson
- Institute for Philosophy and Public Policy, Department of Philosophy, George Mason University, Fairfax, Virginia
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Ney DB, Peterson A, Karlawish J. The ethical implications of paradoxical lucidity in persons with dementia. J Am Geriatr Soc 2021; 69:3617-3622. [PMID: 34628640 PMCID: PMC9924090 DOI: 10.1111/jgs.17484] [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: 05/12/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
This case report describes the ethical implications of paradoxical lucidity in persons with severe stage dementia. Paradoxical lucidity describes an episode of unexpected communication or connectedness in a person who is believed to be noncommunicative due to a progressive and pathological process that causes dementia. A caregiver who witnesses an event of paradoxical lucidity may experience it as ethically and emotionally transformative. We provide an ethical framework for addressing this event in clinical practice. The framework addresses clinician interactions with the patient, caregiver, and family to improve understanding of paradoxical lucidity and to enhance patient care, caregiver well-being, and decision-making. Participants for this case study consented to having the case published. Participant names are changed to protect confidentiality.
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Affiliation(s)
- David B. Ney
- Sidney Kimmel Medical College, Thomas Jefferson University,Penn Program on Precision Medicine for the Brain, Penn Memory Center
| | - Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University,Penn Program on Precision Medicine for the Brain, Penn Memory Center
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center, Perelman School of Medicine, University of Pennsylvania,Penn Program on Precision Medicine for the Brain, Penn Memory Center
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Abstract
This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research.
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Aas S, Peterson A, Wasserman D. What Justifies the Allocation of Scarce Health Care Resources to Patients with Disorders of Consciousness: Response to Commentaries. AJOB Neurosci 2021; 12:W1-W4. [PMID: 34686110 DOI: 10.1080/21507740.2021.1988759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Aminian M, Ghosh T, Peterson A, Rasmussen AL, Stiverson S, Sharma K, Kirby M. Early prognosis of respiratory virus shedding in humans. Sci Rep 2021; 11:17193. [PMID: 34433834 PMCID: PMC8387366 DOI: 10.1038/s41598-021-95293-z] [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: 07/28/2020] [Accepted: 07/23/2021] [Indexed: 11/24/2022] Open
Abstract
This paper addresses the development of predictive models for distinguishing pre-symptomatic infections from uninfected individuals. Our machine learning experiments are conducted on publicly available challenge studies that collected whole-blood transcriptomics data from individuals infected with HRV, RSV, H1N1, and H3N2. We address the problem of identifying discriminatory biomarkers between controls and eventual shedders in the first 32 h post-infection. Our exploratory analysis shows that the most discriminatory biomarkers exhibit a strong dependence on time over the course of the human response to infection. We visualize the feature sets to provide evidence of the rapid evolution of the gene expression profiles. To quantify this observation, we partition the data in the first 32 h into four equal time windows of 8 h each and identify all discriminatory biomarkers using sparsity-promoting classifiers and Iterated Feature Removal. We then perform a comparative machine learning classification analysis using linear support vector machines, artificial neural networks and Centroid-Encoder. We present a range of experiments on different groupings of the diseases to demonstrate the robustness of the resulting models.
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Affiliation(s)
- M Aminian
- Department of Mathematics and Statistics, California State Polytechnic University, Pomona, CA, USA
| | - T Ghosh
- Department of Computer Science, Colorado State University, Fort Collins, CO, 80524, USA
| | - A Peterson
- Department of Mathematics, Colorado State University, Fort Collins, CO, 80524, USA
| | - A L Rasmussen
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan, Saskatoon, SK, Canada.,Center for Global Health Science and Security, Georgetown University Medical Center, Washington, DC, USA
| | - S Stiverson
- Department of Mathematics, Colorado State University, Fort Collins, CO, 80524, USA
| | - K Sharma
- Department of Computer Science, Colorado State University, Fort Collins, CO, 80524, USA
| | - M Kirby
- Department of Mathematics, Colorado State University, Fort Collins, CO, 80524, USA. .,Department of Computer Science, Colorado State University, Fort Collins, CO, 80524, USA.
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Peterson A, Webster F, Gonzalez-Lara LE, Munce S, Owen AM, Weijer C. Caregiver reactions to neuroimaging evidence of covert consciousness in patients with severe brain injury: a qualitative interview study. BMC Med Ethics 2021; 22:105. [PMID: 34320966 PMCID: PMC8320067 DOI: 10.1186/s12910-021-00674-8] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Severe brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope. Methods To examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study. Results Twelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results. Conclusion This study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00674-8.
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Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Fairfax, USA.
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | | | - Sarah Munce
- Toronto Rehabilitation Institute-University Health Network, Toronoto, Canada
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Canada
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Canada
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Singh N, Peterson A, Baraff A, Korpak A, Vaughan-Sarrazin M, Smith N, Curtis J, Weiss N. POS0287 USE OF BIOLOGIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS IN RELATION TO THE RISK OF LYMPHOMA: A COHORT STUDY OF US VETERANS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3395] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Epidemiologic studies suggest that disease duration and degree of inflammatory activity of rheumatoid arthritis (RA) contribute to lymphoma development. However, the association of the use of biologic disease modifying anti-rheumatic drugs (bDMARDs) in patients with RA on lymphoma risk needs further evaluation.Objectives:Examine the effect of administration of bDMARDS on the incidence of lymphoma in an inception cohort of RA.Methods:We identified patients diagnosed with RA in any US Veterans Affairs (VA) facility from 1/1/2002 and 12/31/2018 using the Veteran’s Health Administration (VHA) databases. To be included, each patient was required to meet the following criteria: 1) 2+ RA diagnostic codes at least 7 days apart but no more than 365 days apart 2) a prescription for a conventional synthetic DMARD (csDMARD) within 90 days of the first RA diagnosis 3) One inpatient or outpatient visit 30 days to 2 years preceding first RA diagnosis (indicating they are a regular user of the VHA). We excluded patients for any of the following if they preceded the first RA diagnosis: 1) a prior single RA diagnostic code 2) a prescription for any DMARD medication 3) a concomitant diagnosis of another inflammatory arthritis (e.g. psoriatic arthropathy) 4) a diagnosis of lymphoma. Index date for the study is the date of the first qualifying RA diagnosis. Lymphoma diagnoses were identified through VHA records using the International Classification of Diseases-Oncology codes.Results:We identified 27,536 veterans with RA in the study period meeting the inclusion and exclusion criteria. Of these, 53% (n=14,705) were in the age range 60 to 80 years. The cohort was 89% male, 75.5% White, 13.7% African American. Over the study period, 1.2% (n=332) of the study population developed a lymphoma.Conclusion:Using the nationwide VHA we have identified a large inception cohort of patients with RA of whom 1.2% developed lymphoma over study follow-up. This data will be used in future analyses to produce estimates of the effect of biologic medications on lymphoma risk, adjusting for confounding by indication and other variables.Table 1.Baseline characteristics of the cohort based on bDMARD exposure statusCharacteristicbDMARD-naive (n= 19,095)bDMARD-exposed (n=8,441)Overall Lymphomas Age (years)171161 18-4046 40-606378 60-8010074 >8043 Males17,206 (90%)7,270 (86%)Race White14,150 (74%)6,627 (76%) Black2,674 (14%)1,090 (13%) Asian96 (0.5%)46 (0.5%) Native American or Pacific Islander371 (2%)187 (2.2%) Missing1,804 (9%)491 (6%)Acknowledgements:The work in this abstract is supported by Investigator Award from the Rheumatology Research Foundation to Dr Singh.Disclosure of Interests:None declared
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Jiramongkolchai P, Jones MS, Peterson A, Lee JJ, Liebendorfer A, Klatt-Cromwell CN, Schneider JS, Drescher AJ, Ogden MA, Brunworth JD, Kallogjeri D, Kukuljan S, Peelle JE, Piccirillo JF. Association of Olfactory Training With Neural Connectivity in Adults With Postviral Olfactory Dysfunction. JAMA Otolaryngol Head Neck Surg 2021; 147:502-509. [PMID: 33734298 PMCID: PMC7974830 DOI: 10.1001/jamaoto.2021.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/21/2021] [Indexed: 01/10/2023]
Abstract
Importance Viral upper respiratory tract infections are a major cause of olfactory loss. Olfactory training (OT) is a promising intervention for smell restoration; however, a mechanistic understanding of the changes in neural plasticity induced by OT is absent. Objective To evaluate functional brain connectivity in adults with postviral olfactory dysfunction (PVOD) before and after OT using resting-state functional magnetic resonance imaging. Design, Setting, and Participants This prospective cohort study, conducted from September 1, 2017, to November 30, 2019, recruited adults with clinically diagnosed or self-reported PVOD of 3 months or longer. Baseline olfaction was measured using the University of Pennsylvania Smell Identification Test (UPSIT) and the Sniffin' Sticks test. Analysis was performed between December 1, 2020, and July 1, 2020. Interventions Participants completed 12 weeks of OT using 4 essential oils: rose, eucalyptus, lemon, and clove. The resting-state functional magnetic resonance imaging measurements were obtained before and after intervention. Main Outcome and Measures The primary outcome measure was the change in functional brain connectivity before and after OT. Secondary outcome measures included changes in UPSIT and Sniffin' Sticks test scores, as well as patient-reported changes in treatment response as measured by subjective changes in smell and quality-of-life measures. Results A total of 16 participants with PVOD (11 female [69%] and 14 White [88%]; mean [SD] age, 60.0 [10.5] years; median duration of smell loss, 12 months [range, 3-240 months]) and 20 control participants (15 [75%] female; 17 [85%] White; mean [SD] age, 55.0 [9.2] years; median UPSIT score, 37 [range, 34-39]) completed the study. At baseline, participants had increased connectivity within the visual cortex when compared with normosmic control participants, a connection that subsequently decreased after OT. Furthermore, 4 other network connectivity values were observed to change after OT, including an increase in connectivity between the left parietal occipital junction, a region of interest associated with olfactory processing, and the cerebellum. Conclusions and Relevance The use of OT is associated with connectivity changes within the visual cortex. This case-control cohort study suggests that there is a visual connection to smell that has not been previously explored with OT and that further studies examining the efficacy of a bimodal visual and OT program are needed.
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Affiliation(s)
- Pawina Jiramongkolchai
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael S. Jones
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Andrew Peterson
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jake J. Lee
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Adam Liebendorfer
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Cristine N. Klatt-Cromwell
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - John S. Schneider
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Andrew J. Drescher
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - M. Allison Ogden
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Joseph D. Brunworth
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Statistics Editor, JAMA Otolaryngology—Head and Neck Surgery
| | - Sara Kukuljan
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jonathan E. Peelle
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Editor, JAMA Otolaryngology—Head and Neck Surgery
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41
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Abstract
This paper critically engages ethical issues in the allocation of novel, and potentially costly, health care resources to patients with disorders of consciousness. First, we review potential benefits of novel health care resources for patients and their families and outline preliminary considerations to address concerns about cost. We then address two problems regarding the allocation of health care resources to patients with disorders of consciousness: (1) the problem of uncertain moral status; and (2) the problem of accurately measuring the welfare burdens these resources would relieve. We conclude by suggesting that opportunity-based frameworks might complement standard approaches for justifying resources allocation to patients with disorders of consciousness.
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Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University
| | - Sean Aas
- Kennedy Institute of Ethics, Georgetown University
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42
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Affiliation(s)
- Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Fairfax, Virginia
| | - Adrian M Owen
- The Brain and Mind Institute, University of Western Ontario, London, Ontario, Canada
| | - Jason Karlawish
- Penn Memory Center, University of Pennsylvania, Philadelphia.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
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Asase A, Jiménez‐García D, Peterson A. Effects of climatic change on the potential geographic distribution of the threatened West‐Central African endemic genus,
Talbotiella. Afr J Ecol 2021. [DOI: 10.1111/aje.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alex Asase
- Department of Plant and Environmental Biology University of Ghana Legon Ghana
| | - Daniel Jiménez‐García
- Centro de Agroecología y Ambiente Instituto de Ciencias Benemérita Universidad Autónoma de Puebla Puebla México
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44
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Goldstein CE, Peterson A. Is it unethical to publish data from Chinese transplant research? J Med Ethics 2020; 46:689-690. [PMID: 32817408 DOI: 10.1136/medethics-2020-106719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Cory E Goldstein
- Rotman Institute for Philosophy, University of Western Ontario, London, ON, Canada
| | - Andrew Peterson
- Institute for Philosophy and Public Policy, George Mason University, Fairfax, VA, United States
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45
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Jiramongkolchai P, Peterson A, Kallogjeri D, Lee JJ, Kukuljan S, Liebendorfer A, Schneider JS, Klatt‐Cromwell CN, Drescher AJ, Piccirillo JF. Randomized clinical trial to evaluate mometasone lavage vs spray for patients with chronic rhinosinusitis without nasal polyps who have not undergone sinus surgery. Int Forum Allergy Rhinol 2020; 10:936-943. [DOI: 10.1002/alr.22586] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Pawina Jiramongkolchai
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Andrew Peterson
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Dorina Kallogjeri
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Jake J. Lee
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Sara Kukuljan
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Adam Liebendorfer
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - John S. Schneider
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Cristine N. Klatt‐Cromwell
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Andrew J. Drescher
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
| | - Jay F. Piccirillo
- Department of Otolaryngology‒Head and Neck Surgery Washington University School of Medicine in St Louis St. Louis MO
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46
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Villarreal B, Foster S, Hansen S, Brock M, Sanchez H, Gerwell K, Carrizales F, Peterson A, Pruiksma K, Mysliwiec V. 0860 Sleep Disorders In Female Military Personnel. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.856] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep is an essential biological function and the disruption of sleep has deleterious consequences. Military personnel experience unique stressors related to their service, elevating the risk of developing sleep disorders. The etiologies and impact of sleep disorders on military women’s health is poorly understood. This study is the first to prospectively assess whether military women with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA) have different gender roles, military service-associated factors, and biological characteristics than military men with the same disorders.
Methods
This is a prospective observational study of military personnel with sleep disturbances. The study will evaluate women and men matched for sleep disorder. Participants will complete an evaluation to include polysomnography (PSG), sleep questionnaires and validated clinical assessments of associated disorders of interest. The baseline demographics, questionnaire, and PSG results will be analyzed to assess for commonalities or differences between genders.
Results
We have enrolled 45 patients (24% female). Males had a higher BMI (29.1) than females (26). Males were also older (38) than females (35). The leading diagnosis in males was OSA (44%) and insomnia in females (64%). In males, the apnea-hypopnea index (AHI) was 11.3/hr, arousal index (ARI) was 20/hr, and sleep efficiency (SE) was 86.5%. Total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL) were 364.6, 40.9, and 12.6 minutes, respectively. In females, the average AHI was 6.6/hr, ARI was 15/hr, and SE was 87.2%. Their TST, WASO, and SOL were 359, 44, and 12.6 minutes, respectively.
Conclusion
Military personnel are at increased risk of sleep disorders. Literature comparing male and female characteristics and sleep disorders is scarce. In this study, baseline demographics were similar in both groups but insomnia was the leading diagnosis for women. This emphasizes the importance of adequate recognition and treatment of insomnia in this group.
Support
This study is supported by the Defense Health Agency, Defense Medical Research and Development Program, Clinical Research Intramural Initiative for Military Women’s Health.
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Affiliation(s)
- B Villarreal
- San Antonio Military Healthcare System, Lackland AFB, TX
| | - S Foster
- San Antonio Military Healthcare System, Lackland AFB, TX
| | - S Hansen
- San Antonio Military Healthcare System, Lackland AFB, TX
| | - M Brock
- San Antonio Military Healthcare System, Lackland AFB, TX
| | - H Sanchez
- San Antonio Military Healthcare System, Lackland AFB, TX
| | - K Gerwell
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - F Carrizales
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - A Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - K Pruiksma
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - V Mysliwiec
- San Antonio Military Healthcare System, Lackland AFB, TX
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47
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Taylor D, Bunnell B, Calhoun C, Pruiksma K, Dietch J, Wardle-Pinkston S, Milanak M, Rheingold A, Simmons R, Peterson A, Morin C, Ruggiero K, Brim W, Dolan D, Wilkerson A. 1186 Developing And Testing A Web-based Provider Training For Cognitive Behavioral Therapy Of Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1180] [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
Introduction
Chronic insomnia is a common, debilitating disorder and a risk factor for significant medical morbidity, mental health problems, and workplace difficulties. Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia. However, few providers are trained in CBT-I, in part due to a bottleneck in training availability and the time and cost associated with current training platforms. To address this training deficit, our team developed and evaluated CBTIweb.org, a web-based provider training course for CBT-I.
Methods
Feedback from alpha- and beta-testing of CBTIweb.org was collected and used to optimize course content and functionality. Then, a comparison study was conducted in which licensed providers were randomized to complete either the online CBTIweb.org course (n=21) or an in-person CBT-I training (n=23). During all phases of development, providers completed a Computer System Usability Questionnaire (CSUQ), investigator-developed website usability and content questionnaires, and pre/post-training competency assessments.
Results
Independent samples t-tests indicated significant improvements in CSUQ, and website usability and content questionnaires responses from alpha- to beta-testing (all ps < .05). Linear mixed-effects modeling revealed significant within-subject increases in knowledge acquisition (F(34.7) = 65.4, p < 0.001; baseline = 69% correct, post-training = 92% correct) when collapsed across in-person and web-based groups. The interaction group by time interaction was non-significant (F(34.7) = 1.7, p = 0.204), indicating similar gains in knowledge (i.e., equivalence) between the in-person and the CBTIweb.org training formats.
Conclusion
Alpha and beta testers of CBTIweb.org reported high levels of satisfaction while also noting areas for improvement, which were used to update the site. Findings suggest the final CBTIweb.org product successfully trained clinicians compared to an in-person workshop, given knowledge acquisition improvements. CBTIweb.org is an efficient and effective training platform for clinicians to gain knowledge and competence in the most effective treatment for insomnia.
Support
W81XWH-17-1-0165
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Affiliation(s)
- D Taylor
- University of Arizona, Tucson, AZ
| | - B Bunnell
- Medical University of South Carolina, Charleston, SC
| | - C Calhoun
- Medical University of South Carolina, Charleston, SC
| | | | - J Dietch
- University of North Texas, Denton, TX
| | | | - M Milanak
- Medical University of South Carolina, Charleston, SC
| | - A Rheingold
- Medical University of South Carolina, Charleston, SC
| | - R Simmons
- Medical University of South Carolina, Charleston, SC
| | | | - C Morin
- Laval University, Quebec, QC, CANADA
| | - K Ruggiero
- Medical University of South Carolina, Charleston, SC
| | - W Brim
- Center for Deployment Psychology, Bethesda, MD
| | - D Dolan
- Center for Deployment Psychology, Bethesda, MD
| | - A Wilkerson
- Medical University of South Carolina, Charleston, SC
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48
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Pruiksma KE, Hale W, Mintz J, Peterson A, Young-McCaughan S, Wilkerson A, Nicholson K, Dondanville K, Fina B, Borah E, Roache J, Litz BT, Bryan C, Taylor DJ. 0483 Predictors of Cognitive Behavioral Therapy for Insomnia (CBT) Outcomes in Active Duty U.S. Army Personnel. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.480] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cognitive behavioral therapy for insomnia (CBTi) is well established as the first-line treatment for the management of chronic insomnia. Identifying predictors of response to CBTi should enable the field to efficiently utilize resources to treat those who are likely to respond and to personalize treatment approaches to optimize outcomes for those who are less likely to respond to traditional CBTi. Although a range of studies have been conducted, no clear pattern of predictors of response to CBTi has emerged.
Methods
The purpose of this study was to examine the impact and relative importance of a comprehensive group of pretreatment predictors of insomnia outcomes in 99 active duty service members who received in-person CBTi in a randomized clinical trial.
Results
Results indicated that higher levels of baseline insomnia severity and total sleep time predicted greater improvements on the Insomnia Severity Index (ISI) following treatment. Higher depression symptoms and a history of head injury predicted a worse response to treatment (i.e., smaller improvements on the ISI).
Conclusion
Clinically meaningful improvements, as measured by the reliable change index (RCI), were found in 59% of the sample. Over and above baseline insomnia severity, only depressive symptoms predicted this outcome. Future studies should examine if modifications to CBTi based on these predictors of response can improve outcomes.
Support
This study was conducted with support from the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program award W81XWH-10-1-0828 (PI: Dr Taylor).
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Affiliation(s)
- K E Pruiksma
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - W Hale
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - J Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - A Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - S Young-McCaughan
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - A Wilkerson
- Medical University of South Carolina, Charleston, SC
| | - K Nicholson
- Carl R Darnall Army Medical Center, Fort Hood, TX
| | - K Dondanville
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - B Fina
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - E Borah
- University of Texas at Austin, Austin, TX
| | - J Roache
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - B T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA
| | - C Bryan
- University of Utah, Salt Lake City, UT
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49
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Miles SR, Pruiksma K, Slavish D, Nakase-Richardson R, Nicholson K, Wardle S, Young-McCaughan S, Resick P, Williamson D, Dondanville K, Litz B, Mintz J, Keane T, Peterson A, Taylor D. 1073 Sleep Disorders Contribute To Anger In Service Members With Posttraumatic Stress Disorder. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1069] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
The emotion of anger and behavioral acts of aggression can lead to severe negative consequences, including family violence, legal charges, and death. Anger can be a symptom of posttraumatic stress disorder (PTSD), particularly in service members. Service members report difficulties managing their anger and trouble with the subsequent results. Factors that differentiate service members with PTSD who have anger related problems from those who do not are still unknown. Impaired sleep is associated with negative mood states in the general population and may be a risk factor for anger in those with PTSD. This project examines how sleep disorders commonly diagnosed in service members (i.e., obstructive sleep apnea and insomnia) relate to PTSD and anger.
Methods
Ninety-three service members with comorbid PTSD, insomnia, and nightmares (mean age = 35.86 years, SD = 8.38, 27% female, 45% white) completed polysomnography and other measures as part of a clinical trial. A multiple regression model examined how total Apnea Hypopnea Index (AHI), AHI during REM sleep, insomnia (Insomnia Severity Index), age, and race related to PTSD symptoms (Clinical Administered PTSD Scale-5: CAPS-5). A second multiple regression model examined the same variables’ associations with anger (Dimensions of Anger Reactions-5; DAR-5).
Results
More than a third of the sample (37%) met criteria for OSA (AHI scores>5) and 99% met criteria for insomnia (ISI>10). Total AHI and REM AHI were not associated with CAPS-5 scores or ISI. Across OSA and PSG indices, only greater REM AHI (b=.07, p<.05) and Insomnia (b=.43, p<.05) were positively associated with DAR-5 anger scores. Total AHI was unrelated to anger.
Conclusion
Elevated REM AHI and insomnia were associated with greater anger in service members with PTSD. Current treatments for anger are only moderately effective. Assessing and treating comorbid sleep disorders may reduce anger and enhance successful PTSD treatment.
Support
Consortium to Alleviate PTSD (W81XWH-13-2-0065), DVA (I01CX001136-01), GDHS (W91YTZ-13-C-0015) for DVBIC.
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Affiliation(s)
- S R Miles
- James A. Haley Veterans’ Hospital, Tampa, FL
| | - K Pruiksma
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - D Slavish
- University of North Texas, 76203, TX
| | | | - K Nicholson
- Carl D. Darnall Army Medical Center, Fort Hood, TX
| | - S Wardle
- The University of Arizona, Tucson, AZ
| | - S Young-McCaughan
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | | | - K Dondanville
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - B Litz
- VA Boston Healthcare System, Boston, MA
| | - J Mintz
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - T Keane
- VA Boston Healthcare System, Boston, MA
| | - A Peterson
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - D Taylor
- The University of Arizona, Tucson, AZ
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50
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Affiliation(s)
- Andrew Peterson
- Department of Philosophy, Institute for Philosophy and Public Policy, George Mason University, Fairfax, VA, USA
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Karlawish
- Departments of Medicine, Medical Ethics and Health Policy, and Neurology, Penn Memory Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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