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Chen C, Kaur G, Adiga A, Espinoza B, Venkatramanan S, Warren A, Lewis B, Crow J, Singh R, Lorentz A, Toney D, Marathe M. Wastewater-based Epidemiology for COVID-19 Surveillance: A Survey. ArXiv 2024:arXiv:2403.15291v1. [PMID: 38562450 PMCID: PMC10984000] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The pandemic of COVID-19 has imposed tremendous pressure on public health systems and social economic ecosystems over the past years. To alleviate its social impact, it is important to proactively track the prevalence of COVID-19 within communities. The traditional way to estimate the disease prevalence is to estimate from reported clinical test data or surveys. However, the coverage of clinical tests is often limited and the tests can be labor-intensive, requires reliable and timely results, and consistent diagnostic and reporting criteria. Recent studies revealed that patients who are diagnosed with COVID-19 often undergo fecal shedding of SARS-CoV-2 virus into wastewater, which makes wastewater-based epidemiology (WBE) for COVID-19 surveillance a promising approach to complement traditional clinical testing. In this paper, we survey the existing literature regarding WBE for COVID-19 surveillance and summarize the current advances in the area. Specifically, we have covered the key aspects of wastewater sampling, sample testing, and presented a comprehensive and organized summary of wastewater data analytical methods. Finally, we provide the open challenges on current wastewater-based COVID-19 surveillance studies, aiming to encourage new ideas to advance the development of effective wastewater-based surveillance systems for general infectious diseases.
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Affiliation(s)
- Chen Chen
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Gursharn Kaur
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Aniruddha Adiga
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Baltazar Espinoza
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Srinivasan Venkatramanan
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Andrew Warren
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Bryan Lewis
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
| | - Justin Crow
- Virginia Department of Health, Richmond, 23219, United States
| | - Rekha Singh
- Virginia Department of Health, Richmond, 23219, United States
| | - Alexandra Lorentz
- Division of Consolidated Laboratory Services, Department of General Services, Richmond, 23219, United States
| | - Denise Toney
- Division of Consolidated Laboratory Services, Department of General Services, Richmond, 23219, United States
| | - Madhav Marathe
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, 22904, United States
- Department of Computer Science, University of Virginia, Charlottesville, 22904, United States
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Moniz T, Melro CM, Warren A, Watling C. Twelve tips for maximizing the potential of reflective writing in medical education. Med Teach 2024:1-6. [PMID: 38508199 DOI: 10.1080/0142159x.2024.2326093] [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] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
Reflective writing (RW) is a popular tool in medical education, but it is being used in ways that fail to maximize its potential. Literature in the field focuses on why RW is used - that is to develop, assess, and remediate learner competencies - but less so on how to use it effectively. The emerging literature on how to integrate RW in medical education is haphazard, scattered and, at times, reductionist. We need a synthesis to translate this literature into cohesive strategies for medical educators using RW in a variety of contexts. These 12 tips offer guidelines for the principles and practices of using RW in medical education. This synthesis aims to support more strategic and meaningful integration of RW in medical education.
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Affiliation(s)
- Tracy Moniz
- Department of Communication Studies, Mount Saint Vincent University, Halifax, Canada
| | - Carolyn M Melro
- Department of Communication Studies, Mount Saint Vincent University, Halifax, Canada
| | - Andrew Warren
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Chris Watling
- Department of Oncology, Clinical Neurological Sciences, and Family Medicine, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Leadbeater P, Warren A, Adekunle E, Fielden H, Barry J, Proudfoot A. Comparative before-after study of fever prevention versus targeted temperature management following out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100538. [PMID: 38205148 PMCID: PMC10776978 DOI: 10.1016/j.resplu.2023.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
Background International guidelines for neuroprotection following out-of-hospital cardiac arrest (OHCA) recommend fever prevention ahead of routine temperature management. This study aimed to identify any effect of changing from targeted temperature management to fever prevention on neurological outcome following OHCA. Methods A retrospective observational cohort study was conducted of consecutive admissions to an ICU at a tertiary OHCA centre. Comparison was made between a period of protocolised targeted temperature management (TTM) to 36 °C and a period of fever prevention. Results Data were available for 183 patients. Active temperature management was administered in 86/118 (72%) of the TTM cohort and 20/65 (31%) of the fever prevention group. The median highest temperature prior to the start of temperature management was significantly lower in the TTM group at 35.6 (IQR 34.9-36.2) compared to 37.9 °C (IQR 37.7-38.2) in the fever prevention group (adjusted p < 0.001).There was no difference in the proportion of patients discharged with Cerebral Performance Category 1 or 2 between the groups (42% vs. 40%, p = 0.88). Patients in the fever prevention group required a reduced duration of noradrenaline (36 vs. 46 h, p = 0.03) and a trend towards a reduced duration of propofol (37 vs. 56 h, p = 0.06).In unadjusted analysis, use of active temperature management (irrespective of group) appeared to be associated with decreased risk of poor outcome (OR = 0.43, 95% CI 0.23-0.78) but after adjustment for patient age, presenting rhythm, witnessed arrest and duration of CPR, this was no longer significant (OR = 0.93, 95% CI 0.37-2.31, p = 0.88). Conclusion Switching from TTM to fever prevention following OHCA was associated with similar rates of neurological outcomes, with a possible decrease in sedation and vasopressor requirements.
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Affiliation(s)
- P. Leadbeater
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Anaesthesia and Intensive Care Medicine Training Programmes, Health Education England, London, UK
| | - A. Warren
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Anaesthesia, Critical Care & Pain, University of Edinburgh, Edinburgh, UK
- Critical Care & Perioperative Medicine Group, Queen Mary University London, London, UK
| | - E. Adekunle
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - H. Fielden
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J. Barry
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - A.G. Proudfoot
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Critical Care & Perioperative Medicine Group, Queen Mary University London, London, UK
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Bax F, Warren A, Fouks AA, van den Brink H, van Veluw SJ, Kozberg MG, Greenberg SM. Minocycline in Severe Cerebral Amyloid Angiopathy: A Single-Center Cohort Study. J Am Heart Assoc 2024; 13:e033464. [PMID: 38348811 PMCID: PMC11010112 DOI: 10.1161/jaha.123.033464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Evidence from animal studies suggests that minocycline may reduce lobar intracerebral hemorrhage (ICH) recurrence in cerebral amyloid angiopathy, possibly by inhibiting perivascular extracellular matrix degradation in cerebral small vessels. There is currently no evidence of its safety or efficacy in humans with cerebral amyloid angiopathy. METHODS AND RESULTS To provide preliminary data to support future studies of minocycline's efficacy, the authors performed a retrospective single-center cohort study to assess the incidence of recurrent ICH in patients with an aggressive clinical course of probable cerebral amyloid angiopathy who had been prescribed minocycline off-label via shared decision-making. Crude incidence rate ratios were calculated to compare incidence rates before versus after treatment. Sixteen patients (mean age at minocycline initiation, 66.3±3.5 years; women 62.5%; median of 3 lobar ICHs [range, 1-6]) were initiated on minocycline and followed for a median of 12.4 months (range, 1.8-61.4 months). Adverse events were reported in 4 of 16 patients (gastroenteric, n=3; dizziness, n=1) and were considered mild. ICH incidence sharply increased the year before minocycline initiation compared with the preceding years (2.18 [95% CI, 1.50-3.07] versus 0.40 [95% CI, 0.25-0.60] events per patient-year) and fell to 0.46 (95% CI, 0.23-0.83) events per patient-year afterwards. Incidence rate ratios of recurrent ICH after minocycline was lower (0.21 [95% CI, 0.11-0.42], P<0.0001) compared with the year before initiation. CONCLUSIONS Minocycline appeared safe and generally tolerated in a small group of patients with clinically aggressive cerebral amyloid angiopathy and was associated with reduced ICH recurrence. Determining whether this reduction represents a biological response to minocycline rather than a regression to the mean, however, will require a future controlled treatment trial.
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Affiliation(s)
- Francesco Bax
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
| | - Andrew Warren
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
| | - Avia Abramovitz Fouks
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
| | - Hilde van den Brink
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
| | - Susanne J. van Veluw
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
| | - Mariel G. Kozberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
| | - Steven M. Greenberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School175 Cambridge StreetBoston02114MAUSA
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Warren A, Morrow D, Proudfoot AG. Cardiogenic shock: all hail the RCT, long live the registry. Crit Care 2024; 28:53. [PMID: 38374050 PMCID: PMC10877743 DOI: 10.1186/s13054-024-04835-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Affiliation(s)
- A Warren
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - D Morrow
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alastair G Proudfoot
- Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- Critical Care and Perioperative Medicine Group, Queen Mary University London, London, UK.
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Wilson NM, Calabria C, Warren A, Finlay A, O'Donovan A, Passerello GL, Ribaric NL, Ward P, Gillespie R, Farrel R, McNarry AF, Pan D. Quantifying hospital environmental ventilation using carbon dioxide monitoring - a multicentre study. Anaesthesia 2024; 79:147-155. [PMID: 38059394 DOI: 10.1111/anae.16124] [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] [Accepted: 08/17/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
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Affiliation(s)
- N M Wilson
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Calabria
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Warren
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Finlay
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A O'Donovan
- Department of Process, Energy and Transport Engineering, MeSSO Research Group, Munster Technological University, Cork, Ireland
| | - G L Passerello
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - N L Ribaric
- Faculty of Medicine, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - P Ward
- Department of Anaesthesia, St John's Hospital, Livingston, UK
| | - R Gillespie
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Farrel
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A F McNarry
- Department of Anaesthesia, Western General Hospital, UK
| | - D Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Dokubo II, Tay LJ, Rutigliani L, Appukutty S, Warren A, Shah N, Lamb BW. Prostatic stromal tumour of uncertain malignant potential treated with robotic-assisted radical prostatectomy: medium-term oncological and functional outcome of two cases. Ann R Coll Surg Engl 2023; 105:781-785. [PMID: 37489505 PMCID: PMC10618041 DOI: 10.1308/rcsann.2023.0050] [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: 07/26/2023] Open
Abstract
Stromal tumour of uncertain malignant potential (STUMP) is a rare tumour of the prostate with variable and unpredictable risk and clinical progression. There is no clear consensus on how it should be managed. We describe two cases of patients who presented to their general practitioners with raised prostate-specific antigen in one instance and an abnormal digital rectal examination in the other. Biopsies were carried out and a diagnosis of STUMP was made. Both cases were managed with robot-assisted radical prostatectomy and after 4.8 years of follow-up, there has not been any recurrence. This is the first reported UK case in which STUMP has been successfully managed with robotic surgery with excellent medium-term results. Radical prostatectomy can be used to treat STUMP tumour with good oncological and functional outcomes.
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Affiliation(s)
- I I Dokubo
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - L J Tay
- Cambridge University Hospitals NHS Foundation Trust, UK
| | | | | | | | - N Shah
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - B W Lamb
- Cambridge University Hospitals NHS Foundation Trust, UK
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Li Q, Morotti A, Warren A, Qureshi AI, Dowlatshahi D, Falcone G, Sheth KN, Shoamanesh A, Murthy SB, Viswanathan A, Goldstein JN. Intensive Blood Pressure Reduction is Associated with Reduced Hematoma Growth in Fast Bleeding Intracerebral Hemorrhage. Ann Neurol 2023. [PMID: 37706569 DOI: 10.1002/ana.26795] [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: 03/16/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Patients with spontaneous intracerebral hemorrhage (ICH) at the highest risk of hematoma growth are those with the most potential to benefit from anti-expansion treatment. Large clinical trials have not definitively shown a clear benefit of blood pressure (BP) reduction. We aim to determine whether intensive blood pressure reduction could benefit patients with fast bleeding ICH. METHODS An exploratory analysis of data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) randomized controlled trial was performed. In order to capture not just early bleeding (even if a small amount), but the rate of bleeding (ml/hour), we restricted the study to "Fast bleeding ICH," defined as an ICH volume/onset to computed tomography (CT) time >5 ml/hr. Hematoma growth, as defined as an increase of hematoma volume > 33% between baseline and 24 hours. RESULTS A total of 940 patients were included (mean age = 62.1 years, 61.5% men), of whom 214 (22.8%) experienced hematoma expansion. Of these, 567 (60.3%) met the definition of "fast bleeding" with baseline ICH volume/time to presentation of at least 5 ml/hr. Intensive BP reduction was associated with a significantly lower rate of hematoma growth in fast bleeding patients (20.6% vs 31.0%, p = 0.005). In a subgroup of 266 (46.9%) fast-bleeding patients who received treatment within 2 hours after symptom onset, intensive BP lowering was associated with improved functional independence (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.06-3.69, p = 0.031). INTERPRETATION Our results suggest that early use of intensive BP reduction may reduce hematoma growth and improve outcome in fast bleeding patients. ANN NEUROL 2023.
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Affiliation(s)
- Qi Li
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, Azienda Socio Sanitaria Territoriale Spedali Civili, Brescia, Italy
| | - Andrew Warren
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO
| | - Dar Dowlatshahi
- Department of Medicine, Division of Neurology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Guido Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Departments of Neurology and Neurosurgery, and the Yale Center for Brain and Mind Health, Yale School of Medicine, New Haven, CT
| | - Ashkan Shoamanesh
- Department of Medicine, Division of Neurology, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Warren A, Dea M, Barron IG, Zapata I. Ski and snowboard injury patterns in the United States from 2010 to 2020 in pediatric patients. Injury 2023; 54:110899. [PMID: 37330404 DOI: 10.1016/j.injury.2023.110899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Children and adolescents are at higher risk of injuries from winter sports like skiing and snowboarding which can cause severe lifelong debilitation and death. PURPOSE The objective of this study is to perform a nationwide analysis of pediatric skiing and snowboarding injuries to identify patterns regarding patient demographics, type of injuries, outcomes, and admission rates. STUDY DESIGN Descriptive Epidemiological Study. METHODS This was a retrospective cohort study of publicly available data. Cases were sourced from the National Electronic Injury Surveillance System (NEISS) from 2010 to 2020 and included 6421 incidents. RESULTS Even when the highest percentage of injuries was the head at 19.30%; the diagnosis of concussion was placed third while fractures were the most common diagnosis at 38.20%. The proportion of pediatric incidents by hospital type is changing with children's hospitals currently managing the majority of cases. CONCLUSIONS These findings can assist clinicians in the ED across different hospital types in understanding the patterns of injury to be better prepared for new cases.
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Affiliation(s)
- Andrew Warren
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, United States of America
| | - Michael Dea
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, United States of America
| | - Ileana G Barron
- Department of Epidemiology, University of Alabama Birmingham School of Public Health, Birmingham, AL 35233, United States of America
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, United States of America.
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Alkanhal A, Saunders J, Altammar F, Huber AM, Lynk A, MacLeod A, Ortiz-Alvarez O, Adams M, Ramsey S, Stringer E, Warren A, Lang B. Unexpectedly high incidence of Kawasaki Disease in a Canadian Atlantic Province- an 11-year retrospective descriptive study. Pediatr Rheumatol Online J 2023; 21:30. [PMID: 37013572 PMCID: PMC10069096 DOI: 10.1186/s12969-023-00805-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Kawasaki Disease (KD) is the leading cause of acquired heart disease in children in developed countries with a variable incidence worldwide. Previous studies reported an unexpectedly high incidence of KD in the Canadian Atlantic Provinces. The goals of our study were to validate this finding in the province of Nova Scotia and to carefully review patients' characteristics and disease outcomes. METHODS This was a retrospective review of all children < 16 years old from Nova Scotia diagnosed with KD between 2007-2018. Cases were identified using a combination of administrative and clinical databases. Clinical information was collected retrospectively by health record review using a standardized form. RESULTS Between 2007-2018, 220 patients were diagnosed with KD; 61.4% and 23.2% met the criteria for complete and incomplete disease, respectively. The annual incidence was 29.6 per 100,000 children < 5 years. The male to female ratio was 1.3:1 and the median age was 3.6 years. All patients diagnosed with KD in the acute phase received intravenous immunoglobulin (IVIG); 23 (12%) were refractory to the first dose. Coronary artery aneurysms were found in 13 (6%) patients and one patient died with multiple giant aneurysms. CONCLUSION We have confirmed an incidence of KD in our population which is higher than that reported in Europe and other regions of North America despite our small Asian population. The comprehensive method to capture patients may have contributed to the detection of the higher incidence. The role of local environmental and genetic factors also deserves further study. Increased attention to regional differences in the epidemiology of KD may improve our understanding of this important childhood vasculitis.
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Affiliation(s)
- Abdulrahman Alkanhal
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | | | - Fajer Altammar
- Department of Pediatrics, New Jahra Hospital and Kuwait Institute for Medical Specialization, Al Jahra, Kuwait
| | - Adam M Huber
- Division of Rheumatology, Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Canada
| | - Andrew Lynk
- Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Canada
| | - Alison MacLeod
- Nova Scotia Health and Dalhousie University, Halifax, Canada
| | | | - Meighan Adams
- Pediatric Cardiology, Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre and Memorial University of Newfoundland, St. John's, Canada
| | - Suzanne Ramsey
- Division of Rheumatology, Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Canada
| | - Elizabeth Stringer
- Division of Rheumatology, Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Canada
| | - Andrew Warren
- Division of Cardiology, Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Canada
| | - Bianca Lang
- Division of Rheumatology, Department of Pediatrics, IWK Health and Dalhousie University, Halifax, Canada.
- Division of Rheumatology, Department of Pediatrics, IWK Health Centre, PO Box 9700, 5850-5980 University Ave., Halifax, NS, B3K 6R8, Canada.
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Treffalls J, Hart V, McDonald C, Warren A, Hastings L, Das N, Sako E. Comparison of Multimodal Pain Control Following Bilateral Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.423] [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: 04/05/2023] Open
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Wolf HL, Hillenbrand CJ, Tang GJ, Warren A. Association Of Pre And Perioperative Vein Mapping With Hemodialysis Access - Characteristics And Outcomes. Ann Vasc Surg 2023. [DOI: 10.1016/j.avsg.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Bhattacharya P, Chen J, Hoops S, Machi D, Lewis B, Venkatramanan S, Wilson ML, Klahn B, Adiga A, Hurt B, Outten J, Adiga A, Warren A, Baek YY, Porebski P, Marathe A, Xie D, Swarup S, Vullikanti A, Mortveit H, Eubank S, Barrett CL, Marathe M. Data-driven scalable pipeline using national agent-based models for real-time pandemic response and decision support. Int J High Perform Comput Appl 2023; 37:4-27. [PMID: 38603425 PMCID: PMC9596688 DOI: 10.1177/10943420221127034] [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] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This paper describes an integrated, data-driven operational pipeline based on national agent-based models to support federal and state-level pandemic planning and response. The pipeline consists of (i) an automatic semantic-aware scheduling method that coordinates jobs across two separate high performance computing systems; (ii) a data pipeline to collect, integrate and organize national and county-level disaggregated data for initialization and post-simulation analysis; (iii) a digital twin of national social contact networks made up of 288 Million individuals and 12.6 Billion time-varying interactions covering the US states and DC; (iv) an extension of a parallel agent-based simulation model to study epidemic dynamics and associated interventions. This pipeline can run 400 replicates of national runs in less than 33 h, and reduces the need for human intervention, resulting in faster turnaround times and higher reliability and accuracy of the results. Scientifically, the work has led to significant advances in real-time epidemic sciences.
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Affiliation(s)
- Parantapa Bhattacharya
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Jiangzhuo Chen
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Stefan Hoops
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Dustin Machi
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Bryan Lewis
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | | | - Mandy L Wilson
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Brian Klahn
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Aniruddha Adiga
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Benjamin Hurt
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Joseph Outten
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Abhijin Adiga
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Andrew Warren
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Young Yun Baek
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Przemyslaw Porebski
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Achla Marathe
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
- Dept. of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Dawen Xie
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Samarth Swarup
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
| | - Anil Vullikanti
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
- Dept. of Computer Science, University of Virginia, Charlottesville, VA, USA
| | - Henning Mortveit
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
- Dept. of Eng. Systems and Environment, University of Virginia, Charlottesville, VA, USA
| | - Stephen Eubank
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
- Dept. of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Christopher L Barrett
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
- Dept. of Computer Science, University of Virginia, Charlottesville, VA, USA
| | - Madhav Marathe
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, VA, USA
- Dept. of Computer Science, University of Virginia, Charlottesville, VA, USA
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14
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Warren A, James S, Foulkes R, Rees M. Alternative breast cancer localisation techniques in Wales: an early experience. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01388-0] [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: 11/19/2022]
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15
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Crawshaw A, Warren A, Trincao J, Lunnon M, Duller G, Evans G. VMXm: a new micro/nanofocus protein crystallography beamline at Diamond Light Source. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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16
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Charidimou A, Boulouis G, Frosch MP, Baron JC, Pasi M, Albucher JF, Banerjee G, Barbato C, Bonneville F, Brandner S, Calviere L, Caparros F, Casolla B, Cordonnier C, Delisle MB, Deramecourt V, Dichgans M, Gokcal E, Herms J, Hernandez-Guillamon M, Jäger HR, Jaunmuktane Z, Linn J, Martinez-Ramirez S, Martínez-Sáez E, Mawrin C, Montaner J, Moulin S, Olivot JM, Piazza F, Puy L, Raposo N, Rodrigues MA, Roeber S, Romero JR, Samarasekera N, Schneider JA, Schreiber S, Schreiber F, Schwall C, Smith C, Szalardy L, Varlet P, Viguier A, Wardlaw JM, Warren A, Wollenweber FA, Zedde M, van Buchem MA, Gurol ME, Viswanathan A, Al-Shahi Salman R, Smith EE, Werring DJ, Greenberg SM. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21:714-725. [PMID: 35841910 PMCID: PMC9389452 DOI: 10.1016/s1474-4422(22)00208-3] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations. METHODS In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy. FINDINGS The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard. INTERPRETATION The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations. FUNDING US National Institutes of Health (R01 AG26484).
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France
| | - Matthew P Frosch
- C S Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean-Claude Baron
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Marco Pasi
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean Francois Albucher
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Barbato
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Fabrice Bonneville
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Sebastian Brandner
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Lionel Calviere
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - François Caparros
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Barbara Casolla
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Charlotte Cordonnier
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Marie-Bernadette Delisle
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Vincent Deramecourt
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) and German Center for Neurodegenerative Diseases, Munich, Germany
| | - Elif Gokcal
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Zane Jaunmuktane
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Linn
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Dresden, Germany
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elena Martínez-Sáez
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Mawrin
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Biomedicine of Seville, Hospital Universitario Virgen Macarena, Consejo Superior de Investigaciones Científicas, University of Seville, Spain
| | - Solene Moulin
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean-Marc Olivot
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laurent Puy
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Nicolas Raposo
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jose Rafael Romero
- Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | | | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Stefanie Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Corentin Schwall
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Levente Szalardy
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Pascale Varlet
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Alain Viguier
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Warren
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Helios Dr Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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17
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Meyer F, Fritz A, Deng ZL, Koslicki D, Lesker TR, Gurevich A, Robertson G, Alser M, Antipov D, Beghini F, Bertrand D, Brito JJ, Brown CT, Buchmann J, Buluç A, Chen B, Chikhi R, Clausen PTLC, Cristian A, Dabrowski PW, Darling AE, Egan R, Eskin E, Georganas E, Goltsman E, Gray MA, Hansen LH, Hofmeyr S, Huang P, Irber L, Jia H, Jørgensen TS, Kieser SD, Klemetsen T, Kola A, Kolmogorov M, Korobeynikov A, Kwan J, LaPierre N, Lemaitre C, Li C, Limasset A, Malcher-Miranda F, Mangul S, Marcelino VR, Marchet C, Marijon P, Meleshko D, Mende DR, Milanese A, Nagarajan N, Nissen J, Nurk S, Oliker L, Paoli L, Peterlongo P, Piro VC, Porter JS, Rasmussen S, Rees ER, Reinert K, Renard B, Robertsen EM, Rosen GL, Ruscheweyh HJ, Sarwal V, Segata N, Seiler E, Shi L, Sun F, Sunagawa S, Sørensen SJ, Thomas A, Tong C, Trajkovski M, Tremblay J, Uritskiy G, Vicedomini R, Wang Z, Wang Z, Wang Z, Warren A, Willassen NP, Yelick K, You R, Zeller G, Zhao Z, Zhu S, Zhu J, Garrido-Oter R, Gastmeier P, Hacquard S, Häußler S, Khaledi A, Maechler F, Mesny F, Radutoiu S, Schulze-Lefert P, Smit N, Strowig T, Bremges A, Sczyrba A, McHardy AC. Critical Assessment of Metagenome Interpretation: the second round of challenges. Nat Methods 2022; 19:429-440. [PMID: 35396482 PMCID: PMC9007738 DOI: 10.1038/s41592-022-01431-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/14/2022] [Indexed: 12/20/2022]
Abstract
Evaluating metagenomic software is key for optimizing metagenome interpretation and focus of the Initiative for the Critical Assessment of Metagenome Interpretation (CAMI). The CAMI II challenge engaged the community to assess methods on realistic and complex datasets with long- and short-read sequences, created computationally from around 1,700 new and known genomes, as well as 600 new plasmids and viruses. Here we analyze 5,002 results by 76 program versions. Substantial improvements were seen in assembly, some due to long-read data. Related strains still were challenging for assembly and genome recovery through binning, as was assembly quality for the latter. Profilers markedly matured, with taxon profilers and binners excelling at higher bacterial ranks, but underperforming for viruses and Archaea. Clinical pathogen detection results revealed a need to improve reproducibility. Runtime and memory usage analyses identified efficient programs, including top performers with other metrics. The results identify challenges and guide researchers in selecting methods for analyses. This study presents the results of the second round of the Critical Assessment of Metagenome Interpretation challenges (CAMI II), which is a community-driven effort for comprehensively benchmarking tools for metagenomics data analysis.
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Affiliation(s)
- Fernando Meyer
- Computational Biology of Infection Research, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany
| | - Adrian Fritz
- Computational Biology of Infection Research, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig Site, Braunschweig, Germany
| | - Zhi-Luo Deng
- Computational Biology of Infection Research, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany.,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | | | - Till Robin Lesker
- German Center for Infection Research (DZIF), Hannover-Braunschweig Site, Braunschweig, Germany.,Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Gary Robertson
- Computational Biology of Infection Research, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany
| | - Mohammed Alser
- Department of Information Technology and Electrical Engineering, ETH Zürich, Zurich, Switzerland
| | - Dmitry Antipov
- Center for Algorithmic Biotechnology, Saint Petersburg State University, Saint Petersburg, Russia
| | | | | | | | | | - Jan Buchmann
- Institute for Biological Data Science, Heinrich-Heine-University, Düsseldorf, Germany
| | - Aydin Buluç
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,University of California, Berkeley, Berkeley, CA, USA
| | - Bo Chen
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,University of California, Berkeley, Berkeley, CA, USA
| | | | - Philip T L C Clausen
- National Food Institute, Division of Global Surveillance, Technical University of Denmark, Lyngby, Denmark
| | - Alexandru Cristian
- Drexel University, Philadelphia, PA, USA.,Google Inc., Philadelphia, PA, USA
| | - Piotr Wojciech Dabrowski
- Robert Koch-Institut, Berlin, Germany.,Hochschule für Technik und Wirtschaft Berlin, Berlin, Germany
| | | | - Rob Egan
- DOE Joint Genome Institute, Berkeley, CA, USA.,Lawrence Berkeley National Laboratories, Berkeley, CA, USA
| | - Eleazar Eskin
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Eugene Goltsman
- DOE Joint Genome Institute, Berkeley, CA, USA.,Lawrence Berkeley National Laboratories, Berkeley, CA, USA
| | - Melissa A Gray
- Drexel University, Philadelphia, PA, USA.,Ecological and Evolutionary Signal-Processing and Informatics Laboratory, Philadelphia, PA, USA
| | - Lars Hestbjerg Hansen
- University of Copenhagen, Department of Plant and Environmental Science, Frederiksberg, Denmark
| | - Steven Hofmeyr
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,University of California, Berkeley, Berkeley, CA, USA
| | - Pingqin Huang
- School of Computer Science, Fudan University, Shanghai, China
| | - Luiz Irber
- University of California, Davis, Davis, CA, USA
| | - Huijue Jia
- BGI-Shenzhen, Shenzhen, China.,Shenzhen Key Laboratory of Human Commensal Microorganisms and Health Research, BGI-Shenzhen, Shenzhen, China
| | - Tue Sparholt Jørgensen
- Technical University of Denmark, Novo Nordisk Foundation Center for Biosustainability, Lyngby, Denmark.,Aarhus University, Department of Environmental Science, Roskilde, Denmark
| | - Silas D Kieser
- Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Swiss Institute of Bioinformatics, Geneva, Switzerland
| | | | - Axel Kola
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Kolmogorov
- Department of Computer Science and Engineering, University of California San Diego, San Diego, CA, USA
| | - Anton Korobeynikov
- Center for Algorithmic Biotechnology, Saint Petersburg State University, Saint Petersburg, Russia.,Department of Statistical Modelling, Saint Petersburg State University, Saint Petersburg, Russia
| | - Jason Kwan
- University of Wisconsin-Madison, Madison, WI, USA
| | | | | | - Chenhao Li
- Genome Institute of Singapore, Singapore, Singapore
| | | | - Fabio Malcher-Miranda
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | | | - Vanessa R Marcelino
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Australia
| | | | - Pierre Marijon
- Department of Computer Science, Inria, University of Lille, CNRS, Lille, France
| | - Dmitry Meleshko
- Center for Algorithmic Biotechnology, Saint Petersburg State University, Saint Petersburg, Russia
| | - Daniel R Mende
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Alessio Milanese
- Department of Biology, Institute of Microbiology and Swiss Institute of Bioinformatics, ETH Zürich, Zürich, Switzerland.,Structural and Computational Biology Unit, EMBL, Heidelberg, Germany
| | - Niranjan Nagarajan
- Genome Institute of Singapore, A*STAR, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| | | | - Sergey Nurk
- Genome Informatics Section, Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Leonid Oliker
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,University of California, Berkeley, Berkeley, CA, USA
| | - Lucas Paoli
- Department of Biology, Institute of Microbiology and Swiss Institute of Bioinformatics, ETH Zürich, Zürich, Switzerland
| | | | - Vitor C Piro
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam, Germany
| | | | - Simon Rasmussen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Evan R Rees
- University of Wisconsin-Madison, Madison, WI, USA
| | - Knut Reinert
- Institute for Bioinformatics, FU Berlin, Berlin, Germany
| | - Bernhard Renard
- Hasso Plattner Institute, Digital Engineering Faculty, University of Potsdam, Potsdam, Germany.,Bioinformatics Unit (MF1), Robert Koch Institute, Berlin, Germany
| | | | - Gail L Rosen
- Drexel University, Philadelphia, PA, USA.,Ecological and Evolutionary Signal-Processing and Informatics Laboratory, Philadelphia, PA, USA.,Center for Biological Discovery from Big Data, Philadelphia, PA, USA
| | - Hans-Joachim Ruscheweyh
- Department of Biology, Institute of Microbiology and Swiss Institute of Bioinformatics, ETH Zürich, Zürich, Switzerland
| | - Varuni Sarwal
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Enrico Seiler
- Institute for Bioinformatics, FU Berlin, Berlin, Germany
| | - Lizhen Shi
- Florida Polytechnic University, Lakeland, FL, USA
| | - Fengzhu Sun
- Quantitative and Computational Biology Department, University of Southern California, Los Angeles, CA, USA
| | - Shinichi Sunagawa
- Department of Biology, Institute of Microbiology and Swiss Institute of Bioinformatics, ETH Zürich, Zürich, Switzerland
| | | | - Ashleigh Thomas
- DOE Joint Genome Institute, Berkeley, CA, USA.,University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Mirko Trajkovski
- Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Tremblay
- Energy, Mining and Environment, National Research Council Canada, Montreal, Quebec, Canada
| | | | | | - Zhengyang Wang
- School of Computer Science, Fudan University, Shanghai, China
| | - Ziye Wang
- School of Mathematical Sciences, Fudan University, Shanghai, China
| | - Zhong Wang
- Department of Energy Joint Genome Institute, Berkeley, CA, USA.,Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,School of Natural Sciences, University of California at Merced, Merced, CA, USA
| | | | | | - Katherine Yelick
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,University of California, Berkeley, Berkeley, CA, USA
| | - Ronghui You
- School of Computer Science, Fudan University, Shanghai, China
| | - Georg Zeller
- Structural and Computational Biology Unit, EMBL, Heidelberg, Germany
| | | | - Shanfeng Zhu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Jie Zhu
- BGI-Shenzhen, Shenzhen, China.,Shenzhen Key Laboratory of Human Commensal Microorganisms and Health Research, BGI-Shenzhen, Shenzhen, China
| | | | | | | | - Susanne Häußler
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Ariane Khaledi
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Fantin Mesny
- Max Planck Institute for Plant Breeding Research, Köln, Germany
| | | | | | - Nathiana Smit
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Till Strowig
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Andreas Bremges
- Computational Biology of Infection Research, Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig Site, Braunschweig, Germany
| | - Alexander Sczyrba
- Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Alice Carolyn McHardy
- Computational Biology of Infection Research, Helmholtz Centre for Infection Research, Braunschweig, Germany. .,Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany. .,German Center for Infection Research (DZIF), Hannover-Braunschweig Site, Braunschweig, Germany. .,Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany.
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18
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Qian T, Fujiwara N, Koneru B, Ono A, Kubota N, Jajoriya AK, Tung MG, Crouchet E, Song WM, Marquez CA, Panda G, Hoshida A, Raman I, Li QZ, Lewis C, Yopp A, Rich NE, Singal AG, Nakagawa S, Goossens N, Higashi T, Koh AP, Bian CB, Hoshida H, Tabrizian P, Gunasekaran G, Florman S, Schwarz ME, Hiotis SP, Nakahara T, Aikata H, Murakami E, Beppu T, Baba H, Warren A, Bhatia S, Kobayashi M, Kumada H, Fobar AJ, Parikh ND, Marrero JA, Rwema SH, Nair V, Patel M, Kim-Schulze S, Corey K, O’Leary JG, Klintmalm GB, Thomas DL, Dibas M, Rodriguez G, Zhang B, Friedman SL, Baumert TF, Fuchs BC, Chayama K, Zhu S, Chung RT, Hoshida Y. Molecular Signature Predictive of Long-Term Liver Fibrosis Progression to Inform Antifibrotic Drug Development. Gastroenterology 2022; 162:1210-1225. [PMID: 34951993 PMCID: PMC8934284 DOI: 10.1053/j.gastro.2021.12.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS There is a major unmet need to assess the prognostic impact of antifibrotics in clinical trials because of the slow rate of liver fibrosis progression. We aimed to develop a surrogate biomarker to predict future fibrosis progression. METHODS A fibrosis progression signature (FPS) was defined to predict fibrosis progression within 5 years in patients with hepatitis C virus and nonalcoholic fatty liver disease (NAFLD) with no to minimal fibrosis at baseline (n = 421) and was validated in an independent NAFLD cohort (n = 78). The FPS was used to assess response to 13 candidate antifibrotics in organotypic ex vivo cultures of clinical fibrotic liver tissues (n = 78) and cenicriviroc in patients with nonalcoholic steatohepatitis enrolled in a clinical trial (n = 19, NCT02217475). A serum protein-based surrogate FPS was developed and tested in a cohort of compensated cirrhosis patients (n = 122). RESULTS A 20-gene FPS was defined and validated in an independent NAFLD cohort (adjusted odds ratio, 10.93; area under the receiver operating characteristic curve, 0.86). Among computationally inferred fibrosis-driving FPS genes, BCL2 was confirmed as a potential pharmacologic target using clinical liver tissues. Systematic ex vivo evaluation of 13 candidate antifibrotics identified rational combination therapies based on epigallocatechin gallate, which were validated for enhanced antifibrotic effect in ex vivo culture of clinical liver tissues. In patients with nonalcoholic steatohepatitis treated with cenicriviroc, FPS modulation was associated with 1-year fibrosis improvement accompanied by suppression of the E2F pathway. Induction of the PPARα pathway was absent in patients without fibrosis improvement, suggesting a benefit of combining PPARα agonism to improve the antifibrotic efficacy of cenicriviroc. A 7-protein serum protein-based surrogate FPS was associated with the development of decompensation in cirrhosis patients. CONCLUSION The FPS predicts long-term fibrosis progression in an etiology-agnostic manner, which can inform antifibrotic drug development.
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Affiliation(s)
- Tongqi Qian
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Naoto Fujiwara
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Bhuvaneswari Koneru
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Atsushi Ono
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S.,Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Kubota
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Arun K Jajoriya
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Matthew G Tung
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, U.S
| | - Emilie Crouchet
- Institut de Recherche sur les Maladies Virales et Hépatiques, Inserm U1110, University of Strasbourg, Strasbourg, France
| | - Won-Min Song
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Cesia Ammi Marquez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Gayatri Panda
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Ayaka Hoshida
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Indu Raman
- Microarray Core Facility, Department of Immunology, BioCenter, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Quan-Zhen Li
- Microarray Core Facility, Department of Immunology, BioCenter, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Cheryl Lewis
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Adam Yopp
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Nicole E Rich
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nicolas Goossens
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Switzerland
| | - Takaaki Higashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Anna P Koh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - C Billie Bian
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Hiroki Hoshida
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Parissa Tabrizian
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Ganesh Gunasekaran
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Sander Florman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Myron E Schwarz
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Spiros P Hiotis
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Takashi Nakahara
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eisuke Murakami
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Beppu
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, U.S
| | - Hideo Baba
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, U.S
| | | | | | | | | | - Austin J Fobar
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, U.S
| | - Neehar D Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, U.S
| | - Jorge A Marrero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, U.S.,Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, U.S
| | | | - Venugopalan Nair
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Manishkumar Patel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, U.S
| | | | - Kathleen Corey
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, U.S
| | | | | | - David L Thomas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, U.S
| | | | | | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Scott L Friedman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Thomas F Baumert
- Institut de Recherche sur les Maladies Virales et Hépatiques, Inserm U1110, University of Strasbourg, Strasbourg, France.,IHU, Pole hépato-digestif, Strasbourg University Hospitals, Strasbourg, France
| | - Bryan C Fuchs
- Department of Surgery, Massachusetts General Hospital, Boston, U.S., Ferring Pharmaceuticals, San Diego, U.S
| | - Kazuaki Chayama
- Collaborative Research Laboratory of Medical Innovation, Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Shijia Zhu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Raymond T Chung
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Yujin Hoshida
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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19
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Winger A, Warren A, Hoops S, Marathe M, Lee DW, Kindwall-Keller T. Computational Modeling of Immune System Interactions during Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS) after Chimeric Antigen Receptor (CAR) T-Cell Therapy. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00336-0] [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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20
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Curry DE, Erker C, Price V, Midgen C, Mohsin H, Sett S, Warren A, Hussain A. Massive Saddle Pulmonary Embolism in a Preterm Neonate With Successful Emergent Open Embolectomy. CJC Pediatr Congenit Heart Dis 2022; 1:40-43. [PMID: 37969557 PMCID: PMC10642089 DOI: 10.1016/j.cjcpc.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2023]
Abstract
Pulmonary embolism in the neonate is a rare, life-threatening emergency. Risk factors for neonatal pulmonary embolism (PE) include sepsis, asphyxia, prematurity, and vascular catheterisation. We report the case of a preterm neonate with a massive saddle pulmonary thrombosis of unidentified etiology. Prompt diagnosis by cardiology allowed an emergent lifesaving open surgical thrombectomy, underscoring the importance of efficient multidisciplinary teamwork. Pediatric health-care professionals must be aware of this rare entity when initial oxygen desaturation management fails, even when obvious risk factors for PE are not apparent. We emphasise the importance of seamless multidisciplinary communication and proactive surgical consultation.
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Affiliation(s)
- Dennis E. Curry
- Division of Cardiology, Department of Pediatrics, IWK Children’s Heart Centre, Halifax, Nova Scotia, Canada
| | - Craig Erker
- Division of Hematology–Oncology, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria Price
- Division of Hematology–Oncology, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Craig Midgen
- Department of Pathology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Hina Mohsin
- Department of Diagnostic Imaging, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Suvro Sett
- Division of Pediatric Cardiac Surgery, Department of Surgery, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Warren
- Division of Cardiology, Department of Pediatrics, IWK Children’s Heart Centre, Halifax, Nova Scotia, Canada
| | - Arif Hussain
- Division of Cardiology, Department of Pediatrics, IWK Children’s Heart Centre, Halifax, Nova Scotia, Canada
- Division of Pediatric Cardiology, Children’s Mercy Hospital Kansas, Kansas City, Missouri, USA
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21
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Moniz T, Melro CM, Warren A, Watling C. Dual and duelling purposes: An exploration of educators' perspectives on the use of reflective writing to remediate professionalism in residency. Med Educ 2022; 56:176-185. [PMID: 34437727 PMCID: PMC9297876 DOI: 10.1111/medu.14625] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging-and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism. METHOD In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comparison to identify themes and to understand the relationships among them. RESULTS Medical educators reported using reflective writing as a learning tool to develop insight and as an assessment tool to unearth evidence of insight. The goal of learning may compete with the goal of assessment, creating tension that leads to uncertainty about the sincerity, quality and effectiveness of reflective writing as well as concerns about learner safety. Educators reported uncertainty about whether learners write to pass or to introspect and about how to judge the effectiveness of reflective writing as a learning tool. They expressed concern about creating a safe environment for learners-one that enables the genuine reflection required for insight development-while meeting requirements of remediation. CONCLUSIONS Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism.
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Affiliation(s)
- Tracy Moniz
- Department of Communication StudiesMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | | | - Andrew Warren
- Department of Pediatrics, Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Chris Watling
- Departments of Oncology and Clinical Neurological Sciences, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
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22
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Sokka J, Yoshihara M, Kvist J, Laiho L, Warren A, Stadelmann C, Jouhilahti EM, Kilpinen H, Balboa D, Katayama S, Kyttälä A, Kere J, Otonkoski T, Weltner J, Trokovic R. CRISPR activation enables high-fidelity reprogramming into human pluripotent stem cells. Stem Cell Reports 2022; 17:413-426. [PMID: 35063129 PMCID: PMC8828555 DOI: 10.1016/j.stemcr.2021.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/19/2022] Open
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23
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Smart S, Sivathasan S, Patel K, Nathan A, Warren A, Shah N, Lamb B. Incremental modification of robotic prostatectomy technique can lead to aggregated marginal gains to significantly improve functional outcomes without compromising oncological control. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Subudhi S, Drescher HK, Dichtel LE, Bartsch LM, Chung RT, Hutter MM, Gee DW, Meireles OR, Witkowski ER, Gelrud L, Masia R, Osganian SA, Gustafson JL, Rwema S, Bredella MA, Bhatia SN, Warren A, Miller KK, Lauer GM, Corey KE. Distinct Hepatic Gene-Expression Patterns of NAFLD in Patients With Obesity. Hepatol Commun 2021; 6:77-89. [PMID: 34558849 PMCID: PMC8710788 DOI: 10.1002/hep4.1789] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 06/02/2021] [Accepted: 06/13/2021] [Indexed: 02/06/2023] Open
Abstract
Approaches to manage nonalcoholic fatty liver disease (NAFLD) are limited by an incomplete understanding of disease pathogenesis. The aim of this study was to identify hepatic gene‐expression patterns associated with different patterns of liver injury in a high‐risk cohort of adults with obesity. Using the NanoString Technologies (Seattle, WA) nCounter assay, we quantified expression of 795 genes, hypothesized to be involved in hepatic fibrosis, inflammation, and steatosis, in liver tissue from 318 adults with obesity. Liver specimens were categorized into four distinct NAFLD phenotypes: normal liver histology (NLH), steatosis only (steatosis), nonalcoholic steatohepatitis without fibrosis (NASH F0), and NASH with fibrosis stage 1‐4 (NASH F1‐F4). One hundred twenty‐five genes were significantly increasing or decreasing as NAFLD pathology progressed. Compared with NLH, NASH F0 was characterized by increased inflammatory gene expression, such as gamma‐interferon‐inducible lysosomal thiol reductase (IFI30) and chemokine (C‐X‐C motif) ligand 9 (CXCL9), while complement and coagulation related genes, such as C9 and complement component 4 binding protein beta (C4BPB), were reduced. In the presence of NASH F1‐F4, extracellular matrix degrading proteinases and profibrotic/scar deposition genes, such as collagens and transforming growth factor beta 1 (TGFB1), were simultaneously increased, suggesting a dynamic state of tissue remodeling. Conclusion: In adults with obesity, distinct states of NAFLD are associated with intrahepatic perturbations in genes related to inflammation, complement and coagulation pathways, and tissue remodeling. These data provide insights into the dynamic pathogenesis of NAFLD in high‐risk individuals.
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Affiliation(s)
- Sonu Subudhi
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hannah K Drescher
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura E Dichtel
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lea M Bartsch
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ozanan R Meireles
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Elan R Witkowski
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Louis Gelrud
- Department of Medicine, St. Mary's Hospital Bon Secours, Richmond, VA, USA
| | - Ricard Masia
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie A Osganian
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jenna L Gustafson
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steve Rwema
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Radiology and Interventions, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sangeeta N Bhatia
- Ludwig Center for Molecular Oncology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Andrew Warren
- Ludwig Center for Molecular Oncology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Georg M Lauer
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kathleen E Corey
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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25
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Bowes D, Shearer C, Daigle-Maloney T, Dornan J, Lynk A, Parker J, Romao RL, Stevens S, Allen S, Warren A, Ackroyd-Stolarz S. Development and implementation of a postgraduate medical education-wide initiative in quality improvement and patient safety. Postgrad Med J 2021; 99:postgradmedj-2021-140261. [PMID: 34193538 DOI: 10.1136/postgradmedj-2021-140261] [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: 04/29/2021] [Accepted: 06/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Quality improvement and patient safety (QIPS) have been assigned a higher profile in CanMEDS 2015, CanMEDS-Family Medicine 2017 and new accreditation standards, prompting an initiative at Dalhousie University to create a vision for integrating QIPS into postgraduate medical education. OBJECTIVE The purpose of this study is to describe the implementation of a QIPS strategy across residency education at Dalhousie University. METHODS A QIPS task force was formed, and a literature review and needs assessment survey were completed. A needs assessment survey was distributed to all Dalhousie residency programme directors. 12 programme directors were interviewed individually to collect additional feedback. The results were used to develop a 'road map' of recommendations with a graduated timeline. RESULTS A task force report was released in February 2018. 46 recommendations were developed with a timeframe and responsible party identified for each. Implementation of the QIPS strategy is underway, and evaluation and challenges faced will be described. CONCLUSIONS We have developed a multiyear strategy that is available to provide guidance and support to all programmes in QIPS. The development and implementation of this QIPS framework may serve as a template for other institutions who seek to integrate these competencies into residency training.
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Affiliation(s)
- David Bowes
- Postgraduate Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada .,Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cindy Shearer
- Postgraduate Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Trisha Daigle-Maloney
- Department of Radiation Oncology, Dalhousie University, Saint John, New Brunswick, Canada
| | - John Dornan
- Department of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Andrew Lynk
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennie Parker
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rodrigo Lp Romao
- Departments of Surgery and Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Stevens
- Department of Anaesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stefan Allen
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Warren
- Postgraduate Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stacy Ackroyd-Stolarz
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Light A, Keates A, Thankappannair V, Warren A, Barrett T, Gnanapragasam V. Development of the STRATified CANcer Surveillance protocol for men with favourable-risk prostate cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rossi S, Newsham I, Pita S, Park G, Lach R, Babbage A, Smith C, Brennan K, Mitchell T, Warren A, Gevaert O, Leppert J, Stewart G, Massie C, Samarajiwa S. Accurate differentiation of renal tumour pathological subtypes using a machine learning model of epigenetic markers. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00971-4] [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: 11/28/2022]
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Gibson C, Carr C, Lyons C, Taksa L, Warren A. COVID‐19 and the shifting industrial landscape. Geographical Research 2021. [PMCID: PMC8014100 DOI: 10.1111/1745-5871.12462] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The COVID‐19 coronavirus pandemic has fuelled debate about domestic industry and manufacturing in light of shocks to global supply chains and shortages of medical and personal protective equipment (PPE). Nevertheless, debates have been poorly attuned to geography and history. Calls for reinvigorated domestic manufacturing conceal the degree to which industrial landscapes are already entwined in geometries of power. This is especially so at ports—increasingly privatised—that have become sites of policy focus and biosecurity panic. Crucial trading zones, ports are being refashioned as growth machines for commodity export, energy, and logistics, undergirding national manufacturing capacity via trade and material commodity flows. Yet ports have also always been vectors for disease transmission and are central places for COVID‐19 crises. Writing from Port Kembla, south of Sydney, Australia, we catalogue five themes warranting geographical analysis and global comparison in light of coronavirus: disruptions to supply chains (with implications for global production networks); domestic industrial capacity and the future of manufacturing; biosecuring industrial sites; precarious labour and work; and vernacular emergency response capacities within industrial communities. Amidst heightened geopolitical tensions, geographers reveal how industrial landscapes are contested. Logistical and biosecurity roles are enveloped by enduring infrastructural materialities, local histories, and regional legacies of skill and ingenuity.
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Affiliation(s)
- Chris Gibson
- Australian Centre for Culture, Environment, Society and Space (ACCESS), School of Geography and Sustainable CommunitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Chantel Carr
- Australian Centre for Culture, Environment, Society and Space (ACCESS), School of Geography and Sustainable CommunitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Craig Lyons
- Australian Centre for Culture, Environment, Society and Space (ACCESS), School of Geography and Sustainable CommunitiesUniversity of WollongongWollongongNew South WalesAustralia
| | - Lucy Taksa
- Centre for Workforce Futures, Macquarie Business SchoolMacquarie UniversitySydneyNew South WalesAustralia
| | - Andrew Warren
- Australian Centre for Culture, Environment, Society and Space (ACCESS), School of Geography and Sustainable CommunitiesUniversity of WollongongWollongongNew South WalesAustralia
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Doja A, Eady K, Warren A, Wiesenfeld L, Writer H. Utilization of evidence-based tools and medical education literature by Canadian postgraduate program directors in the teaching and assessment of the CanMEDS roles. Can Med Educ J 2021; 12:e57-e62. [PMID: 33995720 PMCID: PMC8105561 DOI: 10.36834/cmej.70183] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Researchers have shown that clinical educators feel insufficiently informed about how to teach and assess the CanMEDS roles. Thus, our objective was to examine the extent to which program directors utilize evidence-based tools and the medical education literature in teaching and assessing the CanMEDS roles. METHODS In 2016, the authors utilized an online questionnaire to survey 747 Canadian residency program directors (PD's) of Royal College of Physicians and Surgeons of Canada (RCPSC) accredited programs. RESULTS Overall, 186 PD's participated (24.9%). 36.6% did not know whether the teaching strategies they used were evidence-based and another third (31.9%) believed they were "not at all" or "to a small extent" evidence-based. Similarly, 31.8% did not know whether the assessment tools they used were evidence-based and another third (39.7%) believed they were "not at all" or "to a small extent" evidence-based. PD's were aware of research on teaching strategies (62.4%) and assessment tools (51.9%), but felt they did not have sufficient time to review relevant literature (72.1% for teaching and 64.1% for assessment). CONCLUSIONS Canadian PD's reported low awareness of evidence-based tools for teaching and assessment, implying a potential knowledge translation gap in medical education research.
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Affiliation(s)
- Asif Doja
- Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Kaylee Eady
- Faculty of Education, University of Ottawa, Ontario, Canada
| | - Andrew Warren
- Postgraduate Medical Education, Dalhousie Medical School, Dalhousie University, Nova Scotia, Canada
| | - Lorne Wiesenfeld
- Postgraduate Medical Education, University of Ottawa, Ontario, Canada
| | - Hilary Writer
- Department of Pediatrics, University of Ottawa, Ontario, Canada
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Bierer J, Horne D, Warren A, Sett S, Dhillon S, Coolen J. Interprofessional Patient-Specific Simulation Preparation to Improve Management of Neonatal High-Acuity Low-Occurrence (HALO) Scenarios. Can J Cardiol 2021; 37:1271-1274. [PMID: 33689864 DOI: 10.1016/j.cjca.2021.02.021] [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] [Received: 11/16/2020] [Revised: 02/08/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022] Open
Abstract
Fetal compressive intrapericardial teratoma is a rare and life-threatening condition, qualifying as a high-acuity low-occurrence (HALO) event. To prepare for delivery and immediate neonatal management, specialists from pediatric cardiology, cardiac surgery, maternal-fetal-medicine, neonatology, cardiac anesthesia, critical care, clinical perfusion, obstetrical nursing, and operating room nursing convened. An in situ operating room simulation was used to identify and introduce key team members, derive and practice the anticipated clinical management algorithm, position human and equipment resources strategically, and ensure that each specialist team was familiar with the environment and available equipment. As rehearsed in the simulation, the cesarean delivery of the patient and neonatal cardiac surgery was uncomplicated and yielded a favourable clinical outcome. A patient-specific HALO simulation preparation (PSHSP) can facilitate positive clinical outcomes and improve health care team confidence in HALO scenarios such as the birth of newborns anticipated to have cardiorespiratory instabilty.
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Affiliation(s)
- Joel Bierer
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Horne
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Warren
- Division of Cardiology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Suvro Sett
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Santokh Dhillon
- Division of Cardiology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jillian Coolen
- Division of Maternal-Fetal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Castello JP, Teo KC, Abramson JR, Leung IY, Leung WCY, Wang Y, Kourkoulis C, Myserlis EP, Warren A, Henry J, Chan KHH, Cheung R, Ho SL, Anderson CD, Gurol EM, Viswanathan A, Greenberg SM, Lau KK, Rosand J, Biffi A. Abstract P878: Racial and Ethnic Disparities in Early Hypertension Control After Intracerebral Hemorrhage. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p878] [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: 11/16/2022]
Abstract
Introduction:
Survivors of Intracerebral Hemorrhage (ICH) are at high risk of recurrent stroke. This risk is inversely proportional to average Blood Pressure (BP) after ICH. Racial/ethnic minority ICH survivors in the US demonstrate greater hypertension severity after ICH and are at higher risk of recurrent cerebral bleeding. Since most recurrent strokes occur within 12-18 months of index ICH, rapidly achieving BP control is likely to be crucial. We investigated the frequency, prognostic impact, and racial/ethnic disparities in uncontrolled short-term hypertension (HTN) after ICH.
Methods:
We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital (MGH-ICH, n=1305) and the University of Hong Kong (HK-ICH, n=523). We classified HTN as controlled, uncontrolled or treatment-resistant and determined: 1) risk factors for uncontrolled and treatment-resistant HTN; and 2) whether HTN control at 3 months is associated with long-term BP control, stroke recurrence and mortality across self-reported race/ethnicity groups.
Results:
We followed 1828 ICH survivors (1128 White, 565 Asian, 59 Hispanic, 49 Black, 27 other) for a median of 46.2 months. Only 9 of 172 (5%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled HTN, 755 (41%) had undertreated HTN, and 360 (20%) had treatment-resistant HTN. BP measurements at 3 months were highly correlated with measurements during follow-up (p<0.001). Black, Hispanic and Asian race/ethnicity were associated with higher prevalence of uncontrolled HTN at 3 months (all p<0.05). Both undertreated and uncontrolled HTN at 3 months were associated with increased risk of recurrent stroke and mortality during follow-up (all p<0.05).
Conclusions:
Most ICH survivors have inadequate HTN control 3 months after ICH, with under-treatment accounting for the majority of cases. Three-month BP measurements are associated with inadequate long-term HTN control, higher recurrent stroke risk and mortality. ICH survivors self-reporting as Black, Hispanic or Asian appear to be at highest risk for uncontrolled HTN. Optimizing HTN control at 3 months is a unique opportunity to address racial/ethnic disparities in quality of care among survivors of primary ICH.
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Affiliation(s)
| | | | | | - Ian Y Leung
- Neurology, Queen Mary Hosp, Hong Kong, Hong Kong
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Su CM, Warren A, Kraus C, Macias-Konstantopoulos W, Zachrison KS, Viswanathan A, Anderson C, Gurol ME, Greenberg SM, Goldstein JN. Lack of racial and ethnic-based differences in acute care delivery in intracerebral hemorrhage. Int J Emerg Med 2021; 14:6. [PMID: 33468042 PMCID: PMC7814635 DOI: 10.1186/s12245-021-00329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background and aim Early diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. We examined whether racial or ethnic disparities exist in acute care processes in the first hours after ICH. Methods We performed a retrospective review of a prospectively collected cohort of consecutive patients with spontaneous primary ICH presenting to a single urban tertiary care center. Acute care processes studied included time to computerized tomography (CT) scan, time from CT to inpatient bed request, and time from bed request to hospital admission. Clinical outcomes included mortality, Glasgow Outcome Scale, and modified Rankin Scale. Results Four hundred fifty-nine patients presented with ICH between 2006 and 2018 and met inclusion criteria (55% male; 75% non-Hispanic White [NHW]; mean age of 73). In minutes, median time to CT was 43 (interquartile range [IQR] 28, 83), time to bed request was 62 (IQR 33, 114), and time to admission was 142 (IQR 95, 232). In a multivariable analysis controlling for demographic factors, clinical factors, and disease severity, race/ethnicity had no effect on acute care processes. English language, however, was independently associated with slower times to CT (β = 30.7 min, 95% CI 9.9 to 51.4, p = 0.004) and to bed request (β = 32.8 min, 95% CI 5.5 to 60.0, p = 0.02). Race/ethnicity and English language were not independently associated with worse outcome. Conclusions We found no evidence of racial/ethnic disparities in acute care processes or outcomes in ICH. English as first language, however, was associated with slower care processes.
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Affiliation(s)
- Chun Mei Su
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Andrew Warren
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Cassie Kraus
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Wendy Macias-Konstantopoulos
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Christopher Anderson
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA, 02114, USA.
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Al Riyami H, Hussain A, Warren A, Dhillon SS. Practice Variation in Establishing the Adequacy of Beta-Blockers as an Antiarrhythmic Agent in School-Aged Children and Adolescents. CJC Open 2020; 2:244-248. [PMID: 32695975 PMCID: PMC7365819 DOI: 10.1016/j.cjco.2020.03.008] [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: 01/27/2020] [Accepted: 03/12/2020] [Indexed: 10/25/2022] Open
Abstract
Background Beta-blockers (BBs) are commonly prescribed to manage arrhythmias in children and adolescents without any standardised approach to establish BB adequacy. We invited all Canadian pediatric cardiologists to participate in an anonymous survey to understand practice variation in the assessment of BB adequacy in school-aged children and adolescents with arrhythmia or the potential for arrhythmia. Methods An electronic survey approved by the Institutional Ethics Board was distributed by e-mail to 96 Canadian pediatric cardiologists who had been active in practice for at least 1 year. Incomplete surveys were excluded. Results Forty-one cardiologists (43%) responded to all questions in the survey. Thirteen cardiologists (32%) reported always assessing BB adequacy, 17 (41%) did so only for specific arrhythmias, and 11 (27%) reported never performing such an assessment. A total of 19 cardiologists (46%) and 18 cardiologists (44%) reported using Holter monitoring and exercise testing, respectively, to assess beta receptor blockade adequacy. Thirteen cardiologists (32%) considered BB therapy adequate if Holter demonstrated a 20% decrease in heart rate (HR) from baseline, and 10 respondents (24%) defined adequate BB therapy using exercise testing as a 20% decrease in maximal HR or blood pressure from baseline. Conclusion Despite wide variation in practice, Holter monitoring and exercise testing are commonly used methods to measure the adequacy of BB therapy. There are no standard criteria, but the majority (56%) reported using a 20% decrease in HR or blood pressure from the pretreatment state as a criterion for adequate BB therapy in children and adolescents with arrhythmia or the potential for arrhythmia.
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Affiliation(s)
- Hilal Al Riyami
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Arif Hussain
- Division of Cardiology, Department of Pediatrics, Dalhousie University/Izaak-Walton-Killam, Health Centre, Halifax, Nova Scotia, Canada
| | - Andrew Warren
- Division of Cardiology, Department of Pediatrics, Dalhousie University/Izaak-Walton-Killam, Health Centre, Halifax, Nova Scotia, Canada
| | - Santokh S Dhillon
- Division of Cardiology, Department of Pediatrics, Dalhousie University/Izaak-Walton-Killam, Health Centre, Halifax, Nova Scotia, Canada
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Lennon AM, Buchanan AH, Kinde I, Warren A, Honushefsky A, Cohain AT, Ledbetter DH, Sanfilippo F, Sheridan K, Rosica D, Adonizio CS, Hwang HJ, Lahouel K, Cohen JD, Douville C, Patel AA, Hagmann LN, Rolston DD, Malani N, Zhou S, Bettegowda C, Diehl DL, Urban B, Still CD, Kann L, Woods JI, Salvati ZM, Vadakara J, Leeming R, Bhattacharya P, Walter C, Parker A, Lengauer C, Klein A, Tomasetti C, Fishman EK, Hruban RH, Kinzler KW, Vogelstein B, Papadopoulos N. Feasibility of blood testing combined with PET-CT to screen for cancer and guide intervention. Science 2020; 369:eabb9601. [PMID: 32345712 PMCID: PMC7509949 DOI: 10.1126/science.abb9601] [Citation(s) in RCA: 288] [Impact Index Per Article: 72.0] [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] [Received: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
Cancer treatments are often more successful when the disease is detected early. We evaluated the feasibility and safety of multicancer blood testing coupled with positron emission tomography-computed tomography (PET-CT) imaging to detect cancer in a prospective, interventional study of 10,006 women not previously known to have cancer. Positive blood tests were independently confirmed by a diagnostic PET-CT, which also localized the cancer. Twenty-six cancers were detected by blood testing. Of these, 15 underwent PET-CT imaging and nine (60%) were surgically excised. Twenty-four additional cancers were detected by standard-of-care screening and 46 by neither approach. One percent of participants underwent PET-CT imaging based on false-positive blood tests, and 0.22% underwent a futile invasive diagnostic procedure. These data demonstrate that multicancer blood testing combined with PET-CT can be safely incorporated into routine clinical care, in some cases leading to surgery with intent to cure.
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Affiliation(s)
- Anne Marie Lennon
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Medicine Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | | | - Isaac Kinde
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | - Andrew Warren
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
- Third Rock Ventures, LLC, 29 Newbury Street Boston, MA 02116, USA
| | | | - Ariella T Cohain
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | | | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 100 Woodruff Circle Atlanta, GA 30322, USA
| | | | | | - Christian S Adonizio
- Geisinger, 100 N. Academy Avenue Danville, PA 17822, USA
- Geisinger Cancer Institute, 100 N. Academy Avenue Danville, PA 17822, USA
| | - Hee Jung Hwang
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | - Kamel Lahouel
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Joshua D Cohen
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Christopher Douville
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Aalpen A Patel
- Geisinger, 100 N. Academy Avenue Danville, PA 17822, USA
| | - Leonardo N Hagmann
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | | | - Nirav Malani
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | - Shibin Zhou
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Chetan Bettegowda
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - David L Diehl
- Geisinger, 100 N. Academy Avenue Danville, PA 17822, USA
| | - Bobbi Urban
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | | | - Lisa Kann
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | - Julie I Woods
- Geisinger, 100 N. Academy Avenue Danville, PA 17822, USA
| | | | | | | | | | - Carroll Walter
- Geisinger, 100 N. Academy Avenue Danville, PA 17822, USA
| | - Alex Parker
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
| | - Christoph Lengauer
- Thrive Earlier Detection Corp., 38 Sidney Street Cambridge, MA 02139, USA
- Third Rock Ventures, LLC, 29 Newbury Street Boston, MA 02116, USA
| | - Alison Klein
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street Baltimore, MD 21205, USA
| | - Cristian Tomasetti
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Biostatistics, the Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street Baltimore, MD 21205, USA
| | - Elliot K Fishman
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Radiology, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA
| | - Ralph H Hruban
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Pathology, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Kenneth W Kinzler
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Bert Vogelstein
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Nickolas Papadopoulos
- Department of Oncology, the Sidney Kimmel Cancer Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.
- The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- The Ludwig Center, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
- Department of Pathology, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
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Gnanapragasam V, George A, Warren A, Barrett T, Massie C, Pacey S. Integrating image guided-diagnostics, individualised prognostics and molecular profiling to identify targeted medicine strategies in men with aggressive primary non-metastatic prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jones C, Parker A, Warren A, Vanenkevort EA, Gupta M, Lagerman B, Honushefsky AM, Cohain A, Leeming R, O'Broin-Lennon AM, Buchanan AH. Mammography utilization among women with a negative circulating tumor DNA-based early cancer detection test. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1563] [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: 11/20/2022] Open
Abstract
1563 Background: Blood-based tests may enable minimally invasive detection of multiple cancer types. One such test, CancerSEEK, employs ctDNA and protein biomarkers for this purpose. Test performance has been evaluated in women without a history of cancer in an ongoing prospective study called DETECT-A. The introduction of such blood tests holds promise, and their future utility lies in augmenting, not displacing, standard-of-care (SOC) cancer screening. One important safety concern is that a negative test result could provide false reassurance that discourages adherence to SOC cancer screening. To investigate this possibility, we studied delivery of mammography to DETECT-A participants before and after receipt of a negative CancerSEEK result. Methods: DETECT-A screened 10,000 women aged 65-75 using CancerSEEK. Participants completed a survey about cancer screening at enrollment and at one-year post-enrollment. We analyzed only those participants who had received a negative CancerSEEK result, were insured by Geisinger Health Plan (GHP), and had completed both surveys. GHP claims data were used to identify mammograms performed within one year prior-to and post-enrollment. Overall utilization was determined by combining claims and survey data at enrollment and one-year post-enrollment. In addition to comparing SOC screening rates pre- versus post-testing, we evaluated the impact of primary care physician (PCP) type (Geisinger versus any other institution), as screening reminder mechanisms differ between institutions. Results: Of the 2,241 participants who met analysis criteria, 73.6% (n = 1,650) had a mammogram in the year before enrollment while a significantly great number (79.3%, n = 1,777) did so during the one-year follow-up (χ2(1) = 59.05, p < 0.001). At enrollment, there were 591 participants who had not had a mammogram completed in the previous year, but 404 (68.4%) of them did have a mammogram during the one-year follow-up. The rate of change in mammography utilization did not differ between those who had a Geisinger versus a non-Geisinger PCP (χ2(2) = 1.83, p = 0.40). Conclusions: Participants in a study using a novel blood test for earlier cancer detection had a significantly higher rate of annual mammography after study enrollment and testing. These results indicate that introduction of a minimally invasive ctDNA and protein biomarker-based cancer screening test may engender greater, not lesser, utilization of SOC cancer screening. Further study is required to understand the root causes of increased utilization in this context.
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Affiliation(s)
| | - Alex Parker
- Thrive Earlier Detection Corp., Cambridge, MA
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Sambaturu P, Gupta A, Davidson I, Ravi SS, Vullikanti A, Warren A. Efficient Algorithms for Generating Provably Near-Optimal Cluster Descriptors for Explainability. ACTA ACUST UNITED AC 2020. [DOI: 10.1609/aaai.v34i02.5525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Improving the explainability of the results from machine learning methods has become an important research goal. Here, we study the problem of making clusters more interpretable by extending a recent approach of [Davidson et al., NeurIPS 2018] for constructing succinct representations for clusters. Given a set of objects S, a partition π of S (into clusters), and a universe T of tags such that each element in S is associated with a subset of tags, the goal is to find a representative set of tags for each cluster such that those sets are pairwise-disjoint and the total size of all the representatives is minimized. Since this problem is NP-hard in general, we develop approximation algorithms with provable performance guarantees for the problem. We also show applications to explain clusters from datasets, including clusters of genomic sequences that represent different threat levels.
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Adiga A, Venkatramanan S, Schlitt J, Peddireddy A, Dickerman A, Bura A, Warren A, Klahn BD, Mao C, Xie D, Machi D, Raymond E, Meng F, Barrow G, Mortveit H, Chen J, Walke J, Goldstein J, Wilson ML, Orr M, Porebski P, Telionis PA, Beckman R, Hoops S, Eubank S, Baek YY, Lewis B, Marathe M, Barrett C. Evaluating the impact of international airline suspensions on the early global spread of COVID-19. medRxiv 2020:2020.02.20.20025882. [PMID: 32511466 PMCID: PMC7255786 DOI: 10.1101/2020.02.20.20025882] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Global airline networks play a key role in the global importation of emerging infectious diseases. Detailed information on air traffic between international airports has been demonstrated to be useful in retrospectively validating and prospectively predicting case emergence in other countries. In this paper, we use a well-established metric known as effective distance on the global air traffic data from IATA to quantify risk of emergence for different countries as a consequence of direct importation from China, and compare it against arrival times for the first 24 countries. Using this model trained on official first reports from WHO, we estimate time of arrival (ToA) for all other countries. We then incorporate data on airline suspensions to recompute the effective distance and assess the effect of such cancellations in delaying the estimated arrival time for all other countries. Finally we use the infectious disease vulnerability indices to explain some of the estimated reporting delays.
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Das AS, Gokcal E, Regenhardt RW, Warren A, Schwab K, Viswanathan A, Greenberg SM, Rost NS, Rosand J, Schwamm LH, Gurol E. Abstract WP238: Atrial Fibrillation is Associated With Severe Basal Ganglia Perivascular Spaces. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp238] [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: 11/16/2022]
Abstract
Introduction:
High burdens of basal ganglia-perivascular spaces (BG-PVS) are often attributed to underlying hypertensive cerebral small vessel disease (HTN-CSVD). Although PVS are thought to arise from decreased perivascular drainage related to changes in arterial pulsatility, the contribution of pulsatility changes from nonvalvular atrial fibrillation (NVAF) has not been studied.
Hypothesis:
We hypothesized that NVAF patients have a higher burden of BG-PVS than HTN-CSVD patients, possibly through hemodynamic factors related to NVAF.
Methods:
Through an observational single-center study of consecutive stroke patients, we compared BG-EPVS severity between 136 patients with NVAF-related ischemic stroke (NVAF-IS) and 107 patients with HTN-CSVD-related intracerebral hemorrhage (HTN-ICH) without NVAF. Within the NVAF cohort, we also built multiple regression models to evaluate independent effects of NVAF-related factors on BG-PVS. All multiple regression models were adjusted for age, hypertension, sex, and neuroimaging markers of CSVD (extent of white matter hyperintensities (WMH), presence of lacunes, and cerebral microbleeds).
Results:
Patients with NVAF-IS were older than patients with HTN-ICH (75
+
12 vs. 64
+
13,
p
< 0.0001); however, there was no difference in sex between groups (
p
= 0.6). Severe BG-PVS (defined as > 20 PVS in the BG) were found in 42.6% of NVAF-IS patients vs. 8.4% of HTN-ICH (
p
< 0.0001). Even after multivariate adjustment, the presence of NVAF remained significantly related to BG-PVS (
p
= 0.001). Within the NVAF cohort, CHA2DS2-VASc was associated with the presence of severe BG-PVS (
p
= 0.003) despite controlling for other covariates. When CHA2DS2-VASc was replaced with its individual components in the same regression model, congestive heart failure (CHF,
p
= 0.017), WMH burden (
p
= 0.009), and age (
p
= 0.02) were found to be predictors of severe BG-PVS.
Conclusions:
Severe BG-PVS were significantly more common in NVAF patients compared to HTN-CSVD patients. NVAF-related features (CHA2DS2-VASc score) and CHF were associated with higher burdens of BG-PVS. These findings suggest that NVAF might play a role in the development of BG-PVS, conceivably through hemodynamic factors.
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Affiliation(s)
- Alvin S Das
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
| | - Elif Gokcal
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
| | | | - Andrew Warren
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
| | - Kristin Schwab
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
| | | | | | - Natalia S Rost
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
| | | | - Lee H Schwamm
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
| | - Edip Gurol
- Dept of Neurology, Massachusetts General Hosp, Boston, MA
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Vande Lune PL, Thayer D, Mani N, Warren A, Desai AC, Picus DJ, Gunn AJ. Image-Guided Access for Percutaneous Nephrolithotomy: A Single-Center Experience in 591 Patients. Curr Urol 2019; 12:210-215. [DOI: 10.1159/000499304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/13/2018] [Indexed: 11/19/2022] Open
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El-Naggar W, McMillan D, Hussain A, Armson A, Dodds L, Warren A, Whyte R, Vincer M, Simpson D. 142 The effect of umbilical cord milking on neurodevelopmental outcomes of preterm infants at 36 months of age: a randomized controlled trial. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.141] [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: 11/13/2022] Open
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Abstract
OBJECTIVES To Describe the injury incidence and prevalence during two years of a professional women's T20 cricket tournament. DESIGN Prospective cohort study. METHODS Injuries were recorded prospectively for 68 matches during a professional women's T20 tournament in 2016 and 2017. There were six teams of 15 players. Participants were female, aged between 16-38 years (mean 23.4±4.8). Time-loss and non time-loss incidence and prevalence were calculated for match days, region, skill group, mode and activity at time of injury. RESULTS The greatest incidence occurred in the shoulder (1.8 injuries per 100 match days), lower back (1.7 injuries per 100 match days) and knee (1.7 injuries per 100 match days). The highest time-loss prevalence occurred in hand (1.7%), head/face (0.8%) and thigh (0.6%). All head injuries were concussion. Catching related injuries caused the most time-loss (2.5% prevalence) and throwing related shoulder injury had the highest incidence (2.3 injuries per 100 match days). Gradual onset injuries had the highest overall incidence (7.9 injuries per 100 match days). CONCLUSIONS In elite female T20 cricket, time-loss injuries, particularly impact/traumatic injuries are most likely to occur during fielding, suggesting pitch side support and trauma training is a priority. The high incidence of gradual onset injuries, particularly throwing related shoulder pain, indicates that managing workload and ensuring physical preparedness is vital.
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Affiliation(s)
- A Warren
- England & Wales Cricket Board, National Cricket Performance Centre, Loughborough University, UK.
| | - S Dale
- Science and Medicine Department, England & Wales Cricket Board, UK
| | - S McCaig
- Science and Medicine Department, English Institute of Sport, UK
| | - C Ranson
- Science and Medicine Department, English Institute of Sport, UK
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El-Naggar W, Simpson D, Hussain A, Armson A, Dodds L, Warren A, Whyte R, McMillan D. Cord milking versus immediate clamping in preterm infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104:F145-F150. [PMID: 29903720 DOI: 10.1136/archdischild-2018-314757] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate whether umbilical cord milking (UCM) at birth improves systemic blood flow and short-term outcomes, as compared with immediate cord clamping (ICC). DESIGN Randomised clinical trial. SETTING Single tertiary care centre. PATIENTS Infants born to eligible women presenting in preterm labour between 24 and 31 weeks' gestation. INTERVENTIONS UCM three times at birth or ICC. OUTCOME MEASURES Primary outcome included systemic blood flow as represented by echo-derived superior vena cava(SVC) flow at 4-6 hours after birth. The echocardiographer and interpreter were blinded to the randomisation. Secondary outcomes included cardiac output, neonatal morbidities and mortality. Analysis was by intention to treat. RESULTS A total of 73 infants were randomised (37 to UCM and 36 to ICC). Mean (SD) gestational age was 27 (2) weeks and mean (SD) birth weight was 1040 (283) g. Haemoglobin on admission was higher in the UCM than in the ICC group (16.1 vs 15.0 g/L), p=0.049 (mean difference 1.1, 95% CI 0.003 to 2.2). No statistically significant differences were found between groups in SVC flow at 4-6 hours (88.9±37.8 and 107.3±60.1 mL/kg/min), p=0.13 (mean difference -18.4, 95% CI -41.7 to 5.0 mL/kg/min) or at 10-12 hours of age (102.5±41.8 and 90.6±28.4 mL/kg/min), p=0.17 (mean difference 12.0, 95% CI -4.7 to 28.7 mL/kg/min), cardiac output or neonatal morbidities. CONCLUSIONS Cord milking was not shown to improve functional cardiac outcomes, neonatal morbidity or mortality. More research is needed before routine cord milking can be recommended for very preterm infants. TRIAL REGISTRATION NCT01487187.
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Affiliation(s)
- Walid El-Naggar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Simpson
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Arif Hussain
- Division of Cardiology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony Armson
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Dodds
- Perinatal Epidemiology Research Unit, Department of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Warren
- Division of Cardiology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Whyte
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Douglas McMillan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Fotiadis P, van Veluw S, Salat D, Warren A, Grill S, Schwab K, Zollei L, Viswanathan A, Gurol ME, Greenberg SM. Abstract TMP109: Loss of Gray-White Contrast in Cerebral Amyloid Angiopathy: An in-vivo and Ex-Vivo Exploratory Approach. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tmp109] [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: 11/16/2022]
Abstract
Background/Purpose:
Cerebral Amyloid Angiopathy (CAA) is associated with cortical and white matter atrophy. We hypothesized that changes in neural tissue signal properties could reflect microstructural alterations in diffusion, and hence demyelination.
Methods:
Two cohorts of non-demented CAA patients were examined (3T: 45 CAA patients vs 16 age-matched Healthy Controls [HC]; 1.5T: 66 CAA patients vs 18 matched HC), and dichotomized into moderate (3T: n=19; 1.5T: n=24) and severe CAA.
FreeSurfer
was employed to calculate gray and white (GW) matter signal intensities from a T1-weighted sequence, and their ratio was used to assess GW contrast. Two diffusion markers (fractional anisotropy [FA]; apparent diffusion coefficient [ADC]) were measured via Diffusion Weighted Imaging. In addition, brains of 13 deceased patients with CAA were scanned ex-vivo, sectioned, and stained using Luxol Fast Blue, to assess myelin content. GW ratio was calculated the same way as in the in-vivo cohorts.
Results:
CAA patients displayed loss of GW contrast, expressed by increased GW intensity ratio (3T: 0.802±0.01; 1.5T: 0.757±0.02), when compared to HC (3T: 0.789±0.01,p=0.003; 1.5T: 0.738±0.01,p<0.0001). Patients with severe CAA showcased even lower GW contrast (3T: 0.806±0.01; 1.5T: 0.763±0.02) than patients with moderate CAA (3T: 0.797±0.01,p<0.05; 1.5T: 0.745±0.02,p<0.05) [
Fig
]. Moreover, loss of GW contrast within CAA correlated with lower FA (r=-0.30,p=0.049) and increased ADC (r=0.52,p<0.0001). Within the ex-vivo CAA cohort, loss of GW contrast was highly linked to a decrease in underlying myelin concentration (p=0.0025).
Conclusions:
CAA patients consistently displayed lower GW contrast compared to HC. This loss of contrast became more pronounced with increased disease severity, and correlated with lower anisotropy and increased water diffusivity. Indeed, an ex-vivo CAA cohort revealed that loss of GW contrast corresponded to a decrease in myelin concentration.
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Shearer C, Bosma M, Bergin F, Sargeant J, Warren A. Remediation in Canadian medical residency programs: Established and emerging best practices. Med Teach 2019; 41:28-35. [PMID: 29475389 DOI: 10.1080/0142159x.2018.1436164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Policies to guide remediation in postgraduate medical education exist in all Canadian medical schools. This study examines concordance between these policies and processes, and published "best practices" in remediation. METHOD We conducted a literature review to identify best practices in the area of remediation. We then reviewed remediation policies from all 13 English medical schools in Canada other than our own and conducted interviews with key informants from each institution. Each policy and interview transcript pair was then reviewed for evidence of pre-defined "best practices." Team members also noted additional potential policy or process enablers of successful remediation. RESULTS Most policies and processes aligned with some but not all published best practices. For instance, all participating schools tailored remediation strategies to individual resident needs, and a majority encouraged faculty-student relationships during remediation. Conversely, few required the teaching of goal-setting, strategic planning, self-monitoring, and self-awareness. In addition, we identified avoidance of automatic training extension and the use of an educational review board to support the remediation process as enablers for success. DISCUSSION Remediation policies and practices in Canada align well with published best practices in this area. Based on key informant opinions, flexibility to avoid training extension and use of an educational review board may also support optimal remediation outcomes.
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Affiliation(s)
- Cindy Shearer
- a Post-Graduate Medical Education, Clinical Research Centre , Dalhousie University , Halifax , NS , Canada
| | - Mark Bosma
- b Department of Psychiatry , Dalhousie University , Halifax , NS , Canada
| | - Fiona Bergin
- c Department of Family Medicine , Dalhousie University , Halifax , NS , Canada
| | - Joan Sargeant
- d Division of Medical Education and Continuing Professional Development , Dalhousie University , Halifax , NS , Canada
| | - Andrew Warren
- e Post-Graduate Medical Education , Dalhousie University , Halifax , NS , Canada
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Alford S, Warren A, Frongillo E. ROLE OF FOOD ASSISTANCE IN DIABETES MANAGEMENT AMONG LOW-INCOME SENIORS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1207] [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: 11/14/2022] Open
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Wilker EH, Mostofsky E, Fossa A, Koutrakis P, Warren A, Charidimou A, Mittleman MA, Viswanathan A. Ambient Pollutants and Spontaneous Intracerebral Hemorrhage in Greater Boston. Stroke 2018; 49:2764-2766. [PMID: 30580707 DOI: 10.1161/strokeaha.118.023128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose- Associations between exposures to ambient air pollution and spontaneous intracerebral hemorrhage (ICH) have been inconsistent, and data on stroke subtypes are currently limited. Methods- We obtained information on all cases of deep or lobar hematomas from ICH patients who were admitted to the Massachusetts General Hospital in Boston, MA, between 2006 and 2011. We linked the date of admission with 1- to 7-day moving averages of fine particulate matter (PM2.5), black carbon, nitrogen dioxide, and ozone from area monitors. We conducted time-stratified bidirectional case-crossover analyses to assess associations between pollutants and stroke. We also investigated whether associations differed by hemorrhage location and type. Results- There were 577 cases of ICH (295 deep, 282 lobar). Overall, there was no evidence of elevated ICH risk after increases in PM2.5, black carbon, or nitrogen dioxide in the whole population. However, there was suggestion of heightened risk with higher levels of ozone for averages longer than 1 day although CIs were wide. In models stratified by ICH location, associations with ozone remained positive for patients with lobar (3-day moving average odds ratio, 1.62; 95% CI, 1.18-2.22) but not deep ICH (odds ratio, 0.88; 95% CI, 0.65-1.20). Larger estimates were observed among participants with a probable diagnosis of cerebral amyloid angiopathy (odds ratio, 2.23; 95% CI, 1.25-3.96). Conclusions- Exposure to ozone may be associated with incidence of lobar ICH, especially among those who have confirmed or probable cerebral amyloid angiopathy.
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Affiliation(s)
- Elissa H Wilker
- From the Department of Epidemiology (E.H.W., E.M., M.A.M.), Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.H.W., E.M., M.A.M.)
- Sanofi Genzyme, Cambridge, MA (E.H.W.)
| | - Elizabeth Mostofsky
- From the Department of Epidemiology (E.H.W., E.M., M.A.M.), Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.H.W., E.M., M.A.M.)
| | - Alan Fossa
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (A.F.)
| | - Petros Koutrakis
- Department of Environmental Health (P.K.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew Warren
- Department of Neurology, Massachusetts General Hospital, Boston, MA (A.W., A.C., A.V.)
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, Boston, MA (A.W., A.C., A.V.)
| | - Murray A Mittleman
- From the Department of Epidemiology (E.H.W., E.M., M.A.M.), Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (E.H.W., E.M., M.A.M.)
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Boston, MA (A.W., A.C., A.V.)
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Sargeant J, Lockyer JM, Mann K, Armson H, Warren A, Zetkulic M, Soklaridis S, Könings KD, Ross K, Silver I, Holmboe E, Shearer C, Boudreau M. The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? Acad Med 2018; 93:1055-1063. [PMID: 29342008 DOI: 10.1097/acm.0000000000002131] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The authors previously developed and tested a reflective model for facilitating performance feedback for practice improvement, the R2C2 model. It consists of four phases: relationship building, exploring reactions, exploring content, and coaching. This research studied the use and effectiveness of the model across different residency programs and the factors that influenced its effectiveness and use. METHOD From July 2014-October 2016, case study methodology was used to study R2C2 model use and the influence of context on use within and across five cases. Five residency programs (family medicine, psychiatry, internal medicine, surgery, and anesthesia) from three countries (Canada, the United States, and the Netherlands) were recruited. Data collection included audiotaped site assessment interviews, feedback sessions, and debriefing interviews with residents and supervisors, and completed learning change plans (LCPs). Content, thematic, template, and cross-case analysis were conducted. RESULTS An average of nine resident-supervisor dyads per site were recruited. The R2C2 feedback model, used with an LCP, was reported to be effective in engaging residents in a reflective, goal-oriented discussion about performance data, supporting coaching, and enabling collaborative development of a change plan. Use varied across cases, influenced by six general factors: supervisor characteristics, resident characteristics, qualities of the resident-supervisor relationship, assessment approaches, program culture and context, and supports provided by the authors. CONCLUSIONS The R2C2 model was reported to be effective in fostering a productive, reflective feedback conversation focused on resident development and in facilitating collaborative development of a change plan. Factors contributing to successful use were identified.
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Affiliation(s)
- Joan Sargeant
- J. Sargeant is professor, Continuing Professional Development Program and Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. J.M. Lockyer is professor, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. K. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. H. Armson is assistant dean, Continuing Professional Development, and associate professor, Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. A. Warren is associate professor, Department of Pediatrics, and associate dean, Postgraduate Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. M. Zetkulic is assistant professor, Seton Hall School of Medicine, Director of Medical Education, Department of Medicine, Hackensack University Hospital, Hackensack, New Jersey. S. Soklaridis is assistant professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. K.D. Könings is associate professor, Department of Educational Development & Research and School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. K. Ross is research associate, Department of Evaluation, Research and Development, American Board of Internal Medicine, Philadelphia, Pennsylvania. I. Silver is vice president of education, Centre for Addiction and Mental Health, and professor, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. E. Holmboe is senior vice president of milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, adjunct professor of medicine, Yale University, New Haven, Connecticut, and adjunct professor, Uniformed Services University of the Health Sciences, Bethesda, Maryland. C. Shearer is evaluation specialist, Postgraduate Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada. M. Boudreau is evaluation specialist, Continuing Professional Development, Dalhousie University, Halifax, Nova Scotia, Canada
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Luther J, Gala MK, Borren N, Masia R, Goodman RP, Moeller IH, DiGiacomo E, Ehrlich A, Warren A, Yarmush ML, Ananthakrishnan A, Corey K, Kaplan LM, Bhatia S, Chung RT, Patel SJ. Hepatic connexin 32 associates with nonalcoholic fatty liver disease severity. Hepatol Commun 2018; 2:786-797. [PMID: 30202815 PMCID: PMC6123534 DOI: 10.1002/hep4.1179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 12/17/2022] Open
Abstract
Emerging data highlight the critical role for the innate immune system in the progression of nonalcoholic fatty liver disease (NAFLD). Connexin 32 (Cx32), the primary liver gap junction protein, is capable of modulating hepatic innate immune responses and has been studied in dietary animal models of steatohepatitis. In this work, we sought to determine the association of hepatic Cx32 with the stages of human NAFLD in a histologically characterized cohort of 362 patients with NAFLD. We also studied the hepatic expression of the genes and proteins known to interact with Cx32 (known as the connexome) in patients with NAFLD. Last, we used three independent dietary mouse models of nonalcoholic steatohepatitis to investigate the role of Cx32 in the development of steatohepatitis and fibrosis. In a univariate analysis, we found that Cx32 hepatic expression associates with each component of the NAFLD activity score and fibrosis severity. Multivariate analysis revealed that Cx32 expression most closely associated with the NAFLD activity score and fibrosis compared to known risk factors for the disease. Furthermore, by analyzing the connexome, we identified novel genes related to Cx32 that associate with NAFLD progression. Finally, we demonstrated that Cx32 deficiency protects against liver injury, inflammation, and fibrosis in three murine models of nonalcoholic steatohepatitis by limiting initial diet-induced hepatoxicity and subsequent increases in intestinal permeability. Conclusion: Hepatic expression of Cx32 strongly associates with steatohepatitis and fibrosis in patients with NAFLD. We also identify novel genes associated with NAFLD and suggest that Cx32 plays a role in promoting NAFLD development. (Hepatology Communications 2018;2:786-797).
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Affiliation(s)
- Jay Luther
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Clinical and Translational Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Obesity, Metabolism, and Nutrition InstituteMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Manish K. Gala
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Clinical and Translational Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Nynke Borren
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Ricard Masia
- Pathology Unit, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Russell P. Goodman
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Ida Hatoum Moeller
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Obesity, Metabolism, and Nutrition InstituteMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Erik DiGiacomo
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Alyssa Ehrlich
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | | | - Martin L. Yarmush
- Center for Engineering in Medicine, Shriner's HospitalHarvard Medical SchoolBostonMA
| | - Ashwin Ananthakrishnan
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Kathleen Corey
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Lee M. Kaplan
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
- Obesity, Metabolism, and Nutrition InstituteMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | | | - Raymond T. Chung
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Suraj J. Patel
- Gastrointestinal Unit, Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
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Busing N, Rosenfield J, Rungta K, Raegele M, Warren A, Wright B, Walton M, Oandasan I, Sanfilippo A, Saxena A. Smoothing the Transition Points in Canadian Medical Education. Acad Med 2018; 93:715-721. [PMID: 29166354 DOI: 10.1097/acm.0000000000002072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In 2010, the Association of Faculties of Medicine of Canada, Collège des médecins du Québec, College of Family Physicians of Canada, and Royal College of Physicians and Surgeons of Canada launched the Future of Medical Education in Canada Postgraduate (FMEC PG) Project to examine postgraduate medical education (PGME) in Canada and make recommendations for improvement. One recommendation that emerged concerns the transitions learners experience across the undergraduate medical education-PGME-practice continuum. The FMEC PG, using a thorough process, developed projects to address these often-tumultuous transitions for the learner, aiming to provide support, tools, and standards for the learner's educational journey.With leadership by two senior academics and the Transitions Implementation Committee, three working groups helped implement these transitions projects, which addressed (1) the medical-school-to-residency transition, (2) career planning and the residency matching process, and (3) the residency-to-practice transition. Work products include the development of a learner education handover protocol and the establishment of pan-Canadian entrustable professional activities to be used nationally to help define expectations for new graduates entering residencies. A postmatch boot camp tool and a simulated night on-call tool were developed and are available to all medical schools. National standards are being promoted for career services counseling and best practices in residency selection. A practice management curriculum framework, mentorship resources, resiliency training for graduating residents, and the entry-level disciplines of residency are also being explored.Ultimately, with system-wide change and better integration of all players, transitions for Canada's learners will greatly improve.
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Affiliation(s)
- Nick Busing
- N. Busing was project lead, Future of Medical Education in Canada Postgraduate Project, and is former president and CEO, Association of Faculties of Medicine of Canada, Ottawa, Ontario, Canada. J. Rosenfield was co-chair, Future of Medical Education in Canada Postgraduate Project Transitions Implementation Committee, and is professor of paediatrics and former vice dean, MD program, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada. K. Rungta was co-chair, Future of Medical Education in Canada Postgraduate Project Transitions Implementation Committee, and is clinical professor of psychiatry, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. M. Raegele was project coordinator, Future of Medical Education in Canada Postgraduate Project Implementation Project, and works at the Association of Faculties of Medicine of Canada, Ottawa, Ontario, Canada. A. Warren is associate dean for postgraduate medical education, Dalhousie University Faculty of Medicine, and a pediatric cardiologist, Halifax, Nova Scotia, Canada. B. Wright is regional associate dean, Island Medical Program, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada, and head, Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada. M. Walton is associate dean of faculty affairs and former assistant dean of postgraduate medical education, McMaster University Faculty of Health Sciences, and a pediatric surgeon, Hamilton, Ontario, Canada. I. Oandasan is director of education, College of Family Physicians of Canada, Mississauga, Ontario, Canada, and a practicing family physician, Toronto, Ontario, Canada. A. Sanfilippo is associate dean of undergraduate medical education and professor of medicine, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada. A. Saxena is associate dean of postgraduate medical education, College of Medicine, University of Saskatchewan, and a practicing hematopathologist, Saskatoon, Saskatchewan, Canada
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