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Brobert G, Ruigomez A, Schink T, Voss A, Herings R, Smits E, Swart KMA, Friberg L, Balabanova Y, Tarenz C, Suzart-Woischnik K, Soriano-Gabarró M, Vora P, Homering M, Dyszynski T, Nagel G, Amaya P, García Rodríguez LA. Challenges and lessons learned from a long-term postauthorisation safety study programme of rivaroxaban in Europe. BMJ Open 2024; 14:e081348. [PMID: 38531587 PMCID: PMC10966716 DOI: 10.1136/bmjopen-2023-081348] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES To describe opportunities and challenges experienced from the four pharmacoepidemiological database studies included in the rivaroxaban post authorisation safety study (PASS) programme and propose ways to maximise the value of population-based observational research when addressing regulatory requirements. DESIGN PASS programme of rivaroxaban carried out as part of the regulatory postapproval commitment to the European Medicines Agency. SETTING Clinical practice in Germany, the Netherlands, Sweden and the UK (electronic health records)-undertaken by pharmacoepidemiology research teams using country-specific databases with different coding structures. PARTICIPANTS 355 152 patients prescribed rivaroxaban and 338 199 patients prescribed vitamin K antagonists. RESULTS Two major challenges that were encountered throughout the lengthy PASS programme were related to: (1) finalising country-tailored study designs before the extent of rivaroxaban uptake was known, and (2) new research questions that arose during the programme (eg, those relating to an evolving prescribing landscape). RECOMMENDATIONS We advocate the following strategies to help address these major challenges (should they arise in any future PASS): conducting studies based on a common data model that enable the same analytical tools to be applied when using different databases; maintaining early, clear, continuous communication with the regulator (including discussing the potential benefit of studying drug use as a precursor to planning a safety study); consideration of adaptive designs whenever uncertainty exists and following an initial period of data collection; and setting milestones for the review of study objectives.
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Affiliation(s)
| | - Ana Ruigomez
- Spanish Centre for Pharmacoepidemiologic Research, Madrid, Spain
| | - Tania Schink
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS GmbH, Bremen, Germany
| | - Annemarie Voss
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS GmbH, Bremen, Germany
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
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Ruigómez A, Schink T, Voss A, Herings RMC, Smits E, Swart-Polinder K, Balabanova Y, Brobert G, Suzart-Woischnik K, García Rodríguez LA. Safety profile of rivaroxaban in first-time users treated for venous thromboembolism in four European countries. PLoS One 2024; 19:e0298596. [PMID: 38451960 PMCID: PMC10919665 DOI: 10.1371/journal.pone.0298596] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 07/05/2023] [Accepted: 01/28/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The European rivaroxaban post-authorization safety study evaluated bleeding risk among patients initiated on rivaroxaban or vitamin K antagonists for the treatment and secondary prevention of venous thromboembolism in routine clinical practice. METHODS Cohorts were created using electronic healthcare databases from the UK, the Netherlands, Germany and Sweden. Patients with a first prescription of rivaroxaban or vitamin K antagonist during the period from December 2011 (in the UK, January 2012) to December 2017 (in Germany, December 2016) for venous thromboembolism indication, with no record of atrial fibrillation or recent cancer history, were observed until the occurrence of each safety outcome (hospitalization for intracranial, gastrointestinal, urogenital or other bleeding), death or study end (December 2018; in Germany, December 2017). Crude incidence rates of each outcome per 100 person-years were computed. RESULTS Overall, 44 737 rivaroxaban and 45 842 vitamin K antagonist patients were enrolled, mean age, 59.9-63.8 years. Incidence rates were similar between rivaroxaban and vitamin K antagonist users with some exceptions, including higher incidence rates for gastrointestinal bleeding in rivaroxaban users than in vitamin K antagonist users. Among rivaroxaban users, mortality and bleeding risk generally increased with age, renal impairment and diabetes. CONCLUSIONS This study provides further data from routine clinical practice that broadly support safety profile of rivaroxaban for VTE indication and complement findings from previous randomized clinical trials.
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Affiliation(s)
- Ana Ruigómez
- Spanish Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | | | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
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Tan EH, Robinson DE, Jödicke AM, Mosseveld M, Bødkergaard K, Reyes C, Moayyeri A, Voss A, Marconi E, Lapi F, Reinold J, Verhamme KMC, Pedersen L, Braitmaier M, de Wilde M, Ruiz MF, Aragón M, Bosco-Levy P, Lassalle R, Prieto-Alhambra D, Sanchez-Santos MT. Drug utilization analysis of osteoporosis medications in seven European electronic health databases. Osteoporos Int 2023; 34:1771-1781. [PMID: 37436441 PMCID: PMC10511353 DOI: 10.1007/s00198-023-06837-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
We studied the characteristics of patients prescribed osteoporosis medication and patterns of use in European databases. Patients were mostly female, older, had hypertension. There was suboptimal persistence particularly for oral medications. Our findings would be useful to healthcare providers to focus their resources on improving persistence to specific osteoporosis treatments. PURPOSE To characterise the patients prescribed osteoporosis therapy and describe the drug utilization patterns. METHODS We investigated the treatment patterns of bisphosphonates, denosumab, teriparatide, and selective estrogen receptor modulators (SERMs) in seven European databases in the United Kingdom, Italy, the Netherlands, Denmark, Spain, and Germany. In this cohort study, we included adults aged ≥ 18 years, with ≥ 1 year of registration in the respective databases, who were new users of the osteoporosis medications. The study period was between 01 January 2018 to 31 January 2022. RESULTS Overall, patients were most commonly initiated on alendronate. Persistence decreased over time across all medications and databases, ranging from 52-73% at 6 months to 29-53% at 12 months for alendronate. For other oral bisphosphonates, the proportion of persistent users was 50-66% at 6 months and decreased to 30-44% at 12 months. For SERMs, the proportion of persistent users at 6 months was 40-73% and decreased to 25-59% at 12 months. For parenteral treatment groups, the proportions of persistence with denosumab were 50-85% (6 month), 30-63% (12 month) and with teriparatide 40-75% (6 month) decreasing to 21-54% (12 month). Switching occurred most frequently in the alendronate group (2.8-5.8%) and in the teriparatide group (7.1-14%). Switching typically occurred in the first 6 months and decreased over time. Patients in the alendronate group most often switched to other oral or intravenous bisphosphonates and denosumab. CONCLUSION Our results show suboptimal persistence to medications that varied across different databases and treatment switching was relatively rare.
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Affiliation(s)
- Eng Hooi Tan
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Danielle E Robinson
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Annika M Jödicke
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Mees Mosseveld
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Katrine Bødkergaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Carlen Reyes
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Jonas Reinold
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Malte Braitmaier
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Marcel de Wilde
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marc Far Ruiz
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - María Aragón
- Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain
| | - Pauline Bosco-Levy
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Regis Lassalle
- Univ. Bordeaux, INSERM CIC-P1401, Bordeaux PharmacoEpi, Bordeaux, France
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Maria T Sanchez-Santos
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
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Voss A, Kollhorst B, Platzbecker K, Amann U, Haug U. Risk Profiles of New Users of Oral Anticoagulants Between 2011 and 2019 in Germany. Clin Epidemiol 2023; 15:827-837. [PMID: 37483262 PMCID: PMC10362862 DOI: 10.2147/clep.s405585] [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: 02/14/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose Over the last decade, the use of direct oral anticoagulants (DOACs) has strongly increased. We aimed to describe and compare risk profiles including potential changes over time among persons with non-valvular atrial fibrillation initiating treatment with different DOACs or phenprocoumon (vitamin K antagonist) between 2011 and 2019 in Germany. Patients and Methods Using the German Pharmacoepidemiological Research Database (GePaRD; claims data of ~20% of the German population), we identified persons with a first dispensing of phenprocoumon or a DOAC and a diagnosis of non-valvular atrial fibrillation between August 2011 and December 2019. We described the morbidity of included patients prior to treatment initiation, stratified by year of treatment initiation. Results Overall, we included 448,028 new users (phenprocoumon: N = 118,117, rivaroxaban: N = 130,997, apixaban: N = 130,300, edoxaban: N = 38,128, dabigatran: N = 30,486). Comparing new DOAC users in 2019, the proportion with prior ischemic stroke was highest for dabigatran (17%) and lowest for rivaroxaban (8%). The proportion with prior major bleeding was also highest for dabigatran (25%) and lowest for edoxaban (20%). New users of apixaban were oldest and, eg, showed the highest prevalence of congestive heart failure. Changes over time were most pronounced for phenprocoumon. For example, among persons initiating phenprocoumon in 2012 vs 2019, the proportion with prior major bleeding increased from 18% to 35%; the proportion with renal disease increased from 20% to 36% and the proportion with liver disease from 18% to 24%. Conclusion This study demonstrated differences in risk profiles between new users of different oral anticoagulants and substantial changes over time among new phenprocoumon users. These differences have to be considered in head-to-head comparisons of these drugs based on observational data, especially regarding potential unmeasured confounding.
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Affiliation(s)
- Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Katharina Platzbecker
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Ute Amann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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Platzbecker K, Müller-Fielitz H, Foraita R, Koepp MJ, Voss A, Pflock R, Linder R, Pigeot I, Schink T, Schwaninger M. In atrial fibrillation epilepsy risk differs between oral anticoagulants: active comparator, nested case-control study. Europace 2023; 25:euad087. [PMID: 37013704 PMCID: PMC10228540 DOI: 10.1093/europace/euad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is a risk factor for brain infarction, which can lead to epilepsy. We aimed to investigate whether treatment of AF with direct oral anticoagulants (DOACs) affects the risk of epilepsy in comparison to treatment with the vitamin K antagonist phenprocoumon (PPC). METHODS AND RESULTS We performed an active comparator, nested case-control study based on the German Pharmacoepidemiological Research Database that includes claims data from statutory health insurance providers of about 25 million persons since 2004. In 2011-17, 227 707 AF patients initiated treatment with a DOAC or PPC, of which 1828 cases developed epilepsy on current treatment with an oral anticoagulant. They were matched to 19 084 controls without epilepsy. Patients with DOAC treatment for AF had an overall higher risk of epilepsy with an odds ratio of 1.39, 95% CI (1.24; 1.55) compared to current PPC treatment. Cases had higher baseline CHA2DS2-VASc scores and more frequently a history of stroke than controls. After excluding patients with ischaemic stroke prior to the diagnosis of epilepsy, the risk of epilepsy was still higher on DOACs than on PPC. In contrast, within a cohort of patients with venous thromboembolism, the risk of epilepsy on treatment with DOACs was less elevated [adjusted odds ratio 1.15, 95% CI (0.98; 1.34)]. CONCLUSION In patients with AF initiating oral anticoagulation, treatment with a DOAC was associated with an increased risk of epilepsy compared to the vitamin K antagonist PPC. Covert brain infarction may explain the observed elevated risk of epilepsy.
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Affiliation(s)
- Katharina Platzbecker
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Helge Müller-Fielitz
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, Queen Square, Box 29, London WC1N 3BG, United Kingdom
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - René Pflock
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Roland Linder
- Techniker Krankenkasse, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bibliothekstraße 5, 28334 Bremen, Germany
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel, Germany
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Voss A, Smits E, Swart KMA, Balabanova Y, Brobert G, Suzart-Woischnik K, Herings RMC, Schink T, Haug U. Time Trends in Patient Characteristics of New Rivaroxaban Users with Atrial Fibrillation in Germany and the Netherlands. Drugs Real World Outcomes 2023:10.1007/s40801-022-00350-2. [PMID: 36725812 DOI: 10.1007/s40801-022-00350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Use of the direct oral anticoagulant rivaroxaban has strongly increased in Europe since its market approval for non-valvular atrial fibrillation in 2011. Patients characteristics of rivaroxaban initiators may have changed over time but this has not been investigated so far. OBJECTIVE We aimed to describe time trends of patient baseline characteristics among new rivaroxaban users with non-valvular atrial fibrillation from 2011 to 2016/17 in two European countries. METHODS We used data from Germany (German Pharmacoepidemiological Research Database) and the Netherlands (PHARMO Database Network). We included new rivaroxaban users with (i) a first dispensing between 2011 and 2016/17, (ii) ≥ 2 years of age, and (iii) a diagnosis of non-valvular atrial fibrillation and described their baseline medication and comorbidity prior to starting rivaroxaban stratified by year of inclusion. RESULTS Overall, 130,652 new rivaroxaban users were included during the study period (Germany: N = 127,743, the Netherlands: N = 2909). The sex ratio and median age remained relatively stable over time. The proportion of patients without prior use of oral anticoagulants before initiation of rivaroxaban increased in both countries between 2011 and 2016/17 (Germany: from 51 to 76%, the Netherlands: from 57 to 85%). In Germany, we observed a relative decrease by 27% in the proportion of new rivaroxaban users with a history of ischemic stroke and by 18% in the proportion with a transient ischemic attack at baseline. No such a pattern was observed in the Netherlands. The proportion of patients with heart failure at baseline showed a three-fold increase in the Netherlands, while there was a relative decrease by 12% in Germany. CONCLUSIONS Patient characteristics of new rivaroxaban users with non-valvular atrial fibrillation changed between 2011 and 2016/17, but changes differed between countries. These patterns have methodological implications. They have to be considered in the interpretation of observational studies comparing effectiveness and safety of oral anticoagulants, especially regarding potential bias due to unmeasured confounding.
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Affiliation(s)
- Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany. .,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany.
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García Rodríguez LA, Ruigómez A, Schink T, Voss A, Smits E, Swart KMA, Balabanova Y, Suzart-Woischnik K, Brobert G, Herings RMC. Safety and effectiveness of rivaroxaban for prevention of stroke in patients with nonvalvular atrial fibrillation: analysis of routine clinical data from four countries. Expert Opin Drug Saf 2023; 22:493-500. [PMID: 36795067 DOI: 10.1080/14740338.2023.2181334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The safety and effectiveness of rivaroxaban versus vitamin K antagonists (standard of care [SOC]) for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) was evaluated in Europe. RESEARCH DESIGN AND METHODS Observational studies were conducted in the UK, the Netherlands, Germany, and Sweden. Primary safety outcomes were hospitalization for intracranial hemorrhage, gastrointestinal bleeding, or urogenital bleeding among new users of rivaroxaban and SOC with NVAF; outcomes were analyzed using cohort (rivaroxaban or SOC use) and nested case-control designs (current vs nonuse). Statistical analyses comparing rivaroxaban and SOC cohorts were not performed. RESULTS Overall, 162,919 rivaroxaban users and 177,758 SOC users were identified. In the cohort analysis, incidence ranges for rivaroxaban users were 0.25-0.63 events per 100 person-years for intracranial bleeding, 0.49-1.72 for gastrointestinal bleeding, and 0.27-0.54 for urogenital bleeding. Corresponding ranges for SOC users were 0.30-0.80, 0.30-1.42, and 0.24-0.42, respectively. In the nested case-control analysis, current SOC use generally presented a greater risk of bleeding outcomes than nonuse. Rivaroxaban use (vs nonuse) was associated with a higher risk of gastrointestinal bleeding, but a similar risk of intracranial or urogenital bleeding, in most countries. Ischemic stroke incidence ranged from 0.31 to 1.52 events per 100 person-years for rivaroxaban users. CONCLUSIONS Incidences of intracranial bleeding were generally lower with rivaroxaban than with SOC, whereas incidences of gastrointestinal and urogenital bleeding were generally higher. The safety profile of rivaroxaban for NVAF in routine practice is consistent with findings from randomized controlled trials and other studies.
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Affiliation(s)
| | - Ana Ruigómez
- Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Yanina Balabanova
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
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Platzbecker K, Voss A, Reinold J, Elbrecht A, Biewener W, Prieto-Alhambra D, Jödicke AM, Schink T. Validation of Algorithms to Identify Acute Myocardial Infarction, Stroke, and Cardiovascular Death in German Health Insurance Data. Clin Epidemiol 2022; 14:1351-1361. [PMID: 36387925 PMCID: PMC9661914 DOI: 10.2147/clep.s380314] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Validation of outcomes allows measurement of and correction for potential misclassification and targeted adjustment of algorithms for case definition. The purpose of our study was to validate algorithms for identifying cases of acute myocardial infarction (AMI), stroke, and cardiovascular (CV) death using patient profiles, ie, chronological tabular summaries of relevant available information on a patient, extracted from pseudonymized German claims data. Patients and Methods Based on the German Pharmacoepidemiological Research Database (GePaRD), 250 cases were randomly selected (50% males) for each outcome between 2016 and 2017 based on the inclusion criteria age ≥50 years and continuous insurance ≥1 year and applying the following algorithms: hospitalization with a main diagnosis of AMI (ICD-10-GM codes I21.- and I22.-) or stroke (I63, I61, I64) or death with a hospitalization in the 60 days before with a main diagnosis of CV disease. Patient profiles were built including (i) age and sex, (ii) hospitalizations incl. diagnoses, procedures, discharge reasons, (iii) outpatient diagnoses incl. diagnostic certainty, physician specialty, (iv) outpatient encounters, and (v) outpatient dispensings. Using adjudication criteria based on clinical guidelines and risk factors, two trained physicians independently classified cases as “certain”, “probable”, “unlikely” or “not assessable”. Positive predictive values (PPVs) were calculated as percentage of confirmed cases among all assessable cases. Results For AMI, the overall PPV was 97.6% [95% confidence interval 94.8–99.1]. The PPV for any stroke was 94.8% [91.3–97.2] and higher for ischemic (98.3% [95.0–99.6]) than for hemorrhagic stroke (86.5% [76.5–93.3]). The PPV for CV death was 79.9% [74.4–84.4]. It increased to 91.7% [87.2–95.0] after excluding 32 cases with data insufficient for a decision. Conclusion Algorithms based on hospital diagnoses can identify AMI, stroke, and CV death from German claims data with high PPV. This was the first study to show that German claims data contain information suitable for outcome validation.
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Affiliation(s)
- Katharina Platzbecker
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jonas Reinold
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Anne Elbrecht
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Wolfgang Biewener
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Annika M Jödicke
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Correspondence: Tania Schink, Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen, 28359, Germany, Tel +4942121856865, Email
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Andersen M, Stockmarr A, Leffers H, Troldborg A, Voss A, Kristensen S, Deleuran B, Dreyer L, Johnsen L, Colic A, Jacobsen S. POS0761 TIME-DEPENDENT ANALYSES OF CLINICAL MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS IDENTIFY PATIENTS AT HIGH RISK OF INCIDENT PROTEINURIA. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNephritis (LN) in systemic lupus erythematosus (SLE) is still a major determinant of poor prognosis[1].The vast majority of LN occurs in proximity to the SLE diagnosis[2]. Identification of individuals at high risk, especially early onset SLE, is therefore warranted. Inclusion of risk factors prior to the SLE diagnosis may thus be of importance to enable sufficient risk factor profiling. SLE-patients seem to cluster according to clinical and serological phenotypes suggesting distinct disease trajectories[3-5].ObjectivesTo determine if incident proteinuria associated with the debut age of non-renal SLE characteristics.MethodsData of SLE patients from six Danish centers were obtained from the Danbio-database from 2017 – 2020. The occurrence and timing of proteinuria was compared with first time onset of any non-renal manifestations as defined by the 1997 American College of Rheumatology Classification Criteria. Cox-regression models were used to identify risk factors for incident proteinuria. Time from first occurring non-renal manifestation to incident proteinuria or censoring defined time at risk. Covariates were eliminated if p >0.01 in a ‘backwards’ manner. After the model reduction process p-values <0.05 were considered statistically significant.Results586 SLE patients, mainly white (94%) women (88%), mean age at inclusion of 34.6 years (standard deviation, SD = 0.6 years) and observed for a mean of 14.9 years (SD =0.5 years), were recruited. The cumulative prevalence of proteinuria was 40%. Male gender hazard ratio, HR = 1.35 (range 0.77-2.35), p=0.009, lymphopenia HR = 1.77 (range 1.24-2.52), p=0.005 were associated with incident proteinuria. In contrast, patients with discoid rash had lower risk of incident proteinuria HR 0.42 (range 0.21-0.83), p=0.01. Male patients with lymphopenia had the highest risk of proteinuria with a one-, 5- and 10-year risk of proteinuria ranging from 9-27%, 34-75% and 51-89 %, depending on the age at presentation (debut at 20, 30, 40 or 50 years). The corresponding risk-profiles for women with lymphopenia were 3-9%, 8-34% and 12-58%, respectively, as illustrated in Figure 1.ConclusionThe occurrences of lymphopenia and discoid rash were oppositely associated with risk of incident proteinuria and the risk effects varied according to gender and patient age at onset of these manifestations. Thus, the risk of proteinuria may not be constant but could vary according to presentation of non-renal manifestations that may call for a differentiated clinical follow-up. Based on these findings, we suggest that the debut age of known prognostic factors, even prior to the SLE diagnosis should be considered when designing prognostic statistical models.References[1]Faurschou, M., et al., Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol, 2006. 33(8): p. 1563-9.[2]Hanly, J.G., et al., The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology (Oxford), 2016. 55(2): p. 252-62.[3]Diaz-Gallo, L.M., et al., Four Systemic Lupus Erythematosus Subgroups, Defined by Autoantibodies Status, Differ Regarding HLA-DRB1 Genotype Associations and Immunological and Clinical Manifestations. ACR Open Rheumatol, 2022. 4(1): p. 27-39.[4]Jacobsen, S., et al., A multicentre study of 513 Danish patients with systemic lupus erythematosus. II. Disease mortality and clinical factors of prognostic value. Clin Rheumatol, 1998. 17(6): p. 478-84.[5]Leffers, H.C.B., et al., Smoking associates with distinct clinical phenotypes in patients with systemic lupus erythematosus: a nationwide Danish cross-sectional study. Lupus Sci Med, 2021. 8(1).Disclosure of InterestsMartin Andersen Employee of: Novo Nordisk A/S: 2010-2014, Anders Stockmarr: None declared, Henrik Leffers: None declared, Anne Troldborg: None declared, Anne Voss: None declared, Salome Kristensen: None declared, Bent Deleuran: None declared, Lene Dreyer Speakers bureau: Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: Grant from BMS outside the present work, Laura Johnsen: None declared, Ada Colic: None declared, Søren Jacobsen: None declared
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Leffers H, Westergaard D, Saevarsdottir S, Jonsdottir I, Pedersen OB, Troldborg A, Voss A, Kristensen S, Lindhardsen J, Kumar P, Linauskas A, Juul L, Steen Krogh N, Deleuran B, Dreyer L, Schwinn M, Thørner LW, Hindhede L, Erikstrup C, Ullum H, Brunak S, Stefansson K, Banasik K, Jacobsen S. AB0006 ESTABLISHED RISK LOCI FOR SYSTEMIC LUPUS ERYTHEMATOSUS AT NCF2, STAT4, TNPO3, IRF5 AND ITGAM ASSOCIATE WITH DISTINCT CLINICAL MANIFESTATIONS: A DANISH GENOME-WIDE ASSOCIATION STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE) has been associated with more than 100 genetic loci. This parallels positively to the clinical diversity that is reflected by the classification of SLE.ObjectivesWe aimed to investigate associations between disease manifestations of SLE and risk gene variants relevant to Danish subjects of European ancestry.MethodsWe included 427 SLE patients of European ancestry similar to previous reports.[1] We also included 89,699 controls from the Danish Blood Donor Study Genomic Cohort. SLE risk loci in this population were identified by genome-wide association methodology and hereafter correlated to cumulative occurrence of SLE classification items.ResultsFourteen variants mapped to the following genes: NCF2, STAT4, TNPO3/TPI1P2, IRF5, and ITGAM, were significantly associated (p<5E-8) with SLE.The five lead variants were associated (p<0.05) with the following manifestations; NCF2: proteinuria and anti-phospholipid antibodies, STAT4: arthritis, serositis, neurologic disorder, lymphopenia, and anti-Smith antibodies, IRF5: seizures and proteinuria, TNPO3: proteinuria, and ITGAM: photosensitivity (Table 2).ConclusionOur findings support the future use of select, relevant genetic markers in predicting various SLE phenotypes.References[1]Leffers HCB, Troldborg A, Voss A, et al. Smoking associates with distinct clinical phenotypes in patients with systemic lupus erythematosus: a nationwide Danish cross-sectional study. Lupus Sci Med 2021;8(1).Table 1.Associations between five SLE risk loci and specific disease manifestations in 427 Danish patients with SLE*.NCF2STAT4IRF5TNPO3ITGAMrs17849502_Trs7574865_Trs4728142_Ars13239597_Ars11860650_TN (%)Malar rash233 (55%)1.28 (0.84-1.96)0.83 (0.62-1.11)1.01 (0.74-1.38)1.44 (0.97-2.12)1.14 (0.80-1.61)Discoid rash46 (11%)1.49 (0.81-2.73)0.90 (0.56-1.45)1.01 (0.62-1.66)1.16 (0.63-2.12)0.76 (0.42-1.41)Photosensitivity219 (51%)0.96 (0.63-1.46)1.09 (0.81-1.47)0.98 (0.71-1.34)0.84 (0.57-1.25)0.67 (0.47-0.97)Oral ulcers132 (31%)0.96 (0.61-1.50)0.90 (0.65-1.23)0.83 (0.60-1.16)1.30 (0.87-1.96)1.43 (0.99-2.05)Non-erosive Arthritis342 (80%)0.84 (0.52-1.37)1.49 (1.02-2.18)0.93 (0.63-1.36)1.04 (0.64-1.68)1.16 (0.74-1.80)Serositis-Pleuritis124 (29%)0.63 (0.38-1.05)1.38 (1.01-1.89)1.22 (0.87-1.72)0.85 (0.56-1.29)0.84 (0.57-1.24)-Pericarditis72 (17%)0.75 (0.41-1.40)1.35 (0.93-1.96)1.05 (0.70-1.58)1.15 (0.70-1.89)1.09 (0.70-1.72)Persistent proteinuria158 (37%)1.63 (1.07-2.49)1.08 (0.80-1.46)0.68 (0.49-0.94)1.74 (1.16-2.61)1.09 (0.76-1.57)Neurologic disorder-Seizures23 (5%)1.58 (0.75-3.35)1.49 (0.80-2.76)2.10 (1.04-4.25)0.61 (0.26-1.44)0.93 (0.42-2.06)-Psychosis8 (2%)0.76 (0.097-5.87)2.77 (0.94-8.15)0.35 (0.10-1.23)0 (0)2.96 (0.85-10.3)Haematologic disorder-Haemolytic anaemia38 (9%)0.78 (0.34-1.76)1.37 (0.85-2.22)0.75 (0.44-1.29)1.11 (0.57-2.19)1.24 (0.70-2.20)-Leukopenia130 (30%)1.04 (0.67-1.61)1.19 (0.87-1.63)1.00 (0.72-1.39)0.90 (0.60-1.37)0.94 (0.64-1.37)-Lymphopenia228 (53%)0.95 (0.63-1.44)1.35 (1.01-1.81)0.95 (0.70-1.29)1.16 (0.79-1.70)1.09 (0.77-1.54)-Thrombocytopenia102 (24%)1.42 (0.91-2.22)0.84 (0.60-1.18)0.83 (0.58-1.18)1.35 (0.86-2.11)0.91 (0.60-1.37)Immunologic disorder-anti-DNA ab.330 (77%)0.69 (0.44-1.09)1.02 (0.72-1.44)0.94 (0.65-1.35)0.97 (0.62-1.53)1.08 (0.71-1.65)-anti-Smith ab.44 (10%)1.44 (0.79-2.64)1.58 (1.00-2.49)1.23 (0.73-2.07)1.47 (0.80-2.69)1.07 (0.61-1.84)-anti-phospholipid ab.183 (43%)1.63 (1.07-2.49)1.05 (0.79-1.41)0.84 (0.61-1.14)1.14 (0.77-1.68)1.14 (0.80-1.62)* Logistic regression models for each manifestation included all five lead variants (multivariate) and were adjusted for age and sexDisclosure of InterestsHenrik Leffers: None declared, David Westergaard: None declared, Saedis Saevarsdottir: None declared, Ingileif Jonsdottir: None declared, Ole Birger Pedersen: None declared, Anne Troldborg: None declared, Anne Voss: None declared, Salome Kristensen: None declared, Jesper Lindhardsen: None declared, Prabhat Kumar: None declared, Asta Linauskas: None declared, Lars Juul: None declared, Niels Steen Krogh: None declared, Bent Deleuran: None declared, Lene Dreyer Speakers bureau: Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: from BMS outside the present work, Michael Schwinn: None declared, Lise wegner Thørner: None declared, Lotte Hindhede: None declared, Christian Erikstrup: None declared, Henrik Ullum: None declared, Søren Brunak Shareholder of: SB has ownerships in Intomics A/S, Hoba Therapeutics Aps, Novo Nordisk A/S, Lundbeck A/S, Kari Stefansson: None declared, Karina Banasik: None declared, Søren Jacobsen: None declared
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Voss A, Liu Y, Hoppe J, Firsching T, Haake A, Langenhagen A, Wienhold S, Nouailles G, Witzenrath M, Gruber A. Fact or ArtEfact? Transcriptome Analysis of FFPE Tissue May Serve as a Confirmatory Technology. J Comp Pathol 2022. [DOI: 10.1016/j.jcpa.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Santiago-Fuentes LM, Charleston-Villalobos S, Gonzalez-Camarena R, Voss A, Mejia-Avila ME, Buendia-Roldan I, Reulecke S, Aljama-Corrales T. Cardiovascular and Respiratory Interactions in Idiopathic Pulmonary Fibrosis by Extended Partial Directed Coherence: Short-term Effects of Supplemental Oxygen. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:5446-5449. [PMID: 34892358 DOI: 10.1109/embc46164.2021.9630936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease that can lead to chronic arterial hypoxemia, hypercapnia, and dyspnea. To improve clinical symptoms in IPF patients, supplemental oxygen (SupplO2) has been prescribed with the aim to maintain SpO2 level, and consequently to relieve dyspnea, increase physical activity and improve quality of life. In this study, we investigated the effect of disease and short-term SupplO2 on cardiovascular and respiratory autonomic regulation. Linear and nonlinear indices were extracted from the beat-to-beat variability of heart rate (HR), systolic (SYS) blood pressure and respiration (RESP) in IPF patients and healthy subjects spontaneously breathing ambient air (AA) and during SupplO2 at 3 L/min. It was found that the effects on autonomic nervous systems (ANS) regulation were better demonstrated by the Granger causality (GC) method. GC was significantly higher (p<0.01) in patients compared to controls for the interactions RESP→SYS and BBI→SYS.Clinical Relevance-Short-term SupplO2 in IPF could adversely affect systolic blood pressure variability in particular. This study may help in the management of SupplO2 administration.
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Komen JJ, Pottegård A, Mantel-Teeuwisse AK, Forslund T, Hjemdahl P, Wettermark B, Hellfritzsch M, Hallas J, Olesen M, Bennie M, Mueller T, Voss A, Schink T, Haug U, Kollhorst B, Karlstad Ø, Kjerpeseth LJ, Klungel OH. Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries. Europace 2021; 23:1722-1730. [PMID: 34096584 PMCID: PMC8576279 DOI: 10.1093/europace/euab091] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS To assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings. METHODS AND RESULTS We conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only. RESULTS Overall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up. CONCLUSION Persistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban.
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Affiliation(s)
- Joris J Komen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.,Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Tomas Forslund
- Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden.,Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Pharmacy, Pharmacoepidemiology & Social Pharmacy, Uppsala University, Uppsala, Sweden
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Olesen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Glasgow, UK
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Faculty of Human and Life Sciences, University of Bremen, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Øystein Karlstad
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars J Kjerpeseth
- Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olaf H Klungel
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Rovers JJE, van de Linde LS, Kenters N, Bisseling EM, Nieuwenhuijse DF, Oude Munnink BB, Voss A, Nabuurs-Franssen M. Why psychiatry is different - challenges and difficulties in managing a nosocomial outbreak of coronavirus disease (COVID-19) in hospital care. Antimicrob Resist Infect Control 2020; 9:190. [PMID: 33261660 PMCID: PMC7705849 DOI: 10.1186/s13756-020-00853-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/08/2020] [Accepted: 11/18/2020] [Indexed: 01/04/2023] Open
Abstract
Objective Coronavirus disease (COVID-19) was officially declared a pandemic in March 2020. Many cases of COVID-19 are nosocomial, but to the best of our knowledge, no nosocomial outbreaks on psychiatric departments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in Europe. The different nature of psychiatry makes outbreak management more difficult. This study determines which psychiatry specific factors contributed to a nosocomial outbreak taking place in a psychiatric department. This will provide possible interventions in future outbreak management.
Method A case series describing a nosocomial outbreak in a psychiatric department of an acute care hospital in the Netherlands between March 13, 2020 and April, 14 2020. The outbreak was analyzed by combining data from standardized interviews, polymerase chain reaction (PCR) tests and whole genome sequencing (WGS). Results The nosocomial outbreak in which 43% of staff of the psychiatric department and 19% of admitted patients were involved, was caused by healthcare worker (HCW)-to-HCW transmissions, as well as patient-to-HCW-to-patient transmission. We identified four aspects associated with the mental health care system which might have made our department more susceptible to an outbreak. Conclusions Infection control measures designed for hospitals are not directly applicable to psychiatric departments. Psychiatric patients should be considered a high-risk group for infectious diseases and customized measures should be designed and implemented. Extra attention for psychiatric departments is necessary during a pandemic as psychiatric HCWs are less familiar with outbreak management. Clear communication and governance is crucial in correctly implementing these measures.
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Affiliation(s)
- J J E Rovers
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands.
| | - L S van de Linde
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands
| | - N Kenters
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E M Bisseling
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands
| | - D F Nieuwenhuijse
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B B Oude Munnink
- Department of Psychiatry, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6534 SZ, Nijmegen, The Netherlands.,Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Nabuurs-Franssen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Alvarado-Alvarez N, Charleston-Villalobos S, Reulecke S, Dorantes-Mendez G, Voss A, Gonzalez-Camarena R, Aljama-Corrales T. Time-Frequency Analysis of Cardiovascular Variability during an Orthostatic Stress by Complete EMD. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:702-705. [PMID: 33018084 DOI: 10.1109/embc44109.2020.9176709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Diverse analysis techniques have been used to comprehend the regulation by the autonomic nervous system (ANS) of the cardiovascular system when a human being faces a stressor. Recently, however, the complete ensemble empirical mode decomposition (EMD) with adaptive noise (CEEMDAN) allows analyzing nonstationary signals in a nonlinear and time- variant way. Consequently, CEEMDAN may provide a means to obtain clues about ANS regulation in health and disease. In this study, we analyze the average Hilbert-Huang spectrum (HHS) of cardiovascular variability signals by CEEMDAN during a head-up tilt test (HUTT) in 12 healthy female subjects and 18 orthostatic intolerance female patients. Beat-to-beat intervals (BBI) as well as systolic (SYS) blood pressure variability time series were analyzed. In addition, instantaneous amplitudes and frequencies of specific intrinsic mode functions (IMF) were investigated separately to define the influence of the disease on ANS regulation. Female groups demonstrated statistical differences in the high-frequency band of BBI but higher differences for the high and low-frequency bands of SYS from the mechanical transition of HUTT.Clinical Relevance- A relevant outcome of the study is the average HHS of healthy female subjects along HUTT. This HHS may be used as reference to help diagnose OI when HHS of the cardiovascular variability signals of any subject deviates from the normal course.
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Schmidt NS, Voss A, Just SA, Lindegaard HM. SAT0233 CHARACTERISTICS OF PRIMARY SJÖGREN’S SYNDROME INCLUDING ULTRASOUND FINDINGS OF THE SALIVARY GLANDS, ESSDAI AND ESSPRI. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Studies have shown that salivary gland ultrasonography (SGUS) may have a potential value in the diagnosis of Sjogren’s Syndrome (SS).Knowledge of the association between ultrasonography findings, disease activity and damage, serologic markers and patient report outcome is limited.Objectives:To investigate whether the results of SGUS are associated with disease manifestations and damage measured by doctor-reported activity score index (ESSDAI) and serologic markers. Furthermore to investigate the contribution of patient reported outcome measure (ESSPRI) in disease monitoring.Methods:Patients registered at Odense University Hospital with the diagnosis primary SS were included in a Danish cohort. The patients were characterized using the ESSDAI, ESSPRI, serologic markers and SGUS-findings in submandibular and parotid glands. Schirmer’s test and salivary test were performed for measurement of tear and salivary production.SGUS was performed using a linear transducer, Siemens (ACUSON Sequoia Ultrasound System) on the two parotid and two submandibular glands. SGUS images was scored according to the OMERACT SS severity scoring system from 0 to 3, where 2 is moderate and 3 severe(1). A reliability study was performed in advance of the present study.Spearman´s r correlation coefficient was used to assess correlation between scores.Results:The cohort consisted of 48 Caucasian patients diagnosed with primary SS. Details on patient characteristics are shown in table 1.Table 1.Sex, n (%)Women46 (95.8)Age, mean (95%CI)60 (57-62)Smoking, n (%)Smoker1 (2.1)BMI, n (%)< 18.55 (10.4)18.5 – 24.920 (41.7)25.0 – 29.912 (25.0)30.0 – 34.910 (20.8)> 35.01 (2.1)Serologic markers, n (%)SSa positive33 (68.8)SSb positive22 (45.8)ANA positive38 (79.2)Cryoglobulin positive9 (18.8)ESSPRI 0-10, mean (95%CI)Dryness7.3 (6.7-7.9)Fatigue7.1 (6.4-7.7)Pain5.9 (5.1-6.7)SGUS, n (%)Score 06 (12.5)Score 115 (31.3)Score 213 (27.1)Score 314 (29.2)ESSDAI, n (%)ESSDAI < 5 (low-activity)22 (45.8)≤ 5 ESSDAI ≤ 13 (moderate-activity) ESSDAI ≥17 (35.4)14 (high-activity)9 (18.8)The correlation between ESSDAI-scores and SGUS-scores was r = 0.153 (p = 0.299). The correlation between ESSDAI-scores and ESSPRI-scores (dryness, fatique, pain) was r = 0.071 (p = 0.632), r = 0.254 (p = 0.082) and r = -0.002 (p = 0.987). The correlation between SGUS-scores and ESSPRI-scores (dryness, fatique, pain) was r = 0.124 (p = 0.400), r = -0.292 (p = 0.044) and r = -0.459 (p = 0.001).Conclusion:In a Danish cohort of SS most patients had SSa and ANA autoantibodies. SGUS demonstrated high damage (score 2-3) in approximately half of the patients. ESSDAI activity score did not correlate with SGUS damage scores or the ESSPRI. SGUS damage scores correlated with ESSPRI-scores of fatique and pain, but not dryness.Associations between other factors of importance for damage and SGUS scores are to be analyzed. SGUS and the ESSPRI describe different SS-related dimensions and will probably contribute in disease monitoring in the future.References:[1]Jousse-Joulin S, D’Agostino MA, Nicolas C, Naredo E, Ohrndorf S, Backhaus M, et al. Video clip assessment of a salivary gland ultrasound scoring system in Sjogren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Annals of the rheumatic diseases. 2019;78(7):967-73.Disclosure of Interests:None declared
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Kay SD, Genovese F, Siebuhr AS, Karsdal M, Voss A, Junker P. THU0272 BASEMENT MEMBRANE SEROLOGICAL MARKERS OF COLLAGEN TYPE IV AND LAMININ REMODELING ARE DIFFERENTIALLY EXPRESSED IN SLE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Collagen type IV and laminin are the main constituents of basement membranes (BMs). Epitopes on these molecules are targeted in various autoimmune diseases, systemic lupus erythematosus (SLE) in particular. Accelerated large vessel disease is a well-recognized cause of premature cardiovascular morbidity and mortality in SLE. Novel tools for quantification of soluble MMP-derived fragments of collagen type IV (C4M) and laminin (LG1M) have emerged as promising biomarkers for BM remodeling in atherosclerosis.Objectives:To study serum levels of collagen type IV and laminin metabolites in patients with SLE and in healthy controls. And to search for associations with disease activity, organ damage and cardiovascular comorbidity.Methods:One hundred and six SLE patients without and 20 with previous CVD events were included (1). One hundred and twenty male and female blood donors aged 20-65 years served as healthy reference. Disease activity (SLEDAI) and damage (SLICC) scores were calculated. Coronary artery calcification (CAC) was studied by CT scan and expressed as Agatston score. Carotid intima-media thickness (IMT) was measured by ultrasound (LOGIQ E9, GE Healthcare). In either subgroup atherosclerosis was defined as Agatston > 99 U and/or IMT>1 mm and/or presence of plaque. C4M and LG1M were measured by competitive ELISAs (2).Results:Patient characteristics are presented in Table 1. Overall, C4M and LG1M were significantly increased in the entire SLE cohort vs. healthy controls (35.7 ± 17.5 vs. 22.3 ± 9.4 ng/mL, p<0.0001 and 20.9 ± 21.1 vs. 9.7 ± 8.0 ng/mL, p<0.0001, respectively) (Fig 1). Highly significant positive correlations were detected between C4M and LG1M in the entire SLE cohort and in the healthy control group (Fig 2).In terms of CVD and atherosclerosis LG1M was significantly higher in SLE patients with manifest CVD vs. those without (34.47 ± 41.22 vs. 18.34 ± 13.55, p=0.0015) and in those with atherosclerosis by imaging (25.53 ± 28.12 vs 17.53 ± 13.35, p=0.036). There were no associations between C4M and CVD or atherosclerosis. There was a weak association between LG1M and SLICC (r=0.22, p=0.01), but not with SLEDAI. Details on associations with other CVD risk factors and specific organ involvement will be presented.Table 1Characteristics for SLE patients with and without CVDPatients characteristicsAll (126)SLE + CVD (20)SLE without CVD (106)pFemales, no. (%)113 (89)18 (90)95 (89)0.95Age, yrs., mean ± SD50.6± 14.454.8 ± 15.346.8± 14.10.15Disease duration, yrs., mean ± SD13.9 ± 9.319.0± 11.313.0± 11.30.007SLEDAI, median, range4 (0-14)4 (0-10)4 (0-14)0.717SLICC, median, range1 (0-11)3 (1-11)1 (0-10)0.0001Atherosclerosis, no. (%)53 (42)14 (70)39 (37)0.0006LG1M (ng/ml), mean ± SD20.9± 21.234.5± 41.218.3 ± 13.60.0015C4M (ng/ml), mean ± SD35.7 ± 17.538.1± 20.635.3± 16.90.518Conclusion:Serological levels of collagen type IV and laminin biomarkers were elevated and interrelated in an unstratified SLE population. Moreover, LG1M but not C4M was significantly elevated in SLE patients with previous CVD events and in those with atherosclerosis by imaging. These findings indicate that LG1M may serve as a serological marker for SLE-related large vessel disease. However, additional extravascular sites of increased basement membrane remodeling may contribute to the abnormal biomarker pattern.References:[1]Kay SD, Poulsen MK, Diederichsen AC, Voss A. J Rheumatol 2016;43:315–22[2]Sand JM, Larsen L, Hogaboam C et al. PLoS One 2013;8:e84934Kay SD and Genovese F contributed equally to this work.Figure 1.Levels of C4M and LG1M in serum of patients with SLE and healthy controls; graphs are presented as box and whiskers plot (in the style of Tukey). Statistical significance: ****p<0.0001.Figure 2.Correlation plots (Spearman r) of C4M and LG1M in SLE patients and healthy controls.Disclosure of Interests:Susan Due Kay: None declared, Federica Genovese Shareholder of: Own Nordic Bioscience stocks, Employee of: Nordic Bioscience, Anne Sofie Siebuhr Employee of: Nordic Bioscience, Morten Karsdal Shareholder of: Nordic Bioscience A/S., Employee of: Full time employee at Nordic Bioscience A/S., Anne Voss: None declared, Peter Junker: None declared
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Munch Beck M, Möller S, Kay SD, Voss A. AB0450 DANISH PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS SELF-REPORT HIGH LEVELS OF PHYSICAL ACTIVITY, AND MOST PATIENTS FULFILL THE WHO RECOMMENDATIONS ON PHYSICAL ACTIVITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Physical activity is important for enhancing health and the World Health Organization (WHO) recommends that adults aged 18-64 engage in at least 150 minutes of moderate-intensity physical activity throughout the week, or 75 minutes of vigorous-intensity physical activity (1). Swedish patients with SLE reported a lower frequency and capacity of exercise than a control group, and in an Italian study, 60% of the SLE patients did not meet WHO’s recommendations for physical activity.Mental health is important for the individual’s level of physical activity, and symptoms of depression have been associated with a lower level of physical activity in SLE patients (2).Objectives:The aim of this study is to describe the pattern of physical activity in a population of Danish SLE patients, and to investigate the association to depression.Methods:The study was conducted at the Department of Rheumatology at Odense University Hospital, Denmark, in 2018 and 2019. Two questionnaires were handed out before routine outpatient consultation: self-reported physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ), and a continuous variable on energy requirement in the form of the metabolic equivalent (MET) was calculated, and the Major Depression Inventory (MDI) questionnaire was used to screen for depression. Medicine intake was registered, and disease activity and damage were scored using SLEDAI-2K and SLICC/ACR DI.Results:Two hundred and fifteen patients completed the IPAQ and MDI, 5 were excluded. The population consist of 89.5% women and the mean age was 51.7 ± 15.2 years. The mean disease duration was 16.1 ± 10.1 years.The SLE patients reported a mean total MET-score of 5319.9 ± 3650 MET-min/week. If divided into categories, 7.6% reported low level, 21.9% moderate and 70.5% of the patients reported a high level of physical activity and 89.5% fulfilled WHO recommendations. The participants reported 363.7 ± 201 minutes per day in sitting time.Mean MDI score was 12.7 ± 10.1, and if divided into groups, 89.5% were not depressed, 1.9% had a mild depression, 5.3% had a moderate depression and 2.9% had a severe depression. Significantly lower mean MET-scores were observed for the severely depressed patients.An inverse association was found in the univariate analysis, indication that increasing disease duration and SLICC/ACR DI scores were significantly associated with decreasing total MET-scores. In the multivariate analysis time spent sitting was inversely associated with MET-score.Our results were similar to a Brazilian study, where 68% of the patients reported, that they were “physical active” according to IPAQ. In contrast, only 22% of the patients in an Italian study reported high level physical activity. Our proportion of active patients were high when comparing with studies on patients with rheumatoid arthritis and spondylarthritis, where only 25-50% fulfilled the WHO recommendations compared to our 89.5%.A Danish study on registered ICD diagnoses found a prevalence of depression in SLE patients to be 4.3%, which was lower than our prevalence. Foreign studies reported very diverse prevalences of depression, e.g. 16.6% in the Netherlands and 51% in Sweden.Conclusion:A high portion of the SLE patients reported a high level of physical activity and 89.5% fulfilled the WHO recommendations. Significant predictors for a lower level of physical activity were increasing disease duration, higher SLICC/ACR DI score and longer time spent sitting. However, further studies are needed, where more suitable questionnaires could be considered.References:[1]WHO recommendations, Geneva 2010;60:1-58.[2]Gen Hosp Psychiatry. 2009;31:306-15.Disclosure of Interests:None declared
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Dofferhoff ASM, Swinkels A, Sprong T, Berk Y, Spanbroek M, Nabuurs-Franssen MH, Vermaat M, van de Kerkhof B, Willekens MHC, Voss A. [Diagnostic algorithm for COVID-19 at the ER]. Ned Tijdschr Geneeskd 2020; 164:D5042. [PMID: 32406638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Evaluation of a diagnostic algorithm for estimating the risk of COVID-19 in patients who are referred to an emergency department for being suspected of having the disease. DESIGN Retrospective study. METHOD Patients with fever with no apparent cause and patients with recently developed respiratory symptoms, whether or not in combination with fever, were routinely given a PCR test, blood tests (lymphocyte count and LDH levels) and a chest CT scan. The CT scan was assessed according to the CO-RADS classification. Based on the findings, the patients were divided into 3 cohorts (proven COVID-19, strong suspicion of COVID-19, and low suspicion of COVID-19) and the appropriate isolation measures were taken. RESULTS In the period from 8 to 31 March 2020, the algorithm was applied to 312 patients. COVID-19 was proven for 69 (22%) patients. COVID-19 was strongly suspected for 151 (48%) patients and suspicion was low for the remaining 92 (29%) patients. The percentage of patients with positive PCR results and the percentage of patients with abnormal laboratory test results increased as the CO-RADS score increased. Among patients with a CO-RADS score of 4 or 5, this percentage increased further when they also had lymphopenia or elevated LDH levels. We have adjusted the flowchart based on our findings. CONCLUSION In case of patients who have been referred to an emergency department for suspected COVID-19, a good COVID-19 risk assessment can be made on the basis of clinical signs, laboratory abnormalities and low-dose CT scans. Even before the results of the PCR test are known and even if the results are negative, patients can be classified as 'proven COVID-19 patients' using the algorithm.
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Affiliation(s)
- A S M Dofferhoff
- Canisius-Wilhelmina Ziekenhuis, afd. Interne Geneeskunde, Nijmegen
- Contact: A.S.M. Dofferhoff
| | - A Swinkels
- Canisius-Wilhelmina Ziekenhuis, afd. Medische Microbiologie, Nijmegen
| | - T Sprong
- Canisius-Wilhelmina Ziekenhuis, afd. Interne Geneeskunde, Nijmegen
| | - Y Berk
- Canisius-Wilhelmina Ziekenhuis, afd. Longziekten, Nijmegen
| | - M Spanbroek
- Canisius-Wilhelmina Ziekenhuis, afd. Longziekten, Nijmegen
| | | | - M Vermaat
- Canisius-Wilhelmina Ziekenhuis, afd. Radiologie, Nijmegen
| | | | | | - A Voss
- Canisius-Wilhelmina Ziekenhuis, afd. Medische Microbiologie, Nijmegen
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Flury M, Voss A. Komplikationsmanagement der oberen Extremität. Arthroskopie 2020. [DOI: 10.1007/s00142-019-00322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kenters N, Eikelenboom-Boskamp A, Hines J, McGeer A, Huijskens E, Voss A. Product dose considerations for real-world hand sanitiser efficacy. Am J Infect Control 2020; 48:503-506. [PMID: 31924389 DOI: 10.1016/j.ajic.2019.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol based hand rubs (ABHR) are extremely effective at reducing microbial contamination and have an essential role in best practice hand hygiene described by the World Health Organization. METHODS We determined ABHR drying time when performing hand hygiene in a laboratory setting. Which was followed by identifying the amount of ABHR needed for complete hand coverage. When the aforementioned was analyzed real-time data were gathered to examine the amount used for hand hygiene in a hospital setting. In parallel hands of healthcare workers (HCWs) were monitored for drying time and perception on ABHR use. RESULTS In 86% (24,446,397/28,280,383) of the events a single dose of ABHR was used on clinical wards. Twenty-four HCWs expected hand hygiene to take 7.5 seconds (median; range 3-30 seconds). Forty-three HCWs show that 1.5 mL ABHR dose achieves the desired drying time according to World Health Organization guidelines (av. median 26 seconds), but is consistently perceived to have a longer drying time than expected (av. median 18 seconds). In-vivo results (n = 10) indicate that 2.25 mL ABHR is required for adequate coverage (82%-90%) of both sides of the hand. CONCLUSIONS Results indicate that set standards for the use of ABHR do not match "in-vivo" behaviour of HCWs. Perceived drying times are shorter than actual drying time. The needed drying time to reach acceptable antimicrobial efficacy of ABHRs should be revisited.
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Berthold DP, Muench LN, Dyrna F, Mazzocca AD, Beitzel K, Voss A. Komplikationsmanagement in der Versorgung von Verletzungen des Akromioklavikulargelenks. Arthroskopie 2020. [DOI: 10.1007/s00142-020-00361-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Steinbach R, Batrybekova M, Voss A, Rödiger A, Ilse B, Gunkel A, Prell T, W. WO, Grosskreutz J. FV9 Structural grey and white matter imaging patterns differ between bulbar and limb-onset Amyotrophic Lateral Sclerosis (ALS): Cross-sectional subgroup analyses with application of the D50 disease progression model. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Affiliation(s)
- G Kampf
- University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany.
| | - A Voss
- Radboudumc and Canisius-Wilhelmina Hospital, Department of Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands
| | - S Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University, Göttingen, Germany
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Vilen M, Kelly JM, Kankainen A, Brodeur M, Aprahamian A, Canete L, Eronen T, Jokinen A, Kuta T, Moore ID, Mumpower MR, Nesterenko DA, Penttilä H, Pohjalainen I, Porter WS, Rinta-Antila S, Surman R, Voss A, Äystö J. Erratum: Precision Mass Measurements on Neutron-Rich Rare-Earth Isotopes at JYFLTRAP: Reduced Neutron Pairing and Implications for r-Process Calculations [Phys. Rev. Lett. 120, 262701 (2018)]. Phys Rev Lett 2020; 124:129901. [PMID: 32281843 DOI: 10.1103/physrevlett.124.129901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 06/11/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.120.262701.
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Tenstad HB, Mose K, Voss A. Herpes zoster infection-induced common peroneal nerve paresis resulting in foot drop in a patient with eosinophilic fasciitis: a case report. Scand J Rheumatol 2020; 49:251-252. [DOI: 10.1080/03009742.2019.1702220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- HB Tenstad
- Department of Internal Medicine, Section of Rheumatology, Odense University Hospital, Svendborg, Denmark
| | - K Mose
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - A Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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Schulz S, Ritter J, Schneider G, Guntinas-Lichius O, Voss A. Risk detection in patients with obstructive sleep apnea syndrome based on cardiovascular time series analysis .. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:6794-6797. [PMID: 31947400 DOI: 10.1109/embc.2019.8856472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstructive sleep apnea represents the most common form of sleep-disordered breathing and has a high prevalence in patients with cardiovascular disease. Disturbed sleep is a potential risk factor for cardiovascular disorders such as arterial hypertension, cardiac ischemia, sudden cardiac death, and stroke. In this study we investigated polysomnographic records and analyzed the ECG, plethysmogram, respiration and SpO2 time series during wakefulness (WK), NREM, and REM sleep stages applying variability and coupling analyses methods. We enrolled 55 patients with obstructive sleep apnea syndrome (OSAS) and 29 healthy control subjects (CON: 45.9±14.9 years, 21 male) in this study. OSAS patients were subdivided into a low- and high-risk group (LR: 50.8±14.1 years, n=29, 21 male; HR: 57.2±13.4 years, n=26, 19 male) based on the Apnea-Hypopnea Index (AHI) (CON: 0-5 AHI, LR: 5-15 AHI, HR: >15 AHI). We could demonstrate the presence of an altered autonomic function in OSAS patients, differing from healthy controls. This altered autonomic function was mainly based on heart rate-, respiratory-, SpO2- and plethysmogram variability and their couplings. The discriminant analysis showed that the optimal set consisting of two autonomic indices revealed a high classification power (ACC=86.7%, AUC=90.3%, SENS=89.5% and SPEC=84.6%) when comparing low-risk and high-risk OSAS patients during WK. These results were slightly improved when analyzing REM sleep stages. Based on these results it seems to be possible to perform optimal risk stratification for OSAS patients based on autonomic indices. Based on our findings it is possible to differentiate between high-risk OSAS patient and low-risk OSAS patient at an early stage and in a promising manner allowing to set up therapy strategies for those patients in an early stage.
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Reulecke S, Charleston-Villalobos S, Aljama-Corrales T, Charleston-Villalobos S, Voss A, Gonzalez-Camarena R, Gaitan-Gonzalez M, Gonzalez-Hermosillo J, Hernandez-Pacheco G, Aljama-Corrales T, Reulecke S. Temporal cardiovascular causality during orthostatic stress by extended partial directed coherence. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:6359-6362. [PMID: 31947297 DOI: 10.1109/embc.2019.8857021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to investigate the temporal dynamic behavior of cardiovascular interactions between heart period and systolic blood pressure during a 20-min head-up tilt test at 70° in young women with orthostatic intolerance compared to healthy women. Methods included the lagged and extended partial directed coherence applied to short-term windows shifted by 5 seconds, extracted from a multivariate set of cardiovascular and respiratory time series. Findings revealed significantly increased information flow (p <; 0.01) in patients from: a) heart period to blood pressure during supine position which subsequently decreased and b) blood pressure to heart period during the progression of orthostatic phase. Controls developed balanced cardiovascular interactions with smaller information flows than patients.
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Kluytmans J, Voss A, Kahlmeter G, Giske C, MacGowan A, Brown D, Gatermann S, Lina G, Lindemann C, Turnidge J, Canton R, Petinaki E, Vaz CP, Rodriguez Baño J. Obituary: Johan Willem Mouton. Clin Microbiol Infect 2020. [DOI: 10.1016/j.cmi.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Steinbach R, Voss A, Grosskreutz J, Rödiger A, Ilse B, Gunkel A, Stubendorff B, Mayer T, Otto W. P40 TBSS reveals tract pathology in amyotrophic lateral sclerosis that correlates with the D50 disease progression model. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guadilla V, Algora A, Tain JL, Estienne M, Fallot M, Sonzogni AA, Agramunt J, Äystö J, Briz JA, Cucoanes A, Eronen T, Fraile LM, Ganioğlu E, Gelletly W, Gorelov D, Hakala J, Jokinen A, Jordan D, Kankainen A, Kolhinen V, Koponen J, Lebois M, Le Meur L, Martinez T, Monserrate M, Montaner-Pizá A, Moore I, Nácher E, Orrigo SEA, Penttilä H, Pohjalainen I, Porta A, Reinikainen J, Reponen M, Rinta-Antila S, Rubio B, Rytkönen K, Shiba T, Sonnenschein V, Valencia E, Vedia V, Voss A, Wilson JN, Zakari-Issoufou AA. Large Impact of the Decay of Niobium Isomers on the Reactor ν[over ¯]_{e} Summation Calculations. Phys Rev Lett 2019; 122:042502. [PMID: 30768318 DOI: 10.1103/physrevlett.122.042502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Even mass neutron-rich niobium isotopes are among the principal contributors to the reactor antineutrino energy spectrum. They are also among the most challenging to measure due to the refractory nature of niobium, and because they exhibit isomeric states lying very close in energy. The β-intensity distributions of ^{100gs,100m}Nb and ^{102gs,102m}Nb β decays have been determined using the total absorption γ-ray spectroscopy technique. The measurements were performed at the upgraded Ion Guide Isotope Separator On-Line facility at the University of Jyväskylä. Here, the double Penning trap system JYFLTRAP was employed to disentangle the β decay of the isomeric states. The new data obtained in this challenging measurement have a large impact in antineutrino summation calculations. For the first time the discrepancy between the summation model and the reactor antineutrino measurements in the region of the shape distortion has been reduced.
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Affiliation(s)
- V Guadilla
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - A Algora
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
- Institute of Nuclear Research of the Hungarian Academy of Sciences, Debrecen H-4026, Hungary
| | - J L Tain
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - M Estienne
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | - M Fallot
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | - A A Sonzogni
- NNDC, Brookhaven National Laboratory, Upton, New York 11973-5000, USA
| | - J Agramunt
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - J Äystö
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - J A Briz
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | - A Cucoanes
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | - T Eronen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - L M Fraile
- Universidad Complutense, Grupo de Física Nuclear and UPARCOS, CEI Moncloa, E-28040 Madrid, Spain
| | - E Ganioğlu
- Department of Physics, Istanbul University, 34134 Istanbul, Turkey
| | - W Gelletly
- Department of Physics, University of Surrey, GU2 7XH Guildford, United Kingdom
| | - D Gorelov
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - J Hakala
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - A Jokinen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - D Jordan
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - A Kankainen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - V Kolhinen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - J Koponen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - M Lebois
- Institut de Physique Nuclèaire d'Orsay, 91406 Orsay, France
| | - L Le Meur
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | - T Martinez
- Centro de Investigaciones Energéticas Medioambientales y Tecnológicas, E-28040 Madrid, Spain
| | - M Monserrate
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - A Montaner-Pizá
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - I Moore
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - E Nácher
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
- Instituto de Estructura de la Materia, CSIC, E-28006 Madrid, Spain
| | - S E A Orrigo
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - H Penttilä
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - I Pohjalainen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - A Porta
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | - J Reinikainen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - M Reponen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | | | - B Rubio
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - K Rytkönen
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - T Shiba
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
| | | | - E Valencia
- Instituto de Física Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - V Vedia
- Universidad Complutense, Grupo de Física Nuclear and UPARCOS, CEI Moncloa, E-28040 Madrid, Spain
| | - A Voss
- University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - J N Wilson
- Institut de Physique Nuclèaire d'Orsay, 91406 Orsay, France
| | - A-A Zakari-Issoufou
- Subatech, IMT-Atlantique, Université de Nantes, CNRS-IN2P3, F-44307 Nantes, France
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Estienne M, Fallot M, Giot L, Guadilla-Gomez V, Le Meur L, Porta A, Algora A, Taìn JL, Briz JA, Agramunt J, Äystö J, Cormon S, Cucoanes A, Eronen T, Fraile LM, Ganogliu E, Gelletly W, Gorelov D, Hakala J, Jokinen A, Jordan MD, Kankainen A, Kolhinen VS, Koponen J, Lebois M, Martinez T, Monserrate M, Montaner-Pizá A, Moore I, Nácher E, Orrigo SEA, Penttilä H, Pohjalainen I, Reinikainen J, Reponen M, Rinta-Antila S, Rytkönen K, Rubio B, Shiba T, Sonnenschein V, Sonzogni AA, Valencia E, Vedia V, Voss A, Weber C, Wilson JN, Zakari-Issoufou AA. Summation Calculations for Reactor Antineutrino Spectra, Decay Heat and Delayed Neutron Fractions Involving New TAGS Data and Evaluated Databases. EPJ Web Conf 2019. [DOI: 10.1051/epjconf/201921101001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Three observables of interest for present and future reactors depend on the β decay properties of the fission products: antineutrinos from reactors, the reactor decay heat and delayed neutron emission. In these proceedings, we present new results from summation calculations of the first two quantities quoted above, performed with evolved independent yields coupled with fission product decay data, from various nuclear data bases or models. New TAGS results from the latest experiment of the TAGS collaboration at the JYFL facility of Jyväskylä will be displayed as well as their impact on the antineutrino spectra and the decay heat associated to fission pulses of the main actinides.
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Reulecke S, Charleston-Villalobos S, González-Hermosillo J, González-Camarena R, Voss A, Gaitán-González M, Hernández-Pacheco G, Schroeder R, Aljama-Corrales T. Study of impaired cardiovascular and respiratory coupling during orthostatic stress based on joint symbolic dynamics. Med Eng Phys 2018; 61:51-60. [PMID: 30270005 DOI: 10.1016/j.medengphy.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 08/08/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022]
Abstract
The present study investigates the instantaneous coupling among the cardiac, vascular, and respiratory systems, using the heart rate, respiration, and systolic and diastolic blood pressure variability in 12 healthy and 16 vasovagal syncope female subjects during a head-up tilt (HUT) testing protocol at 70° This study contributes to the coupling analysis by using a nonlinear joint symbolic dynamics (JSD) in a high-temporal resolution scheme, based on 5 min segments of the time series that are shifted every minute. For each segment, a bivariate JSD matrix was constructed to obtain global and local coupling indices in accordance to Shannon's entropy and the probability of occurrence of various bivariate words, respectively. The novel approach revealed important findings in the coupling dynamics of the systems, thus allowing the detection of group differences during the early orthostatic phase, and during the HUT test, before the occurrence of any pre-syncopal symptoms. In patients, the global indices indicated a significant decrease of cardiovascular coupling, starting at 10 min after the tilt-up, manifested by reduced baroreflex sensitivity and cardiorespiratory coupling that was initiated 8 min after the onset of the orthostatic phase (OP). A decreased autonomic control on cardiovascular-respiratory couplings was further evidenced by increased alterations of the JSD indices during the OP compared to the supine position in patients compared to controls. Furthermore, findings based on local indices demonstrated that female patients showed reductions and disengagements in cardiovascular (p < 0.001) and cardiorespiratory (p < 0.01) couplings, as early as the first 5 min and during the complete OP.
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Affiliation(s)
- S Reulecke
- Electrical Engineering Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | | | - R González-Camarena
- Health Science Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - A Voss
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, Jena, Germany
| | - M Gaitán-González
- Health Science Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | - R Schroeder
- Institute of Innovative Health Technologies IGHT, Ernst-Abbe-Hochschule Jena, Jena, Germany
| | - T Aljama-Corrales
- Electrical Engineering Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
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Eikelenboom-Boskamp A, Saris K, van Loosbroek M, Drabbe MIJ, de Jongh F, de Jong JWD, Boom-Poels PGM, Voss A. Prevalence of healthcare-associated infections in Dutch nursing homes: follow-up 2010-2017. J Hosp Infect 2018; 101:49-52. [PMID: 30149087 DOI: 10.1016/j.jhin.2018.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
Abstract
Following the first point-prevalence study in Dutch nursing homes conducted each November from 2007 to 2009, we conducted a follow-up point-prevalence study of healthcare-associated infections (HCAIs) each November from 2010 to 2017. Similar methods and criteria were used. Resident characteristics were recorded, data collection was performed by the attending elderly care physicians via an online survey, as well as via a specifically designed App from 2012. As of the same year, information on incontinence was added. Between 2010 until 2017 on average 1786 residents per year were included, ranging from 1571 to 2185. HCAI prevalence with respect to age (mean: 83 years) and sex (31% men and 69% women) were similar over all the years. The overall mean prevalence rate in the first four years was 6.7% versus 2.2% in the last six years. Urinary tract infection was the most prevalent HCAI (1.5%). Most HCAIs occurred among residents of rehabilitation units. The prevalence of HCAI varied by nursing home (0.0-37.0%). The average use of antibiotics was stable over the years (6.0%) irrespective of HCAI rate. Use of incontinence materials was on average 73.5% with 64.3% of residents being reported as incontinent. Those implementing improvement of infection control and surveillance within a new setting do need to continue for multiple years before seeing the success of their endeavour.
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Affiliation(s)
- A Eikelenboom-Boskamp
- Canisius-Wilhelmina Hospital (CWZ), Department of Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands; Radboudumc, Department of Medical Microbiology, Nijmegen, The Netherlands.
| | - K Saris
- Canisius-Wilhelmina Hospital (CWZ), Department of Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands; Radboudumc, Department of Medical Microbiology, Nijmegen, The Netherlands; Radboudumc, REshape Center for Innovation, Nijmegen, The Netherlands
| | - M van Loosbroek
- ZZG Zorggroep, Nursing Home Juliana, Nijmegen, The Netherlands
| | - M I J Drabbe
- Zorggroep Maas en Waal, Nursing Home Waelwick, Ewijk, The Netherlands
| | - F de Jongh
- Stichting Kalorama, Nursing Home Veste Brakkenstein, Nijmegen, The Netherlands
| | - J W D de Jong
- De Waalboog, Nursing Home Honinghoeve, Nijmegen, The Netherlands
| | - P G M Boom-Poels
- Zorgcentra Pantein, Nursing Home Madeleine, Boxmeer, The Netherlands
| | - A Voss
- Canisius-Wilhelmina Hospital (CWZ), Department of Medical Microbiology and Infectious Diseases, Nijmegen, The Netherlands; Radboudumc, Department of Medical Microbiology, Nijmegen, The Netherlands; Radboudumc, REshape Center for Innovation, Nijmegen, The Netherlands
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Kay SD, Carlsen AL, Voss A, Burton M, Diederichsen ACP, Poulsen MK, Heegaard NHH. Associations of circulating cell-free microRNA with vasculopathy and vascular events in systemic lupus erythematosus patients. Scand J Rheumatol 2018; 48:32-41. [DOI: 10.1080/03009742.2018.1450892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- SD Kay
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - AL Carlsen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - A Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - M Burton
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Research Unit and Human Genetics, University of Southern Denmark, Odense, Denmark
| | - ACP Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - MK Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - NHH Heegaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Reulecke S, Charleston-Villalobos S, Voss A, Gonzalez-Camarena R, Gaitan-Gonzalez M, Gonzalez-Hermosillo J, Hernandez-Pacheco G, Corrales TA. Cardiovascular variability in young male and female subjects in health and orthostatic intolerance. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:2957-2960. [PMID: 30441020 DOI: 10.1109/embc.2018.8513002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this study was to investigate the effect of head-up tilt (HUT) test on male and female young patients, diagnosed with orthostatic intolerance (OI), in comparison to male and female healthy subjects. Twenty seven OI patients (21 women, 6 men) and 26 age-matched healthy subjects (13 women, 13 men) were enrolled in a 70° HUT test. In addition to hemodynamic variables, cardiovascular and respiratory parameters were determined using linear and nonlinear methods to analyze heart rate (HRV) and blood pressure variability (BPV). During the complete test, HRV was lower in healthy men than in female controls. Decreased HRV and increased BPV were observed in female patients compared to healthy women. Furthermore, systolic BPV was increased in male and female patients. However, linear (rmssd) and nonlinear (plvar2) parameters indicated that diastolic BPV decreased in male patients during orthostatic phase, but remained unchanged in female patients. Findings indicated gender dependent mechanisms for the regulation of diastolic blood pressure during orthostatic stress in patients.
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Vilen M, Kelly JM, Kankainen A, Brodeur M, Aprahamian A, Canete L, Eronen T, Jokinen A, Kuta T, Moore ID, Mumpower MR, Nesterenko DA, Penttilä H, Pohjalainen I, Porter WS, Rinta-Antila S, Surman R, Voss A, Äystö J. Precision Mass Measurements on Neutron-Rich Rare-Earth Isotopes at JYFLTRAP: Reduced Neutron Pairing and Implications for r-Process Calculations. Phys Rev Lett 2018; 120:262701. [PMID: 30004755 DOI: 10.1103/physrevlett.120.262701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 02/17/2018] [Indexed: 06/08/2023]
Abstract
The rare-earth peak in the r-process abundance pattern depends sensitively on both the astrophysical conditions and subtle changes in nuclear structure in the region. This work takes an important step towards elucidating the nuclear structure and reducing the uncertainties in r-process calculations via precise atomic mass measurements at the JYFLTRAP double Penning trap. ^{158}Nd, ^{160}Pm, ^{162}Sm, and ^{164-166}Gd have been measured for the first time, and the precisions for ^{156}Nd, ^{158}Pm, ^{162,163}Eu, ^{163}Gd, and ^{164}Tb have been improved considerably. Nuclear structure has been probed via two-neutron separation energies S_{2n} and neutron pairing energy metrics D_{n}. The data do not support the existence of a subshell closure at N=100. Neutron pairing has been found to be weaker than predicted by theoretical mass models. The impact on the calculated r-process abundances has been studied. Substantial changes resulting in a smoother abundance distribution and a better agreement with the solar r-process abundances are observed.
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Affiliation(s)
- M Vilen
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - J M Kelly
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - A Kankainen
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - M Brodeur
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - A Aprahamian
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - L Canete
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - T Eronen
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - A Jokinen
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - T Kuta
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - I D Moore
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - M R Mumpower
- University of Notre Dame, Notre Dame, Indiana 46556, USA
- Theory Division, Los Alamos National Lab, Los Alamos, New Mexico 87544, USA
| | - D A Nesterenko
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - H Penttilä
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - I Pohjalainen
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - W S Porter
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - S Rinta-Antila
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - R Surman
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - A Voss
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
| | - J Äystö
- University of Jyväskylä, P.O. Box 35, FI-40014 University of Jyväskylä, Finland
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Kenters N, Gottlieb T, Hopman J, Mehtar S, Schweizer ML, Tartari E, Huijskens EGW, Voss A. An international survey of cleaning and disinfection practices in the healthcare environment. J Hosp Infect 2018; 100:236-241. [PMID: 29772262 DOI: 10.1016/j.jhin.2018.05.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. AIM To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. METHODS The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. FINDINGS A total of 110 healthcare professionals, representing 23 countries, participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. CONCLUSIONS The survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide.
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Affiliation(s)
- N Kenters
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, Australia
| | - J Hopman
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - S Mehtar
- Unit of Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa
| | - M L Schweizer
- Department of Epidemiology, College of Public Health, Department of Internal Medicine, Iowa, USA
| | - E Tartari
- Infection Control Programme and WHO Collaborating Centre of Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - E G W Huijskens
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Voss
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Department of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Petersen MP, Möller S, Bygum A, Voss A, Bliddal M. Epidemiology of cutaneous lupus erythematosus and the associated risk of systemic lupus erythematosus: a nationwide cohort study in Denmark. Lupus 2018; 27:1424-1430. [PMID: 29788808 DOI: 10.1177/0961203318777103] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives The objectives of this paper are to describe the epidemiology of cutaneous lupus erythematosus (CLE) and its subtypes in Denmark, and to investigate the probability of receiving a subsequent diagnosis of systemic lupus erythematosus (SLE) and the related time course. Methods A nationwide registry-based cohort study was conducted in Denmark based on data from the Danish National Patient Registry from 1998 to 2013 using International Classification of Diseases, Revision 10. Results We identified 2380 patients with CLE. The annual incidence rate (IR) of CLE was 2.74/100,000 with a female:male ratio of 4:1. During 12,047 person-years of follow-up, 8% were diagnosed with SLE. The probability of receiving a subsequent diagnosis of SLE was 12.9% after 10 years taking death as a competing risk into consideration, and the probability was highest among women and patients diagnosed with subacute CLE. The median time until a diagnosis of SLE was 2.05 years. Conclusions This is the first nationwide study on CLE in Denmark. Although we found the annual IR of CLE and the risk of receiving an additional diagnosis of SLE to be lower than previously described, continued monitoring and thorough information for patients with CLE is important due to the inherent risk of SLE.
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Affiliation(s)
- M Prütz Petersen
- 1 Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Möller
- 2 OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark.,3 Odense University Hospital, Odense, Denmark
| | - A Bygum
- 1 Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - A Voss
- 4 Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - M Bliddal
- 2 OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Denmark.,3 Odense University Hospital, Odense, Denmark
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Domenyuk V, Gatalica Z, Santhanam R, Wei X, Stark A, Kennedy P, Toussaint B, Levenberg S, Wang R, Xiao N, Greil R, Rinnerthaler G, Gampenrieder S, Heimberger AB, Berry DJ, Barker A, Demetri GD, Quackenbush J, Marshall JL, Poste G, Vacirca JL, Vidal GA, Schwartzberg LS, Halbert DD, Voss A, Miglarese MR, Famulok M, Mayer G, Spetzler D. Abstract P2-09-09: Polyligand profiling differentiates cancer patients according to their benefit of treatment. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-09] [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
Abstract
Introduction: Deconvolution of multi-nodal perturbations in cancer network architecture demands highly multiplexed profiling assays. We demonstrate the value of polyligand profiling of tumor systems states using libraries of single stranded oligodeoxynucleotides (ssODN) to distinguish between tumor tissue from breast cancer patients who did or did not derive benefit from treatment regimens containing trastuzumab.
Methods: This study included cases from women with invasive breast cancer who received chemotherapy+ trastuzumab (C+T) or trastuzumab monotherapy with available retrospective data on the time to next treatment (TTNT). A library of 2x1012 unique ssODN was exposed to FFPE tissues from patients who benefited (B) or not (NB) from trastuzumab-based regimens in several rounds of positive and negative selection. Two enriched libraries were screened on independent set of 42 B and 19 NB cases using a modified IHC protocol for detection of bound ssODNs. Poly-Ligand Profiles (PLP) were scored by a blinded pathologist. Two libraries, EL-NB and EL-B, showed significant p-values between groups of responders and non-responders. A Cox-PH model was fitted using either tumors' HER2 status or PLP test results as the independent variable. Median survival time was calculated from the Kaplan-Meier estimate. A separate group of 63 cases with TTNT data from chemotherapy without trastuzumab was used as a control to distinguish prognostic from predictive performance.
Results: The PLP scores of EL-NB and EL-B were assessed by receiver operating characteristic (ROC) curves and resulted in a combined AUC value of 0.81. EL-NB and EL-B were able to effectively classify B and NB patients with either HER2-negative/equivocal (AUC = 0.73) or HER2-positive cancers (AUC = 0.84). In contrast, HER2 status alone yielded an AUC value of 0.47. The combined PLP scores for the independent set of 63 patients treated with C excluding trastuzumab resulted in an AUC value of 0.53, indicating that the assay was predictive and not simply prognostic. Kaplan-Meier curves analysis shows that PLP+ cases have 429 days median TTNT, while PLP- cases have 129 days (HR = 0.38, log-rank p = 0.001). Analysis based on HER2 status showed no significant difference in TTNT between patients that were HER2+ (280 days) or HER2-negative/equivocal (336 days, HR = 1.27, log-rank p =0.45).
Summary: Performance of the PLP assay in differentiating patients who did or did not benefit from trastuzumab therapy outperforms the standard IHC assay for HER2 status. These results represent a promising step towards the development of a CDx to identify the 50-70% of HER2+ patients who will not benefit from trastuzumab. In addition, PLP also has the potential to identify the HER2-negative/equivocal patients who may benefit from trastuzumab-containing regimens.
Citation Format: Domenyuk V, Gatalica Z, Santhanam R, Wei X, Stark A, Kennedy P, Toussaint B, Levenberg S, Wang R, Xiao N, Greil R, Rinnerthaler G, Gampenrieder S, Heimberger AB, Berry DJ, Barker A, Demetri GD, Quackenbush J, Marshall JL, Poste G, Vacirca JL, Vidal GA, Schwartzberg LS, Halbert DD, Voss A, Miglarese MR, Famulok M, Mayer G, Spetzler D. Polyligand profiling differentiates cancer patients according to their benefit of treatment [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-09.
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Affiliation(s)
- V Domenyuk
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - Z Gatalica
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - R Santhanam
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - X Wei
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - A Stark
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - P Kennedy
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - B Toussaint
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - S Levenberg
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - R Wang
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - N Xiao
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - R Greil
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - G Rinnerthaler
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - S Gampenrieder
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - AB Heimberger
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - DJ Berry
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - A Barker
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - GD Demetri
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - J Quackenbush
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - JL Marshall
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - G Poste
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - JL Vacirca
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - GA Vidal
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - LS Schwartzberg
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - DD Halbert
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - A Voss
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - MR Miglarese
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - M Famulok
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - G Mayer
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
| | - D Spetzler
- Caris Life Sciences, Phoenix, AZ; Paracelsus Medical University Salzburg, Austria and Salzburg Cancer Research Institute, and Cancer Cluster Salzburg, Salzburg, Austria; University of Texas MD Anderson Cancer Center, Houston, TX; Complex Adaptive Systems Initiative, Arizona State University, Scottsdale, AZ; Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, MA; Dana-Farber Cancer Institute, Boston, Boston, MA; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; North Shore Hematology Oncology Associates Cancer Center, New York, NY; University of Tennessee Health Science Center, Memphis, TN; LIMES Program Unit Chemical Biology & Medicinal Chemistry, c/o Kekulé Institute for Organic Chemistry and Biochemistry, University of Bonn, Bonn, Germany; Chemical Biology Max-Planck-Fellowship Group, Center of Advanced European Studies and Research (CAESAR, Bonn, Germany; Center of Aptamer Research and Development, University of Bonn, Bonn, Germany
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Hartswood MJ, Rouchy P, Rouncefield M, Slack R, Voss A, Procter RN. Working IT Out in Medical Practice: IT Systems Design and Development as Co-Realisation. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives: The paper explores possibilities for situating IT design and development work within the context of use so as to support the co-realisation of technology and ‘design in use’. The aim is to build a new understanding between IT professionals and users which is grounded upon what happens as the latter grapple with the problems of applying IT, appropriating its functionalities and affordances into their work practices and relations.
Methods: Following a discussion of participatory design and ethnomethodology, a novel method called co-realisation, which aims to provide a synthesis of the preceding methods, is suggested as an alternative. Through a discussion of findings from a case study of IT systems design and development in healthcare we show how the co-realisation approach might provide work-affording systems and how user-designer relations might be reformulated. We suggest that work-affording systems can be developed through the deployment of an engaged facilitator who works with the users to unpack the work site-specific potentialities of technology.
Results: The case study shows how risk of non-adoption might be minimised through the development of partnerships, and how the presence of the facilitator in the workplace capitalises on the mundane work undertaken therein and how the facilitator might work with the users to develop artefacts that support this work as opposed to reconfiguring it.
Conclusions: The case study illustrates co-realisation in action and how it might be seen to reconfigure relations between users and designers in a way that appears productive. Co-realisation can help address the widely observed problem of IT systems failures in healthcare.
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Abstract
Summary
Objectives:
The traditional techniques of data analysis are often not sufficient to characterize the complex dynamics of respiration. In this study the respiratory pattern variability was analyzed using symbolic dynamics.
Methods:
A group of 20 patients on weaning trials from mechanical ventilation were studied at two different pressure support ventilation levels. Breath duration (TTOT) time series and the relation TI/TTOT, that contains the influence of inspiratory time (TI), were considered. Length-3 words and 3 different symbols were proposed. The incidence of the overlapping τ and the parameter α were analyzed.
Results:
From the breath duration time series, the distribution of words with probability of occurrence higher than 6% was concentrated on one word for low respiratory variability, whereas high variability was characterized by 4 words, presenting a statistically significant difference (p ≤ 0.0005). The probability occurrence of words “110” and “111” was also significantly different (p ≤ .0005) when comparing both variabilities.
Conclusion:
The analysis carried out obtained discriminant functions able to correctly classify all the testing set series. These results permit the consideration of symbolic dynamics as a promising methodology to study the respiratory pattern variability.
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Baumert M, Baier V, Haueisen J, Wessel N, Meyerfeldt U, Schirdewan A, Voss A. Forecasting of Life Threatening Arrhythmias Using the Compression Entropy of Heart Rate. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1633859] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives:
Ventricular tachycardia (VT) provoking sudden cardiac death (SCD) are a major cause of mortality in the developed countries. The most efficient therapy for SCD prevention are implantable cardioverter defibrillators (ICD). In this study heart rate variability (HRV) measures were analyzed for short-term forecasting of VT in order to improve VT sensing and to enable a patient warning of forthcoming shocks.
Methods:
The last 1000 normal beat-to-beat intervals before 50 VT episodes stored by the ICD were analyzed and compared to individually acquired control time series (CON). HRV analysis was performed with standard parameters of time and frequency domain as suggested by the HRV Task Force and furthermore with a newly developed and optimized nonlinear parameter that assesses the compression entropy of heart rate (Hc).
Results:
Except of meanNN (p = 0.02) we found no significant differences in standard HRV parameters. In contrast, Hc revealed highly significant (p = 0.007) alterations in VT compared with CON suggesting a decreased complexity before the onset of VT.
Conclusion:
Compression entropy might be a suitable parameter for short-term forecasting of life-threatening tachycardia in ICD.
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Voss A, Imhoff A. Editorial zur Rubrik „AGA‑Assistenten“. Arthroskopie 2018. [DOI: 10.1007/s00142-018-0192-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fischer C, Schroeder R, Figulla HR, Goernig M, Voss A. Segmented Poincaré Plot Analysis for Risk Stratification in Patients with Dilated Cardiomyopathy. Methods Inf Med 2018; 49:511-5. [DOI: 10.3414/me09-02-0050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 01/04/2010] [Indexed: 11/09/2022]
Abstract
Summary
Background: The prognostic value of heart rate variability in patients with dilated cardiomyopathy (DCM) is limited and does not contribute to risk stratification although the dynamics of ventricular repolarization differs considerably between DCM patients and healthy subjects. Neither linear nor nonlinear methods of heart rate variability analysis could discriminate between patients at high and low risk for sudden cardiac death.
Objective: The aim of this study was to analyze the suitability of the new developed segmented Poincaré plot analysis (SPPA) to enhance risk stratification in DCM.
Methods: In contrast to the usual applied Poincaré plot analysis the SPPA retains nonlinear features from investigated beat-to-beat interval time series. Main features of SPPA are the rotation of cloud of points and their succeeded variability depended segmentation.
Results: Significant row and column probabilities were calculated from the segments and led to discrimination (up to p < 0.005) between low and high risk in DCM patients.
Conclusion: For the first time an index from Poincaré plot analysis of heart rate variability was able to contribute to risk stratification in patients suffering from DCM.
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Magiorakos AP, Burns K, Rodríguez Baño J, Borg M, Daikos G, Dumpis U, Lucet JC, Moro ML, Tacconelli E, Simonsen GS, Szilágyi E, Voss A, Weber JT. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control. Antimicrob Resist Infect Control 2017; 6:113. [PMID: 29163939 PMCID: PMC5686856 DOI: 10.1186/s13756-017-0259-z] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [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: 06/02/2017] [Accepted: 09/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background Infections with carbapenem-resistant Enterobacteriaceae (CRE) are increasingly being reported from patients in healthcare settings. They are associated with high patient morbidity, attributable mortality and hospital costs. Patients who are “at-risk” may be carriers of these multidrug-resistant Enterobacteriaceae (MDR-E). The purpose of this guidance is to raise awareness and identify the “at-risk” patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE. Methods The guidance was created by a group of experts who were functioning independently of their organisations, during two meetings hosted by the European Centre for Disease Prevention and Control. A list of epidemiological risk factors placing patients “at-risk” for carriage with CRE was created by the experts. The conclusions of a systematic review on the prevention of spread of CRE, with the addition of expert opinion, were used to construct lists of core and supplemental infection prevention and control measures to be implemented for “at-risk” patients upon admission to healthcare settings. Results Individuals with the following profile are “at-risk” for carriage of CRE: a) a history of an overnight stay in a healthcare setting in the last 12 months, b) dialysis-dependent or cancer chemotherapy in the last 12 months, c) known previous carriage of CRE in the last 12 months and d) epidemiological linkage to a known carrier of a CRE. Core infection prevention and control measures that should be considered for all patients in healthcare settings were compiled. Preliminary supplemental measures to be implemented for “at-risk” patients on admission are: pre-emptive isolation, active screening for CRE, and contact precautions. Patients who are confirmed positive for CRE will need additional supplemental measures. Conclusions Strengthening the microbiological capacity, surveillance and reporting of new cases of CRE in healthcare settings and countries is necessary to monitor the epidemiological situation so that, if necessary, the implemented CRE prevention strategies can be refined in a timely manner. Creating a large communication network to exchange this information would be helpful to understand the extent of the CRE reservoir and to prevent infections in healthcare settings, by applying the principles outlined here. This guidance document offers suggestions for best practices, but is in no way prescriptive for all healthcare settings and all countries. Successful implementation will result if there is local commitment and accountability. The options for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources. Electronic supplementary material The online version of this article (10.1186/s13756-017-0259-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A P Magiorakos
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - K Burns
- Beaumont Hospital, Royal College of Surgeons in Ireland & Health Protection Surveillance Centre, Dublin, Ireland
| | - J Rodríguez Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Universidad de Sevilla / Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - M Borg
- Departments of Infection Control & Sterile Services, Mater Dei Hospital, MSD2090, Msida, Malta
| | - G Daikos
- First Department of Medicine, Laikon General Hospital, Athens, Greece
| | - U Dumpis
- Department of Infectious diseases and Infection Control. Pauls Stradins University Hospital, Riga, Latvia
| | - J C Lucet
- Infection Control Unit, Bichat Claude Bernard Hospital, AP-HP, Paris, France
| | - M L Moro
- Agenzia Sanitaria e Sociale Regione Emilia-Romagna, Bologna, Italy
| | - E Tacconelli
- Division of Infectious Diseases, Department Internal Medicine 1, DZIF Center, Tübingen University, Tübingen, Germany
| | - G Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, and UiT - The Arctic University of Norway, Tromsø, Norway
| | - E Szilágyi
- Department of Epidemiology and Hospital Hygiene, National Public Health and Medical Officer Service, Budapest, Hungary
| | - A Voss
- Department of Medical Microbiology, Radboud University Medical Centre and Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J T Weber
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
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Busch RW, Kay SD, Voss A. Hospitalizations among Danish SLE patients: a prospective study on incidence, causes of admission and risk factors in a population-based cohort. Lupus 2017; 27:165-171. [PMID: 29050537 DOI: 10.1177/0961203317734919] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective To determine the incidence, duration and cause of hospitalization in a cohort of Danish patients with systemic lupus erythematosus (SLE). In addition, we investigated risk factors for admission and prolonged hospital stay. Methods A total of 155 SLE patients from a population-based cohort were included in the study during a period of 70 months, from January 2007 to October 2012. Data on frequency, cause and duration of hospitalizations were obtained by review of medical charts. Data on disease manifestations, organ damage and treatment were collected prospectively. Results A total of 101 of the 155 SLE patients (65%) had one or more hospitalization during the study period. The incidence rate of all hospitalizations was 0.50 per year. Leading causes of admission were complications to SLE or its treatment, but infections were also common. Mean duration of hospital stay was 6.4 ± 10.5 days, and SLE Disease Activity Index 2000 (SLEDAI-2K) on admission emerged as a risk factor for prolonged hospital stay. Conclusion Danish SLE patients experience frequent admissions to hospital. Complications to SLE or its treatment, as well as infections, are leading causes of admission. High SLEDAI-2K on admission is a risk factor for prolonged hospital stay.
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Affiliation(s)
- R W Busch
- Department of Rheumatology, Odense University Hospital, Denmark
| | - S D Kay
- Department of Rheumatology, Odense University Hospital, Denmark
| | - A Voss
- Department of Rheumatology, Odense University Hospital, Denmark
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Siepen FAD, Bauer R, Voss A, Hein S, Aurich M, Riffel J, Mereles D, Röcken C, Buss SJ, Katus HA, Kristen AV. Predictors of survival stratification in patients with wild-type cardiac amyloidosis. Clin Res Cardiol 2017; 107:158-169. [DOI: 10.1007/s00392-017-1167-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
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Tain J, Guadilla V, Valencia E, Algora A, Zakari-Issoufou AA, Rice S, Meur LL, Agramunt J, Äystö J, Batist L, Bowry M, Briz J, Bui V, Caballero-Folch R, Cano-Ott D, Cucoanes A, Elomaa VV, Eronen T, Estevez E, Estienne M, Fallot M, Farrelly G, Fraile L, Ganioglu E, Garcia A, Gelletly W, Gómez-Hornillos B, Gorelov D, Gorlychev V, Hakala J, Jokinen A, Jordan M, Kankainen A, Kolhinen V, Kondev F, Koponen J, Lebois M, Martínez T, Mason P, Mendoza E, Monserrate M, Montaner-Pizá A, Moore I, Nacher E, Orrigo S, Penttilä H, Podolyák Z, Pohjalainen I, Porta A, Regan P, Reinikainen J, Reponen M, Rinta-Antila S, Rissanen J, Rubio B, Rytkönen K, Shiba T, Sonnenschein V, Sonzogni A, Vedia V, Voss A, Wilson J. Strong γ-ray emission from neutron unbound states populated in β-decay: Impact on (n,γ) cross-section estimates. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201714601002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Núñez-Núñez M, Navarro MD, Palomo V, Rajendran NB, Del Toro MD, Voss A, Sharland M, Sifakis F, Tacconelli E, Rodríguez-Baño J. The methodology of surveillance for antimicrobial resistance and healthcare-associated infections in Europe (SUSPIRE): a systematic review of publicly available information. Clin Microbiol Infect 2017; 24:105-109. [PMID: 28750921 DOI: 10.1016/j.cmi.2017.07.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Surveillance is a key component of any control strategy for healthcare-associated infections (HAIs) and antimicrobial resistance (AMR), and public availability of methodologic aspects is crucial for the interpretation of the data. We sought to systematically review publicly available information for HAIs and/or AMR surveillance systems organized by public institutions or scientific societies in European countries. METHODS A systematic review of scientific and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was performed. Information on HAIs and/or AMR surveillance systems published until 31 October 2016 were included. RESULTS A total of 112 surveillance systems were detected; 56 from 20 countries were finally included. Most exclusions were due to lack of publicly available information. Regarding AMR, the most frequent indicator was the proportion of resistant isolates (27 of 34 providing information, 79.42%); only 18 (52.9%) included incidence rates; the data were only laboratory based in 33 (78.5%) of the 42 providing this information. Regarding HAIs in intensive care units, all 22 of the systems providing data included central line-associated bloodstream infections, and 19 (86.3%) included ventilator-associated pneumonia and catheter-associated urinary tract infections; incidence density was the most frequent indicator. Regarding surgical site infections, the most frequent procedures included were hip prosthesis, colon surgery and caesarean section (21/22, 95.5%). CONCLUSIONS Publicly available information about the methods and indicators of the surveillance system is frequently lacking. Despite the efforts of European Centre for Disease Control and Prevention (ECDC) and other organizations, wide heterogeneity in procedures and indicators still exists.
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Affiliation(s)
- M Núñez-Núñez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/Universidad de Sevilla/Centro Superior de Investigaciones Científicas (CSIC), Spain; Unidad Clínica de Farmacia Hospitalaria, Hospital Universitario Virgen Macarena, Seville, Spain
| | - M D Navarro
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/Universidad de Sevilla/Centro Superior de Investigaciones Científicas (CSIC), Spain
| | - V Palomo
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/Universidad de Sevilla/Centro Superior de Investigaciones Científicas (CSIC), Spain
| | - N B Rajendran
- Infectious Diseases, Internal Medicine 1, DZIF Center, Tübingen University Hospital, Tübingen, Germany
| | - M D Del Toro
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/Universidad de Sevilla/Centro Superior de Investigaciones Científicas (CSIC), Spain
| | - A Voss
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's University London, London, UK
| | - F Sifakis
- AstraZeneca LP, Gaithersburg, Maryland, USA
| | - E Tacconelli
- Infectious Diseases, Internal Medicine 1, DZIF Center, Tübingen University Hospital, Tübingen, Germany
| | - J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/Universidad de Sevilla/Centro Superior de Investigaciones Científicas (CSIC), Spain.
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