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Arem H, Duarte DA, White B, Vinson K, Hinds P, Ball N, Dennis K, McCready DM, Cafferty LA, Berg CJ. Young Adult Cancer Survivors' Perspectives on Cancer's Impact on Different Life Areas Post-Treatment: A Qualitative Study. J Adolesc Young Adult Oncol 2024. [PMID: 38695773 DOI: 10.1089/jayao.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
Purpose: Young adult cancer survivors experience disruptions in various life domains (e.g., relationships, academic/career) during and after treatment. This study examined life disruptions and related supports to update interventions to improve psychological outcomes. Methods: In April-July 2023, young adult survivors (n = 23) were recruited (via clinics, support groups, nonprofit organizations, etc.) to complete semi-structured interviews assessing cancer's impact across life domains, how they coped with related disruptions, and facilitators to improved psychosocial well-being. We used a dual deductive-inductive approach to develop a codebook and then coded transcripts in Dedoose. Results: This sample was on average 33.7 years old (standard deviation [SD] = 4.4), 78.3% female, 73.9% non-Hispanic White, 47.8% married/cohabitating, 2.4 (SD = 1.0) years post-diagnosis, 1.4 years (SD = 0.9) post-treatment, and largely diagnosed with breast cancer (52.1%) or leukemia/lymphoma (34.7%). The most salient themes related to disruptions included mental health, feelings of isolation during survivorship, and disruptions to career and relationships with family or partners. Participants reported challenges navigating these feelings and disruptions, and difficulty understanding and conveying their needs. Many experienced limited support for navigating cancer-related trauma and life disruptions as a survivor. Participants also reported some positive impacts, like reevaluating their values and goals or feeling resilient, and emphasized the need to identify supports, accept that life had changed because of cancer, and have their needs and continued struggles validated by others during survivorship. Conclusions: Young adults experience ongoing disruptions across multiple life domains, underscoring the need for integrated, longer-term psychosocial supports to help them navigate these disruptions and reevaluate their goals.
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Affiliation(s)
- Hannah Arem
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA
| | - Danielle A Duarte
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Benjamin White
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Katie Vinson
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Pamela Hinds
- Department of Pediatrics, George Washington University, Children's National Hospital, Washington, District of Columbia, USA
| | - Nathan Ball
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Kyla Dennis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Darcey M McCready
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Lauren A Cafferty
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
- GW Cancer Center, George Washington University, Washington, District of Columbia, USA
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White B, Hetzel A, Willgerodt M, Durkee-Neuman E, Nguyen L. The impact of COVID-19 on school nursing: A qualitative survey of stressors faced by school nurses. Public Health Nurs 2024; 41:543-554. [PMID: 38497562 DOI: 10.1111/phn.13297] [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: 07/20/2023] [Revised: 01/26/2024] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND As students returned to school, school nurses were responsible for infection control, communication, and the preparation of supplies and facilities. School nurses in the Pacific Northwest US demonstrated a higher prevalence of mental health symptoms in the years since the pandemic began, suggesting that their experience may have been unique. OBJECTIVE This study aimed to explore the stressors of school nurses in the Pacific Northwest at two time points. DESIGN This study is a qualitative, descriptive analysis of anonymous survey responses collected in June of 2021 (n = 333) and between October and December 2021 (n = 284). SAMPLE Self-identifying school nurses working in K-12 schools in Washington State were invited to participate. MEASUREMENTS Participants completed open-ended survey questions designed to elicit their experiences during the pandemic. RESULTS Four themes emerged from the data: (1) isolation from administration and the school community, (2) COVID-19-related workload, (3) disorganized and inconsistent communication, and (4) concern for students, themselves, and others. CONCLUSIONS School nurses played a vital public health role during the pandemic. However, their effectiveness may not have been fully utilized and sometimes undermined. Lastly, our findings highlight the difficulties encountered in implementing the changing scientific and public health guidance during the pandemic.
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Affiliation(s)
| | - Annie Hetzel
- WA Office of the Superintendent for Public Instruction, Seattle, Washington, USA
| | | | | | - Lan Nguyen
- Seattle University, Seattle, Washington, USA
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Coughlan A, Klijn SL, Xiao H, White B, Franco-Villalobos C, Sichevaya A, Hnoosh A, Miteva D, Yucel A. HSR24-132: Value of Early Transfusion Burden Reduction in Lower-Risk Myelodysplastic Syndromes (LR-MDS). J Natl Compr Canc Netw 2024; 22:HSR24-132. [PMID: 38579810 DOI: 10.6004/jnccn.2023.7266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
| | | | - Hong Xiao
- 2Bristol Myers Squibb, Princeton, NJ
| | | | | | | | | | - Dimana Miteva
- 7Celgene International Sarl, a Bristol Myers Squibb Company, Boudry, Switzerland
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Baugh CW, Cash RE, Meguerdichian D, Dunham L, Stump T, Stevens R, Reust A, White B, Dutta S. An Electronic Medical Record Intervention to Increase Pharmacologic Prophylaxis for Venous Thromboembolism in Emergency Department Observation Patients. Ann Emerg Med 2024; 83:24-34. [PMID: 37725025 DOI: 10.1016/j.annemergmed.2023.08.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
STUDY OBJECTIVE The role of venous thromboembolism (VTE) prophylaxis among patients receiving emergency department (ED) observation unit care is unclear. We investigated an electronic health record-based clinical decision support tool aimed at increasing pharmacologic VTE prophylaxis use among at-risk patients placed in ED observation units. METHODS We conducted an interrupted time-series study of an Epic-based best practice advisory implemented in May 2019 at a health care system comprising 2 academic medical centers and 4 community hospitals with dedicated ED observation units. The best practice advisory alerted staff at 24 hours to conduct a risk assessment and linked to a VTE prophylaxis order set. We used an interrupted time series, Bayesian structured time series, and a multivariable mixed-effect regression model to estimate the intervention effect. RESULTS Prior to the best practice advisory implementation, there were 8,895 ED observation unit patients with a length of stay more than or equal to 24 hours, and 0.9% received pharmacologic VTE prophylaxis. Afterward, there were 12,664 ED observation unit patients with a length of stay more than or equal to 24 hours, and 4.8% received pharmacologic VTE prophylaxis. The interrupted time series and causal impact analysis showed a statistically significant increase in VTE prophylaxis (eg, absolute percent difference 3.8%, 95% confidence interval 3.5 to 4.1). In a multivariable model, only the intervention was significantly associated with receiving VTE prophylaxis (odds ratio 4.56, 95% confidence interval 2.22 to 9.37). CONCLUSION An electronic health record-based alert helped to prompt staff caring for ED observation unit patients at risk for VTE with prolonged visits to order recommended pharmacologic prophylaxis. The best risk assessment model to use and the true incidence of VTE events in this population are unclear.
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Affiliation(s)
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Lisette Dunham
- Clinical Informatics, Mass General Brigham Digital, Boston, MA
| | - Timothy Stump
- Clinical Informatics, Mass General Brigham Digital, Boston, MA
| | - Ronelle Stevens
- Mosaic Inpatient Applications, Boston Children's Hospital, Boston, MA
| | - Audrey Reust
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA
| | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Sayon Dutta
- Clinical Informatics, Mass General Brigham Digital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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5
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Matteson NL, Hassler GW, Kurzban E, Schwab MA, Perkins SA, Gangavarapu K, Levy JI, Parker E, Pride D, Hakim A, De Hoff P, Cheung W, Castro-Martinez A, Rivera A, Veder A, Rivera A, Wauer C, Holmes J, Wilson J, Ngo SN, Plascencia A, Lawrence ES, Smoot EW, Eisner ER, Tsai R, Chacón M, Baer NA, Seaver P, Salido RA, Aigner S, Ngo TT, Barber T, Ostrander T, Fielding-Miller R, Simmons EH, Zazueta OE, Serafin-Higuera I, Sanchez-Alavez M, Moreno-Camacho JL, García-Gil A, Murphy Schafer AR, McDonald E, Corrigan J, Malone JD, Stous S, Shah S, Moshiri N, Weiss A, Anderson C, Aceves CM, Spencer EG, Hufbauer EC, Lee JJ, King AJ, Ramesh KS, Nguyen KN, Saucedo K, Robles-Sikisaka R, Fisch KM, Gonias SL, Birmingham A, McDonald D, Karthikeyan S, Martin NK, Schooley RT, Negrete AJ, Reyna HJ, Chavez JR, Garcia ML, Cornejo-Bravo JM, Becker D, Isaksson M, Washington NL, Lee W, Garfein RS, Luna-Ruiz Esparza MA, Alcántar-Fernández J, Henson B, Jepsen K, Olivares-Flores B, Barrera-Badillo G, Lopez-Martínez I, Ramírez-González JE, Flores-León R, Kingsmore SF, Sanders A, Pradenas A, White B, Matthews G, Hale M, McLawhon RW, Reed SL, Winbush T, McHardy IH, Fielding RA, Nicholson L, Quigley MM, Harding A, Mendoza A, Bakhtar O, Browne SH, Olivas Flores J, Rincon Rodríguez DG, Gonzalez Ibarra M, Robles Ibarra LC, Arellano Vera BJ, Gonzalez Garcia J, Harvey-Vera A, Knight R, Laurent LC, Yeo GW, Wertheim JO, Ji X, Worobey M, Suchard MA, Andersen KG, Campos-Romero A, Wohl S, Zeller M. Genomic surveillance reveals dynamic shifts in the connectivity of COVID-19 epidemics. Cell 2023; 186:5690-5704.e20. [PMID: 38101407 PMCID: PMC10795731 DOI: 10.1016/j.cell.2023.11.024] [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: 03/12/2023] [Revised: 08/21/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
The maturation of genomic surveillance in the past decade has enabled tracking of the emergence and spread of epidemics at an unprecedented level. During the COVID-19 pandemic, for example, genomic data revealed that local epidemics varied considerably in the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lineage importation and persistence, likely due to a combination of COVID-19 restrictions and changing connectivity. Here, we show that local COVID-19 epidemics are driven by regional transmission, including across international boundaries, but can become increasingly connected to distant locations following the relaxation of public health interventions. By integrating genomic, mobility, and epidemiological data, we find abundant transmission occurring between both adjacent and distant locations, supported by dynamic mobility patterns. We find that changing connectivity significantly influences local COVID-19 incidence. Our findings demonstrate a complex meaning of "local" when investigating connected epidemics and emphasize the importance of collaborative interventions for pandemic prevention and mitigation.
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Affiliation(s)
| | - Gabriel W Hassler
- Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ezra Kurzban
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Madison A Schwab
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Sarah A Perkins
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Karthik Gangavarapu
- Department of Biomathematics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA, USA; Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Joshua I Levy
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Edyth Parker
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - David Pride
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Abbas Hakim
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA; COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Peter De Hoff
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA; COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Willi Cheung
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA; COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Anelizze Castro-Martinez
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA; Sanford Consortium of Regenerative Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Andrea Rivera
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Anthony Veder
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Ariana Rivera
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Cassandra Wauer
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Jacqueline Holmes
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Jedediah Wilson
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Shayla N Ngo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Ashley Plascencia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Elijah S Lawrence
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Elizabeth W Smoot
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Emily R Eisner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Rebecca Tsai
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Marisol Chacón
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Nathan A Baer
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Phoebe Seaver
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Rodolfo A Salido
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Stefan Aigner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Toan T Ngo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Tom Barber
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Tyler Ostrander
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA; Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | | | - Oscar E Zazueta
- Department of Epidemiology, Secretaria de Salud de Baja California, Tijuana, Baja California, Mexico
| | | | - Manuel Sanchez-Alavez
- Centro de Diagnostico COVID-19 UABC, Tijuana, Baja California, Mexico; Department of Molecular Medicine, Scripps Research, La Jolla, CA, USA
| | | | - Abraham García-Gil
- Clinical Laboratory Department, Salud Digna, A.C, Tijuana, Baja California, Mexico
| | | | - Eric McDonald
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Jeremy Corrigan
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - John D Malone
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Sarah Stous
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Seema Shah
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Niema Moshiri
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Alana Weiss
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Catelyn Anderson
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Christine M Aceves
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Emily G Spencer
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Emory C Hufbauer
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Justin J Lee
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Alison J King
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Karthik S Ramesh
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Kelly N Nguyen
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Kieran Saucedo
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | | | - Kathleen M Fisch
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA; Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Steven L Gonias
- Department of Pathology, University of California, San Diego, La Jolla, CA, USA
| | - Amanda Birmingham
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Smruthi Karthikeyan
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Natasha K Martin
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Robert T Schooley
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Agustin J Negrete
- Facultad de Ciencias de la Salud Universidad Autonoma de Baja California Valle de Las Palmas, Tijuana, Baja California, Mexico
| | - Horacio J Reyna
- Facultad de Ciencias de la Salud Universidad Autonoma de Baja California Valle de Las Palmas, Tijuana, Baja California, Mexico
| | - Jose R Chavez
- Facultad de Ciencias de la Salud Universidad Autonoma de Baja California Valle de Las Palmas, Tijuana, Baja California, Mexico
| | - Maria L Garcia
- Facultad de Ciencias de la Salud Universidad Autonoma de Baja California Valle de Las Palmas, Tijuana, Baja California, Mexico
| | - Jose M Cornejo-Bravo
- Facultad de Ciencias Quimicas e Ingenieria, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | | | | | | | | | - Richard S Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | | | | | - Benjamin Henson
- Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Kristen Jepsen
- Institute for Genomic Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Beatriz Olivares-Flores
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Ciudad de México, CDMX, Mexico
| | - Gisela Barrera-Badillo
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Ciudad de México, CDMX, Mexico
| | - Irma Lopez-Martínez
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Ciudad de México, CDMX, Mexico
| | - José E Ramírez-González
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Ciudad de México, CDMX, Mexico
| | - Rita Flores-León
- Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Ciudad de México, CDMX, Mexico
| | | | - Alison Sanders
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Allorah Pradenas
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Benjamin White
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Gary Matthews
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Matt Hale
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Ronald W McLawhon
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Sharon L Reed
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | - Terri Winbush
- Return to Learn, University of California, San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | | | - Sara H Browne
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, CA, USA; Specialist in Global Health, Encinitas, CA, USA
| | - Jocelyn Olivas Flores
- Facultad de Ciencias Quimicas e Ingenieria, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico; University of HealthMx, Tijuana, Baja California, Mexico
| | - Diana G Rincon Rodríguez
- University of HealthMx, Tijuana, Baja California, Mexico; Facultad de Medicina, Universidad Xochicalco, Tijuana, Baja California, Mexico
| | - Martin Gonzalez Ibarra
- University of HealthMx, Tijuana, Baja California, Mexico; Facultad de Medicina, Universidad Xochicalco, Tijuana, Baja California, Mexico
| | - Luis C Robles Ibarra
- University of HealthMx, Tijuana, Baja California, Mexico; Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Tijuana, Baja California, Mexico
| | - Betsy J Arellano Vera
- University of HealthMx, Tijuana, Baja California, Mexico; Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | - Jonathan Gonzalez Garcia
- University of HealthMx, Tijuana, Baja California, Mexico; SIMNSA, Tijuana, Baja California, Mexico
| | | | - Rob Knight
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
| | - Louise C Laurent
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA; Sanford Consortium of Regenerative Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gene W Yeo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA; Sanford Consortium of Regenerative Medicine, University of California, San Diego, La Jolla, CA, USA; Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Joel O Wertheim
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Xiang Ji
- Department of Mathematics, School of Science and Engineering, Tulane University, New Orleans, LA, USA
| | - Michael Worobey
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Marc A Suchard
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristian G Andersen
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA.
| | - Abraham Campos-Romero
- Innovation and Research Department, Salud Digna, A.C, Tijuana, Baja California, Mexico
| | - Shirlee Wohl
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA
| | - Mark Zeller
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA, USA.
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6
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Chan MPS, Liu S, White B, Zhang A, Zhou Y, Leung M, Dai W, Liu X, Durantini M, Ye Q, Palmese L, O’Keefe D, Albarracín D. The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics. J Consult Clin Psychol 2023; 91:574-595. [PMID: 37410398 PMCID: PMC10527151 DOI: 10.1037/ccp0000827] [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] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population). METHOD This meta-analysis of 331 reports (clusters; number of effect sizes [k] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups. RESULTS Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index. CONCLUSIONS Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Man-pui Sally Chan
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Sicong Liu
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | | | - Angela Zhang
- Department of Psychology and Annenberg Public Policy Center, University of Pennsylvania
| | - Yubo Zhou
- Department of Psychology and Annenberg Public Policy Center, University of Pennsylvania
| | - Melody Leung
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Wenhao Dai
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Xi Liu
- Department of Psychology, University of Illinois
| | - Marta Durantini
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Qijia Ye
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Lidia Palmese
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Devlin O’Keefe
- Annenberg School of Communication and Annenberg Public Policy Center, University of Pennsylvania
| | - Dolores Albarracín
- Annenberg School of Communication, Department of Family and Community Health, and Department of Psychology, University of Pennsylvania
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7
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George J, Ramage J, White B, Srirajaskanthan R. The role of serotonin inhibition within the treatment of carcinoid syndrome. Endocr Oncol 2023; 3:e220077. [PMID: 37434648 PMCID: PMC10305560 DOI: 10.1530/eo-22-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/20/2023] [Indexed: 07/13/2023]
Abstract
Carcinoid syndrome is the most frequent hormonal complication associated with neuroendocrine neoplasms. It was first reported in 1954, and the classical symptoms are diarrhoea, flushing and abdominal pain. It is caused by the secretion of several vasoactive substances, the most prominent being serotonin, which play a pathophysiological role in the clinical symptoms which characterise carcinoid syndrome. Therefore, the focus of carcinoid syndrome treatment is to reduce serotonin production and hence improve the patient's quality of life. There are a variety of management options for carcinoid syndrome including medical, surgical and loco-regional interventional radiological procedures. The most widely used are somatostatin analogues with three clinically approved drugs: lanreotide and octreotide (first-generation) and pasireotide (second-generation). Both everolimus and interferon used in combination with octreotide have shown significant reduction in urinary 5-hydroxyindoleacetic acid compared to octreotide alone. Telotristat ethyl has been increasingly utilised for patients with symptoms despite taking somatostatin analogues. It has also been shown to have a significant improvement in bowel movement frequency which was associated with a significant improvement in quality of life. Peptide receptor radionuclide therapy has proven symptomatic improvement in patients with uncontrolled symptoms. Chemotherapy is primarily reserved for patients with high proliferation tumours, with limited research on the efficacy in reducing symptoms. Surgical resection remains the optimal treatment due to being the only one that can achieve a cure. Liver-directed therapies are considered in patients where curative resection is not possible. There are therefore numerous different therapies. This paper describes the pathophysiology and therapy of carcinoid syndrome.
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Affiliation(s)
- Joel George
- Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom of Great Britain and Northern Ireland
| | - John Ramage
- Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom of Great Britain and Northern Ireland
| | - Benjamin White
- Hampshire Hospitals NHS Trust, Basingstoke, United Kingdom of Great Britain and Northern Ireland
| | - Rajaventhan Srirajaskanthan
- Kings Health Partners NET Centre of Excellence, London, United Kingdom of Great Britain and Northern Ireland
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8
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Pregler KC, Obedzinski M, Gilbert‐Horvath EA, White B, Carlson SM, Garza JC. Assisted gene flow from outcrossing shows the potential for genetic rescue in an endangered salmon population. Conserv Lett 2022. [DOI: 10.1111/conl.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kasey C. Pregler
- Department of Environmental Science, Policy, and Management University of California, Berkeley Berkeley California USA
| | - Mariska Obedzinski
- Department of Environmental Science, Policy, and Management University of California, Berkeley Berkeley California USA
- California Sea Grant Windsor California USA
| | - Elizabeth A. Gilbert‐Horvath
- Southwest Fisheries Science Center National Marine Fisheries Service and University of California, Santa Cruz Santa Cruz California USA
| | - Benjamin White
- U.S. Army Corps of Engineers, Don Clausen/Warm Springs Hatchery Geyserville California USA
| | - Stephanie M. Carlson
- Department of Environmental Science, Policy, and Management University of California, Berkeley Berkeley California USA
| | - John Carlos Garza
- Southwest Fisheries Science Center National Marine Fisheries Service and University of California, Santa Cruz Santa Cruz California USA
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9
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Ling R, White B, Roberts J, Cretikos M, Howard MV, Haber PS, Lintzeris N, Reeves P, Dunlop AJ, Searles A. Depot buprenorphine as an opioid agonist therapy in New South Wales correctional centres: a costing model. BMC Health Serv Res 2022; 22:1326. [PMID: 36348369 PMCID: PMC9644557 DOI: 10.1186/s12913-022-08687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background In 2019 daily liquid methadone and sublingual buprenorphine-naloxone were primary opioid agonist treatments for correctional centres in New South Wales, Australia. However, both had significant potential for diversion to other patients, and their daily administration was resource intensive. An alternative treatment in the form of subcutaneous depot buprenorphine became a viable option following a safety trial in 2020 – the UNLOC-T study. Depot preparation demonstrated advantages over current treatments as more difficult to divert and requiring fewer administrations. This paper reports the results of economic modelling of staffing costs in medication administration comparing depot buprenorphine, methadone, and sublingual buprenorphine provision in UNLOC-T trial facilities. Methods The costing study adopted a micro-costing approach involving the synthesis of cost data from the UNLOC-T clinical trial as well as data collected from Justice Health and Forensic Mental Health Network records. Labour and materials data were collected during site observations and interviews. Costs were calculated from two payer perspectives: a) the New South Wales (state) government which funds custodial and health services; and b) the Australian Commonwealth government, which pays for medications. The analysis compared the monthly-per-patient cost for each of the three medications in trial-site facilities during July 2019. This was followed by simulation of depot buprenorphine implementation across the study population. Costs associated with medical assessment and reviews were excluded. Results The monthly-per-patient New South Wales government service costs of depot buprenorphine, methadone and sublingual buprenorphine were: $151, $379 and $1,529 respectively while Commonwealth government medication costs were $434, $80 and $525. The implementation simulation found that service costs of depot buprenorphine declined as patients transitioned from weekly to monthly administration. Costs of treatment using the other medications increased as patient numbers decreased alongside fixed costs. At 12 months, monthly-per-patient service costs for depot buprenorphine, methadone and sublingual buprenorphine—which would be completely phased out by month 13—were $92, $530 and $2,162 respectively. Conclusions Depot buprenorphine was consistently the least costly of the treatment options. Future modelling could allow for dynamic patient populations and downstream impacts for participants and the state health system. Trial registration ACTRN12618000942257. Registered 4 June 2018.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08687-8.
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Purnat TD, Bertrand-Ferrandis C, Yau B, Ishizumi A, White B, Briand S, Ngueyn T. Training health professionals in infodemic management to mitigate the harm caused by infodemics. Eur J Public Health 2022; 32:ckac129.324. [PMCID: PMC9832944 DOI: 10.1093/eurpub/ckac129.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background Due to their multifaceted impacts on health and society, understanding and controlling infodemics to support uptake of vaccines, public health and social measures, treatments, and health behaviours is rapidly becoming a priority for many health authorities. WHO has developed a comprehensive training programme to support health professionals in the new field of expertise of managing infodemics. Objectives The WHO infodemic management multiformat and transdisciplinary training program builds the skills and knowledge needed to prepare for and respond to infodemics. The trainings are built on WHO competency framework for building an infodemic response workforce. The methodology used relies on human-centred and emotional design evidence and practice and uses evaluation for continuous learning design improvement. Results Since November 2020, three WHO global trainings organized online with US Centers for Disease Control and Prevention, UNICEF and other partners, including four-week-long simulation exercises, creating a network of 772 infodemic managers in 133 countries. A “train-the-trainers” companion package was prepared and by April 2022 delivered in Iran and Malaysia. Deep dive training modules on specialist infodemic management practice topics have been prepared for use at country level. In addition, a comprehensive set of self-paced free online courses enhances infodemic literacy and resilience to misinformation. Between December 2021 and April 2022, the OpenWHO Infodemic Management 101 course reached over 17 000 enrolments. The training programme will be updated based on evaluations, the feedback from field responders and the updated to the WHO competency framework for infodemic management workforce. Conclusions The WHO multiformat blended training program allows an efficient and rapid dissemination of infodemic management skills and knowledge. Key messages • A global network of trained infodemic managers is ready to support national preparedness and response planning. • Skills and knowledge in infodemic management are accessible to all thanks to free online courses.
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Affiliation(s)
- TD Purnat
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | | | - B Yau
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - A Ishizumi
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - B White
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - S Briand
- High Impact Events Preparedness, WHO, Geneva, Switzerland
| | - T Ngueyn
- High Impact Events Preparedness, WHO, Geneva, Switzerland
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11
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Purnat TD, Ishizumi A, Yau B, White B, Bertrand-Ferrandis C, Briand S, Nguyen T. Delivering actionable infodemic insights and recommendations for the COVID-19 pandemic response. Eur J Public Health 2022; 32:ckac129.645. [PMCID: PMC9593848 DOI: 10.1093/eurpub/ckac129.645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Issue The COVID-19 pandemic and current recovery efforts have been complicated by a parallel infodemic. The infodemic has manifested itself in the rapid spread of questions, concerns and misinformation that can affect population attitudes and behavior harmful to health -promoting stigma and discrediting science, non-recommended treatments and cures, politicizing health programs and eroding trust in health workers and health systems. Description WHO's COVID-19 Pillar 2 (risk communication, community engagement and infodemic management) developed an integrated public health infodemic insights methodology for weekly analysis of social media, traditional media and other data sources to identify, categorize, and understand the key concerns and narratives expressed, and inform risk communication and response activities. Results The infodemic characterization, integrated analysis and insights generation consisted of a 3-step mixed-methods approach. First, data was collected from publicly available social and news media and categorized into categories of conversations by a COVID-19 public health taxonomy. Second, the dataset was analyzed and compared week-on-week to identify changes in narratives and conversation sentiment. Third, the digital infodemic intelligence was reviewed by a group of subject matter experts and triangulated with other data sources to derive infodemic insights and provide recommendations for action for the week. The methodology has been applied to inform COVID-19 response, COVID-19 vaccine demand promotion, and preparing for mass gatherings or mass immunization campaigns. Lessons The methodology for infodemic intelligence generation and integration has introduced evidence-based analytical practices for generation of infodemic insights and recommendations for action into the work of WHO. It must be further adapted for use by different health programmes and preparedness functions, and is described WHO Field Infodemiology Manual. Key messages • Health authorities can use infodemic insights to respond to people’s concerns, questions and information deficits in a timely and effective manner. • An evidence-based methodology has been developed and validated to generate infodemic insights and recommendations for action during an acute health event or emergency.
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Affiliation(s)
- TD Purnat
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - A Ishizumi
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - B Yau
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - B White
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | | | - S Briand
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
| | - T Nguyen
- Epidemic and Pandemic Preparedness and Prevention, WHO, Geneva, Switzerland
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12
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Ishizumi A, Dunn AG, Purnat T, Yau B, Bertrand-Ferrandis C, White B, Briand S, Nguyen T. Measuring the burden of infodemics on health outcomes through harmonized global metrics. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue/problem
Infodemics happen when an excess of information makes it difficult for people to discern what they see and hear to make good health decisions. Several challenges limit the usefulness of applying infodemiology research to the practice of managing infodemics including inconsistency in how information exposure is measured and a lack of focus on assessing associations with health behaviors.
Description of the problem
In 2021, WHO partnered with the University of Sydney to develop a study toolkit. We sought to create novel tools for measuring information exposure that can be easily deployed, linked to surveys measuring health behaviors, and implements a standardized study protocol so that data can be directly synthesized into a global analysis of information risk factors associated with health behaviors.
Results
A web-based study platform was developed, comprising tools for capturing information exposures within studies that link to health behavior surveys. The first tool is a smartphone application that asks users to actively record relevant information they see or hear in diary. The second application is a web browser plugin that passively tracks webpages with relevant keywords. Because localized studies follow a standardized protocol and de-identified participant data are recorded in a common format, local study investigators can opt-in to contributing study data to support global surveillance efforts.
Lessons
Through standardization of measurement tools and relevant study protocols, the toolkit can be used to quickly collect and synthesize data for global or regional analysis of infodemics, including in Europe. Validation of the toolkit in the field is needed to inform its open-source release.
Key messages
• A toolkit for measuring information risk factors associated with behavioral outcomes was developed.
• Global collaboration using the toolkit can improve synthesisability of studies investigating infodemic burden of disease.
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Affiliation(s)
- A Ishizumi
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - AG Dunn
- Biomedical Informatics and Digital Health, University of Sydney , Sydney, Australia
| | - T Purnat
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - B Yau
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | | | - B White
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - S Briand
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
| | - T Nguyen
- Epidemic & Pandemic Preparedness & Prevention , WHO, Geneva, Switzerland
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13
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Dan J, Concha J, Sprow G, Feng R, Afarideh M, Kodali N, Vazquez T, Diaz D, White B, Werth V. 238 Cutaneous dermatomyositis area and severity index activity score (CDASI-A) and associated patient-reported outcomes in a phase 2 clinical trial in dermatomyositis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Vazquez T, Sharma M, Feng R, Diaz D, Kodali N, Dan J, Grinnell M, Keyes E, Sprow G, White B, Werth V. 068 Lenabasum reduces IFNγ and pIRF3 in dermatomyositis skin: Biomarker results from a double-blind phase 3 international randomized controlled trial. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Karthikeyan S, Levy JI, De Hoff P, Humphrey G, Birmingham A, Jepsen K, Farmer S, Tubb HM, Valles T, Tribelhorn CE, Tsai R, Aigner S, Sathe S, Moshiri N, Henson B, Mark AM, Hakim A, Baer NA, Barber T, Belda-Ferre P, Chacón M, Cheung W, Cresini ES, Eisner ER, Lastrella AL, Lawrence ES, Marotz CA, Ngo TT, Ostrander T, Plascencia A, Salido RA, Seaver P, Smoot EW, McDonald D, Neuhard RM, Scioscia AL, Satterlund AM, Simmons EH, Abelman DB, Brenner D, Bruner JC, Buckley A, Ellison M, Gattas J, Gonias SL, Hale M, Hawkins F, Ikeda L, Jhaveri H, Johnson T, Kellen V, Kremer B, Matthews G, McLawhon RW, Ouillet P, Park D, Pradenas A, Reed S, Riggs L, Sanders A, Sollenberger B, Song A, White B, Winbush T, Aceves CM, Anderson C, Gangavarapu K, Hufbauer E, Kurzban E, Lee J, Matteson NL, Parker E, Perkins SA, Ramesh KS, Robles-Sikisaka R, Schwab MA, Spencer E, Wohl S, Nicholson L, Mchardy IH, Dimmock DP, Hobbs CA, Bakhtar O, Harding A, Mendoza A, Bolze A, Becker D, Cirulli ET, Isaksson M, Schiabor Barrett KM, Washington NL, Malone JD, Schafer AM, Gurfield N, Stous S, Fielding-Miller R, Garfein RS, Gaines T, Anderson C, Martin NK, Schooley R, Austin B, MacCannell DR, Kingsmore SF, Lee W, Shah S, McDonald E, Yu AT, Zeller M, Fisch KM, Longhurst C, Maysent P, Pride D, Khosla PK, Laurent LC, Yeo GW, Andersen KG, Knight R. Wastewater sequencing reveals early cryptic SARS-CoV-2 variant transmission. Nature 2022; 609:101-108. [PMID: 35798029 PMCID: PMC9433318 DOI: 10.1038/s41586-022-05049-6] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/29/2022] [Indexed: 11/23/2022]
Abstract
As SARS-CoV-2 continues to spread and evolve, detecting emerging variants early is critical for public health interventions. Inferring lineage prevalence by clinical testing is infeasible at scale, especially in areas with limited resources, participation, or testing and/or sequencing capacity, which can also introduce biases1–3. SARS-CoV-2 RNA concentration in wastewater successfully tracks regional infection dynamics and provides less biased abundance estimates than clinical testing4,5. Tracking virus genomic sequences in wastewater would improve community prevalence estimates and detect emerging variants. However, two factors limit wastewater-based genomic surveillance: low-quality sequence data and inability to estimate relative lineage abundance in mixed samples. Here we resolve these critical issues to perform a high-resolution, 295-day wastewater and clinical sequencing effort, in the controlled environment of a large university campus and the broader context of the surrounding county. We developed and deployed improved virus concentration protocols and deconvolution software that fully resolve multiple virus strains from wastewater. We detected emerging variants of concern up to 14 days earlier in wastewater samples, and identified multiple instances of virus spread not captured by clinical genomic surveillance. Our study provides a scalable solution for wastewater genomic surveillance that allows early detection of SARS-CoV-2 variants and identification of cryptic transmission. Emerging SARS-CoV-2 variants of concern were detected early and multiple cases of virus spread not captured by clinical genomic surveillance were identified using high-resolution wastewater and clinical sequencing.
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Affiliation(s)
- Smruthi Karthikeyan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Joshua I Levy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Peter De Hoff
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.,COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Greg Humphrey
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Amanda Birmingham
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Kristen Jepsen
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sawyer Farmer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Helena M Tubb
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tommy Valles
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | - Rebecca Tsai
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Stefan Aigner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Shashank Sathe
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Niema Moshiri
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Benjamin Henson
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Adam M Mark
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Abbas Hakim
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.,COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Nathan A Baer
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tom Barber
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Pedro Belda-Ferre
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Marisol Chacón
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Willi Cheung
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.,COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Evelyn S Cresini
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Emily R Eisner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alma L Lastrella
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elijah S Lawrence
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Clarisse A Marotz
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Toan T Ngo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tyler Ostrander
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Ashley Plascencia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Rodolfo A Salido
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Phoebe Seaver
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth W Smoot
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Robert M Neuhard
- Operational Strategic Initiatives, University of California San Diego, La Jolla, CA, USA.,Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Angela L Scioscia
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.,Student Health and Well-Being, University of California San Diego, La Jolla, CA, USA
| | | | | | - Dismas B Abelman
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - David Brenner
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Judith C Bruner
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Anne Buckley
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Michael Ellison
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Jeffrey Gattas
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Steven L Gonias
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Matt Hale
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Faith Hawkins
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Lydia Ikeda
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Hemlata Jhaveri
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Ted Johnson
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Vince Kellen
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Brendan Kremer
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Gary Matthews
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Ronald W McLawhon
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Pierre Ouillet
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Daniel Park
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Allorah Pradenas
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Sharon Reed
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Lindsay Riggs
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Alison Sanders
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | | | - Angela Song
- Operational Strategic Initiatives, University of California San Diego, La Jolla, CA, USA.,Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Benjamin White
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Terri Winbush
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Christine M Aceves
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Catelyn Anderson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Karthik Gangavarapu
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Emory Hufbauer
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ezra Kurzban
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Justin Lee
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Nathaniel L Matteson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Edyth Parker
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Sarah A Perkins
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Karthik S Ramesh
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Refugio Robles-Sikisaka
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Madison A Schwab
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Emily Spencer
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Shirlee Wohl
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | | | | | - David P Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - John D Malone
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | | | - Nikos Gurfield
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Sarah Stous
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.,Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Richard S Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Tommi Gaines
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Natasha K Martin
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Robert Schooley
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | | | - Duncan R MacCannell
- Office of Advanced Molecular Detection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Seema Shah
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Eric McDonald
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Alexander T Yu
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Mark Zeller
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Kathleen M Fisch
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.,Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Christopher Longhurst
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Patty Maysent
- Office of the UC San Diego Health CEO, University of California, San Diego, USA
| | - David Pride
- Departments of Pathology and Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Pradeep K Khosla
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Louise C Laurent
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA.,Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gene W Yeo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.,Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA, USA.,Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kristian G Andersen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA. .,Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA. .,Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
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16
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Werth V, White B, Dgetluck N, Hally K, Constantine S, Aggarwal R, Fiorentino D, Lundberg IE, Oddis CV. OP0162 EFFICACY AND SAFETY OF LENABASUM IN THE PHASE 3 DETERMINE TRIAL IN DERMATOMYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5037] [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
BackgroundSafe and effective treatments are of significant unmet need in DM. Lenabasum, a CB2 agonist that activates resolution of inflammation, improved skin disease, patient-reported outcomes, and biomarkers in a Phase 2 study of DM patients with active skin disease.ObjectivesTo evaluate the efficacy and safety of lenabasum in a Phase 3 double-blind study in DM.MethodsDM patients ≥ 18 years old with active skin with or without muscle involvement were enrolled in 55 sites in North America, Europe, and Asia-Pacific. Stable doses of background immunosuppressants were allowed. Subjects were randomized 2:1:2 to lenabasum 20 mg BID, lenabasum 5 mg BID, or placebo BID for 52 weeks, with visits ≤ 8 weeks apart. The study was stopped after all subjects completed Week 28. Some subjects had completed Week 52 by then. The primary efficacy endpoint was Total Improvement Score (TIS) at Week 28 and a secondary efficacy endpoint was TIS at Week 52, for lenabasum 20 mg BID vs placebo.Results175 subjects (69 lenabasum 20 mg BID, 35 lenabasum 5 mg BID, 71 placebo BID) received study drug; 167 completed Week 28, and 103 completed Week 52. The most common reasons for study discontinuation were study stopped by Sponsor (34.3%), withdrawal of consent (4.5%), and adverse events (AEs, 3.9%), with similar rates among groups. Baseline demographics and disease measurements were similar among groups and in total subjects were (mean or %): age 52.0 years; 81.1% female, 75.4% White; MMT-8 133.3; CDASI activity score 23.4; HAQ-DI 0.84, MDGA 5.55, EMGA 5.23; and PtGA 5.12. Corticosteroids were used by 48.1% and 38.0%, immunoglobulins by 5.8% and 7.0%, and other immunosuppressives by 51.0% and 54.9%, and monoclonal antibodies by 8.7% and 7.0% of lenabasum and placebo groups at baseline, respectively. The primary efficacy endpoint was not met - mean (SD) TIS score was 28.3 (19.75) vs 27.2 (19.23) at Week 28 for lenabasum 20 mg BID vs placebo, p = 0.3311, MMRM. Week 52 values were 40.6 (16.88) vs 34.8 (19.94), p = 0.2290. When analyses were restricted to subjects with muscle weakness at baseline (MMT8 < 142), TIS scores and treatment differences were greater and reached nominal statistical significance at Week 40, p = 0.0172. Mean (SD) improvements in CDASI activity score were numerically greater but not statistically different between lenabasum 20 mg BID group vs placebo at Week 28 [-7.1 (7.76) vs -5.8 (8.88) points, p = 0.2775] and Week 52 [-10.0 (9.45) vs -6.2 (12.8) points, p = 0.0932]. When restricting analysis of participants without muscle weakness (MMT-8 = 150), improvement in CDASI activity score was greater in the lenabasum 20 mg BID group vs placebo at Week 28, p = 0.0461, and Week 52 p = 0.0059.Treatment-emergent AEs (TEAEs) occurred in 87.0%, 85.7%, and 87.3% of lenabasum 20 mg BID, lenabasum 5 mg BID, and placebo groups, with no deaths. Related TEAEs leading to withdrawal of study product were infrequent, occurring in 1.4%, 0%, and 2.0% of subjects in the same groups. Serious TEAEs occurred in 11.6%, 8.6%, and 4.2% of subjects in the lenabasum 20 mg BID, lenabasum 5 mg BID, and placebo groups. No serious TEAE preferred term occurred in more than 1 subject in any group. TEAE occurring in ≥ 10% of lenabasum 20 mg BID subjects were (% lenabasum vs % placebo): dermatomyositis (flare) 27.5% vs 40.8%; diarrhea 14.5% vs 8.5%; dizziness 13.0% vs 4.2%; nausea 11.6% vs 4.2%; headache 10.1% vs 14.1%; and arthralgia 10.1% vs 2.8%.ConclusionAlthough, primary or secondary endpoints were not met in the study, subgroup analysis of patients with muscle weakness and without muscle weakness, showed improvement in muscle strength and rash, respectively in lenabasum 20 mg BID group vs placebo. Lenabasum was administered safely and was well-tolerated in this study.Disclosure of InterestsVictoria Werth Speakers bureau: University of Pennsylvania, who own the copyright for the CLASI and SDASI, Consultant of: AbbVie, Amgen, Argenx, AstraZeneca, Biogen, BMS, Celgene, Chrysalis, CSL Behring, Cugene, Eli Lilly, EMD Serono, Genentech, GSK, Incyte, Idera, Janssen, Kirin, Medimmune, Medscape, Nektar, Octapharma, Pfizer, Principa, Regeneron, Resolve, and Viela Bio, Grant/research support from: AstraZeneca, Biogen, Celgene, Corbus Pharmaceuticals, Genentech, Gilead, Janssen, Pfizer, Syntimmune, and Viela Bio, Barbara White Shareholder of: Corbus Pharmaceuticals, Employee of: Previous employee of Corbus Pharmaceuticals, Nancy Dgetluck Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Kathleen Hally Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Scott Constantine Shareholder of: Corbus Pharmaceuticals, Employee of: Corbus Pharmaceuticals, Rohit Aggarwal Consultant of: For Abbvie, Q32, Alexion, AstraZeneca, BMS, Boehringer Ingelheim, Corbus, Csl Behring, EMD Serono, Galapagos, Janssen, Kezar, Jubliant, Kyverna, Mallinckrodt, Merck, Novartis, Octapharma, Pfizer, Octazyme, Roivant, Scipher., Grant/research support from: BMS, Mallinkrodt, EMD Serono, Q32, Pfizer, David Fiorentino Consultant of: Corbus Pharmaceuticals, Grant/research support from: Corbus Pharmaceuticals, Ingrid E. Lundberg Shareholder of: Roche and Novartis., Consultant of: Corbus Pharmaceuticals Inc, Astra Zeneca, Bristol Myer´s Squibb, Corbus Pharmaceutical, EMD Serono Research & Development Institute, Argenx, Octapharma, Kezaar, Orphazyme, and Janssen, Grant/research support from: Astra Zeneca, Chester V Oddis Consultant of: Corbus Pharmaceuticals
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17
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Dan J, Patel J, Sprow G, Concha J, Feng R, Kodali N, Vazquez T, Diaz D, White B, Werth V. AB1485 PATIENT-REPORTED OUTCOMES AND BIOMARKERS ASSOCIATED WITH THE CUTANEOUS DERMATOMYOSITIS AREA AND SEVERITY ACTIVITY (CDASI-A) SCORE IN A PHASE 2 CLINICAL TRIAL IN DERMATOMYOSITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4986] [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
BackgroundRetrospective reviews of clinical databases from two sites have identified strong relationships between patient-reported outcomes and skin activity in dermatomyositis (DM), as measured by CDASI-A.1,2 No studies validate these associations in a controlled setting. Additionally, the relationship between the PROMIS-29 Short Form and skin activity in DM has not been assessed. Previous investigations have demonstrated a correlation between IL-31 and itch in DM.3 IFN-β and IFN-γ are known type I and II interferons, which are critical drivers of DM pathogenesis.4ObjectivesTo assess correlations between CDASI-A, quality of life (QoL), and biomarkers of disease activity in a double-blind, randomized, placebo-controlled clinical trial.MethodsData were retrospectively collected from five visits of a Phase 2 trial evaluating Lenabasum, a cannabinoid receptor type 2 agonist. Quality of life assessments extracted from the trial included Patient Global Assessment (PtGA) scores, PROMIS domains, and Skindex domains. Skindex question 10, regarding itch, was included in the analysis as a separate domain. Physician Global Assessment scores were also evaluated. Additionally, biomarkers derived from skin samples via IHC/PCR collected at visits 1 and 6 were assessed for predictors of CDASI-A response and association with disease activity. Analysis used linear mixed effect models to account for within subject-variability and repeated measures, where applicable. Analysis was performed without regard to treatment arm, as our goal was to correlate CDASI, QoL, and biomarkers among all subjects.ResultsData from 22 subjects with DM and a combined total of 110 visits were included. Biopsies were collected from 12 subjects. Improvement in CDASI-A significantly correlated with Skindex-S, Skindex-E, Skindex-F, Skindex-Itch, PtGA global skin, PtGA global skin, PtGA global skin, and PtGA global skin, with p < 0.001. Improvement in PROMIS social role (p = 0.046) correlated with improvement in CDASI-A. Worsening of PROMIS fatigue (p = 0.019) and pain (p < 0.001) correlated with improvement in CDASI-A. Decreases in PGA overall disease, PGA skin activity, and PGA global skin all correlated with improvement of CDASI-A (p < 0.001). Change in IL-31 protein area positively correlated with change in disease activity (p = 0.047). A positive relationship between changes in IFN-β and IFN-γ protein area and disease activity trended towards significance.ConclusionIn accordance with previous investigations from our group, well-established measures of QoL correlated significantly with CDASI-A. These findings support that CDASI-A reflects both clinical and patient-reported aspects of skin disease and is an appropriate outcome in DM clinical trials. Additionally, Skindex and PtGA scores may better relate to skin activity as measured by the CDASI compared to PROMIS domains. IL-31, a cytokine previously associated with itch in DM,3 correlated significantly with CDASI-A in our study. Trends for IFN-β and IFN-γ reduction with disease improvement support their role in the pathogenesis of DM. This study helps define patient-reported outcomes and biomarkers that may be informative in DM trials.References[1]Goreshi R, et al. J Am Acad Dermatol. 2011;65(6):1107-1116[2]Robinson ES, et al. Br J Dermatol. 2015;172(1):169-174.[3]Patel J, et al. J Invest Dermatol. 2021;141(9):2151-2160.[4]Wong D, et al. PLoS One. 2012;7(1):e29161Disclosure of InterestsJoshua Dan: None declared, Jay Patel: None declared, Grant Sprow: None declared, Josef Concha: None declared, Rui Feng: None declared, Nilesh Kodali: None declared, Thomas Vazquez: None declared, DeAnna Diaz: None declared, Barbara White Shareholder of: Corbus Pharmaceuticals, Victoria Werth Speakers bureau: University of Pennsylvania, which owns the copyright for the CDASI, Grant/research support from: Corbus Pharmaceuticals
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18
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Karthikeyan S, Levy JI, De Hoff P, Humphrey G, Birmingham A, Jepsen K, Farmer S, Tubb HM, Valles T, Tribelhorn CE, Tsai R, Aigner S, Sathe S, Moshiri N, Henson B, Mark AM, Hakim A, Baer NA, Barber T, Belda-Ferre P, Chacón M, Cheung W, Cresini ES, Eisner ER, Lastrella AL, Lawrence ES, Marotz CA, Ngo TT, Ostrander T, Plascencia A, Salido RA, Seaver P, Smoot EW, McDonald D, Neuhard RM, Scioscia AL, Satterlund AM, Simmons EH, Abelman DB, Brenner D, Bruner JC, Buckley A, Ellison M, Gattas J, Gonias SL, Hale M, Hawkins F, Ikeda L, Jhaveri H, Johnson T, Kellen V, Kremer B, Matthews G, McLawhon RW, Ouillet P, Park D, Pradenas A, Reed S, Riggs L, Sanders A, Sollenberger B, Song A, White B, Winbush T, Aceves CM, Anderson C, Gangavarapu K, Hufbauer E, Kurzban E, Lee J, Matteson NL, Parker E, Perkins SA, Ramesh KS, Robles-Sikisaka R, Schwab MA, Spencer E, Wohl S, Nicholson L, Mchardy IH, Dimmock DP, Hobbs CA, Bakhtar O, Harding A, Mendoza A, Bolze A, Becker D, Cirulli ET, Isaksson M, Barrett KMS, Washington NL, Malone JD, Schafer AM, Gurfield N, Stous S, Fielding-Miller R, Garfein RS, Gaines T, Anderson C, Martin NK, Schooley R, Austin B, MacCannell DR, Kingsmore SF, Lee W, Shah S, McDonald E, Yu AT, Zeller M, Fisch KM, Longhurst C, Maysent P, Pride D, Khosla PK, Laurent LC, Yeo GW, Andersen KG, Knight R. Wastewater sequencing uncovers early, cryptic SARS-CoV-2 variant transmission. medRxiv 2022:2021.12.21.21268143. [PMID: 35411350 PMCID: PMC8996633 DOI: 10.1101/2021.12.21.21268143] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
As SARS-CoV-2 continues to spread and evolve, detecting emerging variants early is critical for public health interventions. Inferring lineage prevalence by clinical testing is infeasible at scale, especially in areas with limited resources, participation, or testing/sequencing capacity, which can also introduce biases. SARS-CoV-2 RNA concentration in wastewater successfully tracks regional infection dynamics and provides less biased abundance estimates than clinical testing. Tracking virus genomic sequences in wastewater would improve community prevalence estimates and detect emerging variants. However, two factors limit wastewater-based genomic surveillance: low-quality sequence data and inability to estimate relative lineage abundance in mixed samples. Here, we resolve these critical issues to perform a high-resolution, 295-day wastewater and clinical sequencing effort, in the controlled environment of a large university campus and the broader context of the surrounding county. We develop and deploy improved virus concentration protocols and deconvolution software that fully resolve multiple virus strains from wastewater. We detect emerging variants of concern up to 14 days earlier in wastewater samples, and identify multiple instances of virus spread not captured by clinical genomic surveillance. Our study provides a scalable solution for wastewater genomic surveillance that allows early detection of SARS-CoV-2 variants and identification of cryptic transmission.
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Affiliation(s)
- Smruthi Karthikeyan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Joshua I Levy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Peter De Hoff
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Greg Humphrey
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Amanda Birmingham
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Kristen Jepsen
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sawyer Farmer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Helena M. Tubb
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tommy Valles
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | - Rebecca Tsai
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Stefan Aigner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Shashank Sathe
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Niema Moshiri
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Benjamin Henson
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Adam M. Mark
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Abbas Hakim
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Nathan A Baer
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tom Barber
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Pedro Belda-Ferre
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Marisol Chacón
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Willi Cheung
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Evelyn S Cresini
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Emily R Eisner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alma L Lastrella
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elijah S Lawrence
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Clarisse A Marotz
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Toan T Ngo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tyler Ostrander
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Ashley Plascencia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Rodolfo A Salido
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Phoebe Seaver
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth W Smoot
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Robert M Neuhard
- Operational Strategic Initiatives, University of California San Diego, La Jolla, CA, USA
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Angela L Scioscia
- Student Health and Well-Being, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | | | | | - Dismas B. Abelman
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - David Brenner
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Judith C. Bruner
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Anne Buckley
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Michael Ellison
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Jeffrey Gattas
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Steven L. Gonias
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Matt Hale
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Faith Hawkins
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Lydia Ikeda
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Hemlata Jhaveri
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Ted Johnson
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Vince Kellen
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Brendan Kremer
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Gary Matthews
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | | | - Pierre Ouillet
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Daniel Park
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Allorah Pradenas
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Sharon Reed
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Lindsay Riggs
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Alison Sanders
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | | | - Angela Song
- Operational Strategic Initiatives, University of California San Diego, La Jolla, CA, USA
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Benjamin White
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Terri Winbush
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Christine M Aceves
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Catelyn Anderson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Karthik Gangavarapu
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Emory Hufbauer
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ezra Kurzban
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Justin Lee
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Nathaniel L Matteson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Edyth Parker
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Sarah A Perkins
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Karthik S Ramesh
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Refugio Robles-Sikisaka
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Madison A Schwab
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Emily Spencer
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Shirlee Wohl
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Laura Nicholson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ian H Mchardy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - David P Dimmock
- Rady Children’s Institute for Genomic Medicine, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - John D Malone
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | | | - Nikos Gurfield
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Sarah Stous
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Richard S. Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Tommi Gaines
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Natasha K. Martin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Robert Schooley
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | - Duncan R. MacCannell
- Office of Advanced Molecular Detection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Seema Shah
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Eric McDonald
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Alexander T. Yu
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Mark Zeller
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Christopher Longhurst
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Patty Maysent
- Office of the UC San Diego Health CEO, University of California, San Diego
| | - David Pride
- Departments of Pathology and Medicine, University of California, San Diego, La Jolla, CA
| | - Pradeep K. Khosla
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Louise C. Laurent
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
| | - Gene W Yeo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA
| | - Kristian G Andersen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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19
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Karthikeyan S, Levy JI, De Hoff P, Humphrey G, Birmingham A, Jepsen K, Farmer S, Tubb HM, Valles T, Tribelhorn CE, Tsai R, Aigner S, Sathe S, Moshiri N, Henson B, Mark AM, Hakim A, Baer NA, Barber T, Belda-Ferre P, Chacón M, Cheung W, Cresini ES, Eisner ER, Lastrella AL, Lawrence ES, Marotz CA, Ngo TT, Ostrander T, Plascencia A, Salido RA, Seaver P, Smoot EW, McDonald D, Neuhard RM, Scioscia AL, Satterlund AM, Simmons EH, Abelman DB, Brenner D, Bruner JC, Buckley A, Ellison M, Gattas J, Gonias SL, Hale M, Hawkins F, Ikeda L, Jhaveri H, Johnson T, Kellen V, Kremer B, Matthews G, McLawhon RW, Ouillet P, Park D, Pradenas A, Reed S, Riggs L, Sanders A, Sollenberger B, Song A, White B, Winbush T, Aceves CM, Anderson C, Gangavarapu K, Hufbauer E, Kurzban E, Lee J, Matteson NL, Parker E, Perkins SA, Ramesh KS, Robles-Sikisaka R, Schwab MA, Spencer E, Wohl S, Nicholson L, Mchardy IH, Dimmock DP, Hobbs CA, Bakhtar O, Harding A, Mendoza A, Bolze A, Becker D, Cirulli ET, Isaksson M, Barrett KMS, Washington NL, Malone JD, Schafer AM, Gurfield N, Stous S, Fielding-Miller R, Garfein RS, Gaines T, Anderson C, Martin NK, Schooley R, Austin B, MacCannell DR, Kingsmore SF, Lee W, Shah S, McDonald E, Yu AT, Zeller M, Fisch KM, Longhurst C, Maysent P, Pride D, Khosla PK, Laurent LC, Yeo GW, Andersen KG, Knight R. Wastewater sequencing uncovers early, cryptic SARS-CoV-2 variant transmission. medRxiv 2022. [PMID: 35411350 DOI: 10.1101/2022.01.27.22269965] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
As SARS-CoV-2 continues to spread and evolve, detecting emerging variants early is critical for public health interventions. Inferring lineage prevalence by clinical testing is infeasible at scale, especially in areas with limited resources, participation, or testing/sequencing capacity, which can also introduce biases. SARS-CoV-2 RNA concentration in wastewater successfully tracks regional infection dynamics and provides less biased abundance estimates than clinical testing. Tracking virus genomic sequences in wastewater would improve community prevalence estimates and detect emerging variants. However, two factors limit wastewater-based genomic surveillance: low-quality sequence data and inability to estimate relative lineage abundance in mixed samples. Here, we resolve these critical issues to perform a high-resolution, 295-day wastewater and clinical sequencing effort, in the controlled environment of a large university campus and the broader context of the surrounding county. We develop and deploy improved virus concentration protocols and deconvolution software that fully resolve multiple virus strains from wastewater. We detect emerging variants of concern up to 14 days earlier in wastewater samples, and identify multiple instances of virus spread not captured by clinical genomic surveillance. Our study provides a scalable solution for wastewater genomic surveillance that allows early detection of SARS-CoV-2 variants and identification of cryptic transmission.
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Affiliation(s)
- Smruthi Karthikeyan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Joshua I Levy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Peter De Hoff
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Greg Humphrey
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Amanda Birmingham
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Kristen Jepsen
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sawyer Farmer
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Helena M Tubb
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tommy Valles
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | - Rebecca Tsai
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Stefan Aigner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Shashank Sathe
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Niema Moshiri
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Benjamin Henson
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, USA
| | - Adam M Mark
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
| | - Abbas Hakim
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Nathan A Baer
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tom Barber
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Pedro Belda-Ferre
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Marisol Chacón
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Willi Cheung
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Evelyn S Cresini
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Emily R Eisner
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Alma L Lastrella
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elijah S Lawrence
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Clarisse A Marotz
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Toan T Ngo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Tyler Ostrander
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Ashley Plascencia
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Rodolfo A Salido
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Phoebe Seaver
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth W Smoot
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Daniel McDonald
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Robert M Neuhard
- Operational Strategic Initiatives, University of California San Diego, La Jolla, CA, USA
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Angela L Scioscia
- Student Health and Well-Being, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | | | | | - Dismas B Abelman
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - David Brenner
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Judith C Bruner
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Anne Buckley
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Michael Ellison
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Jeffrey Gattas
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Steven L Gonias
- Department of Pathology, University of California San Diego, La Jolla, CA, USA
| | - Matt Hale
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Faith Hawkins
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Lydia Ikeda
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Hemlata Jhaveri
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Ted Johnson
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Vince Kellen
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Brendan Kremer
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Gary Matthews
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Ronald W McLawhon
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Pierre Ouillet
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Daniel Park
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Allorah Pradenas
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Sharon Reed
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Lindsay Riggs
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Alison Sanders
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | | | - Angela Song
- Operational Strategic Initiatives, University of California San Diego, La Jolla, CA, USA
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Benjamin White
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Terri Winbush
- Return to Learn, University of California San Diego, La Jolla, CA, USA
| | - Christine M Aceves
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Catelyn Anderson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Karthik Gangavarapu
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Emory Hufbauer
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ezra Kurzban
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Justin Lee
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Nathaniel L Matteson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Edyth Parker
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Sarah A Perkins
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Karthik S Ramesh
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Refugio Robles-Sikisaka
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Madison A Schwab
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Emily Spencer
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Shirlee Wohl
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Laura Nicholson
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ian H Mchardy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - David P Dimmock
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - John D Malone
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | | | - Nikos Gurfield
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Sarah Stous
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Richard S Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Tommi Gaines
- Division of Infectious Disease and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Natasha K Martin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Robert Schooley
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | - Duncan R MacCannell
- Office of Advanced Molecular Detection, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Seema Shah
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Eric McDonald
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Alexander T Yu
- COVID-19 Detection, Investigation, Surveillance, Clinical, and Outbreak Response, California Department of Public Health, Richmond, CA, USA
| | - Mark Zeller
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Christopher Longhurst
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Patty Maysent
- Office of the UC San Diego Health CEO, University of California, San Diego
| | - David Pride
- Departments of Pathology and Medicine, University of California, San Diego, La Jolla, CA
| | - Pradeep K Khosla
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
| | - Louise C Laurent
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
| | - Gene W Yeo
- Expedited COVID Identification Environment (EXCITE) Laboratory, Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Sanford Consortium of Regenerative Medicine, University of California San Diego, La Jolla, CA
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA
| | - Kristian G Andersen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
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20
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Jaffe TA, Wang D, Loveless B, Lai D, Loesche M, White B, Raja AS, He S. A Scoping Review of Emergency Department Discharge Risk Stratification. West J Emerg Med 2021; 22:1218-1226. [PMID: 34787544 PMCID: PMC8597698 DOI: 10.5811/westjem.2021.6.52969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Although emergency department (ED) discharge presents patient-safety challenges and opportunities, the ways in which EDs address discharge risk in the general ED population remains disparate and largely uncharacterized. In this study our goal was to conduct a review of how EDs identify and target patients at increased risk at time of discharge. METHODS We conducted a literature search to explore how EDs assess patient risk upon discharge, including a review of PubMed and gray literature. After independently screening articles for inclusion, we recorded study characteristics including outcome measures, patient risk factors, and tool descriptions. Based on this review and discussion among collaborators, major themes were identified. RESULTS PubMed search yielded 384 potentially eligible articles. After title and abstract review, we screened 235 for potential inclusion. After full text and reference review, supplemented by Google Scholar and gray literature reviews, we included 30 articles for full review. Three major themes were elucidated: 1) Multiple studies include retrospective risk assessment, whereas the use of point-of-care risk assessment tools appears limited; 2) of the point-of-care tools that exist, inputs and outcome measures varied, and few were applicable to the general ED population; and 3) while many studies describe initiatives to improve the discharge process, few describe assessment of post-discharge resource needs. CONCLUSION Numerous studies describe factors associated with an increased risk of readmission and adverse events after ED discharge, but few describe point-of-care tools used by physicians for the general ED population. Future work is needed to investigate standardized tools that assess ED discharge risk and patients' needs upon ED discharge.
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Affiliation(s)
- Todd A Jaffe
- Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts
| | - Daniel Wang
- Kansas City University School of Medicine, Kansas City, Missouri
| | - Bosten Loveless
- Rocky Vista University College of Osteopathic Medicine, Ivins, Utah
| | - Debbie Lai
- University College of London, Division of Psychology and Language Sciences, London, England
| | - Michael Loesche
- Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts
| | - Benjamin White
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Ali S Raja
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Shuhan He
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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21
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Sunderrajan A, White B, Durantini M, Sanchez F, Glasman L, Albarracín D. Complex solutions for a complex problem: A meta-analysis of the efficacy of multiple-behavior interventions on change in outcomes related to HIV. Health Psychol 2021; 40:642-653. [PMID: 34435836 DOI: 10.1037/hea0001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this meta-analysis was to examine the success of multiple-behavior interventions and to identify whether the efficacy of such programs depends on the number of recommendations prescribed and the type of outcomes measured. METHOD We conducted a synthesis of 136 research reports (N = 59,330) using a robust variance estimate model (Tanner-Smith et al., 2016) to study change between baseline and the first follow-up across multiple-behavior interventions, single-behavior interventions, and passive controls. RESULTS Multiple-behavior interventions were more efficacious than their single-behavior counterparts (multiple-behaviors: d = .44 [95% confidence interval, CI [.27, .60]); single-behavior: d = .21 [95% CI [.00, .43]), with efficacy varying based on the type of outcomes measured. Publication bias analysis revealed a small asymmetry but controlling for it did not eliminate these effects. There was a strong linear relation between the number of recommendations prescribed by an intervention and intervention efficacy (B = .07, SE = .01, p < .001), with strongest improvements observed for interventions making five or more recommendations. These patterns remained when controlling for other intervention and population characteristics. CONCLUSIONS Multiple-behavior interventions are successful in the HIV domain and increasing the number of recommendations made in the intervention generally maximizes improvements. These findings provide insights that may guide the design and implementation of integrated interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Benjamin White
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Marta Durantini
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Flor Sanchez
- Department of Social Psychology and Methodology, Universidad Autónoma de Madrid
| | - Laura Glasman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
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22
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Werth V, Concha J, Burroughs J, Okawa J, Feng R, Jobanputra A, Borucki R, Hally K, Hejazi E, Tillinger M, Constantine S, Dgetluck N, White B. POS0315 LONG-TERM SAFETY AND EFFICACY OF LENABASUM DURING 3 YEARS IN AN OPEN-LABEL EXTENSION (OLE) OF A PHASE 2 STUDY OF LENABASUM IN REFRACTORY SKIN DISEASE IN DERMATOMYOSITIS (DM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lenabasum is a synthetic, non-immunosuppressive, selective cannabinoid receptor type 2 agonist that activates resolution of inflammation. Lenabasum had acceptable safety and tolerability and improved efficacy outcomes in the initial 16-week double-blinded, randomized, placebo-controlled Part A of Phase 2 trial JBT101-DM-001 (NCT02466243) in DM subjects with refractory skin involvement. In that study, lenabasum or placebo was added to stable background treatment, with immunosuppressive therapies allowed.Objectives:To assess long-term safety and efficacy in DM subjects in this study.Methods:Subjects who completed Part A of the Phase 2 study (n = 22) were eligible to receive oral lenabasum 20 mg BID in an open-label extension (OLE) that assessed safety and efficacy at 4 weeks, then every 8 weeks.Results:20/22 (91%) eligible subjects enrolled in the OLE, following a mean interval of 31 weeks from the end of Part A, during which they continued to receive standard-of care treatments, to the start of the OLE during which lenabasum 20 mg BID was added. 17/20 (85%) subjects were on stable baseline immunosuppressive drugs. At the time of this data cut-off, 17 subjects were still enrolled, 17 had completed 140 months (2.7 years), and 15 had completed 156 months (3 years) of OLE dosing.All OLE subjects experienced at least 1 adverse event (AE), with 118 AEs during the OLE through Dec 2020. Most AEs were mild (n = 111, 94%), with 2 severe AEs (fatigue and metastatic prostate cancer) considered unrelated to lenabasum. AEs occurring in ≥ 3/20 OLE subjects were: URI (n = 5); fatigue (n = 4); nausea (n = 3); common cold (n = 3); UTI (n = 3); and DM flare (n = 3). No serious AEs related to lenabasum have been reported in this OLE to date. No subject discontinued the OLE because of an AE related to lenabasum.Improvement was seen in multiple physician- and patient-reported efficacy outcomes. CDASI activity score improved through the first 15 months of lenabasum treatment in the OLE and remained stable thereafter, with an improvement of ~20 points from the beginning of the study maintained from Month 15 through Year 3 in the OLE. CDASI damage score increased through the first year of the OLE, even though skin activity was decreasing, but lessened thereafter, returning after 3 years to about the same level it was at the beginning of the OLE. Other outcomes shown in Figure 1 followed the same general pattern as CDASI activity score, with improvement through the first 12-16 months of the OLE, then stability thereafter. Of note, 2 subjects had disease flares shortly after stopping lenabasum for conclusion of the OLE.Conclusion:Lenabasum continues to have a favorable safety and tolerability profile in the OLE of the Phase 2 trial JBT101-DM-001 with no serious AEs or study discontinuations related to lenabasum. The CDASI activity score and multiple other physician and patient-reported outcomes improved and have remained stable, showing durability of improvement in these patients with refractory skin disease. Skin damage was reversible and began to improve once skin activity stabilized. The limitations of attributing this improvement to lenabasum in the setting of open-label dosing is acknowledged. These data support further testing of lenabasum for the treatment of DM, and a Phase 3 study of lenabasum in DM is ongoing.Figure 1.Change from Baseline in Selected Efficacy Outcomes in OLE of Phase 2 Trial JBT101-DM-001Disclosure of Interests:Victoria Werth Grant/research support from: Investigator for Corbus Pharmaceuticals and received funding to conduct trials, Josef Concha: None declared, Julie Burroughs: None declared, Joyce Okawa: None declared, Rui Feng: None declared, Anisha Jobanputra: None declared, Robert Borucki: None declared, Kathleen Hally Employee of: Employee of Corbus Pharmaceuticals, Emily Hejazi: None declared, Michael Tillinger Employee of: Employee of Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals
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Richarz S, Stevenson K, White B, Thomson P, Jackson A, Isaak A, Kingsmore D. Early-cannulation arteriovenous grafts are safe and effective in avoiding recurrent tunneled central catheter infection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and a further TCVC. Theoeretically, insertion of an early-cannualtion graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr).
Methods
Retrospective comparison of two cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39).
Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions.
Results
18/299 patients identified from 2012-2020 had an ecAVG implanted as treatment for a TCVCi. In a one-year time-period (1/1/2015 -31/12/2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/ 1000 HD days, p < 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/ 1000 HD days, p = 0.000).
Conclusion
An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - K Stevenson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - P Thomson
- Department of Nephrology, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Jackson
- Department of Renal and Transplant Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
| | - A Isaak
- Department of Vascular Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - D Kingsmore
- Department of Vascular and Endovascular Surgery, Queen Elizabeth University Hospital Glasgow, Glasgow, United Kingdom
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech T, Stevens W, Gordon J, Kafaja S, Matucci-Cerinic M, Distler O, Lee EB, Levy Y, Jun JB, Constantine S, Dgetluck N, White B, Furst D, Denton C. OP0171 PHASE 3 TRIAL OF LENABASUM, A CB2 AGONIST, FOR THE TREATMENT OF DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lenabasum is an oral CB2 agonist that attenuates inflammation and fibrosis in SSc animal models and showed clinical benefit with acceptable safety in a Phase 2 trial in dcSSc.Objectives:Test efficacy and safety of lenabasum in a Phase 3 trial in dcSSc.Methods:Subjects ≥18 years old with disease duration ≤ 6 years were randomized 1:1:1 to lenabasum 5 mg, 20 mg, or placebo (PBO), all BID, with stable background immunosuppressant therapy (IST) allowed. The primary efficacy endpoint was ACR CRISS score, and secondary endpoints were ΔmRSS, ΔHAQ-DI, and ΔFVC, all at Week 52 for lenabasum 20 mg vs PBO.Results:363 adults were dosed; 37 (10%) stopped study drug early, with only 1 subject (PBO cohort) stopping due to adverse event (AE). Baseline demographics were similar among groups. Disease duration was ≤ 3 years in 60% and 66%, mean mRSS score was 22.0 and 23.3, and background IST was used by 89% and 84% of lenabasum 20 mg and PBO groups, respectively.Safety results showed serious AEs and severe AEs occurred in 9.2% and 5.8% vs 14.6% and 13.0%, respectively, of lenabasum 20 mg and PBO groups.Efficacy results (Table) demonstrated:Table 1.Primary and secondary efficacy endpoints and post-hoc analyses, Week 52Group, by IST treatmentCohortNΔmRSS, mean (SD)ΔFVC% mean (SD)ΔFVC, mL mean (SD)ΔHAQ-DI mean (SD)ACR CRISS medianmITT population, MMRM primary analysis methodAllPlacebo123-8.1 (7.72)-1.0 (8.68)-51 (317)-0.13 (0.468)0.887Lenabasum 20 mg120-6.7 (6.59)-1.6 (6.91)-78 (265)-0.13 (0.436)0.888Placebo subjects, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417All ISTPlacebo97-8.9 (7.07)-1.0 (9.2)-43 (330)-0.17 (0.474)0.936MMF, no other ISTPlacebo29-10.7 (8.1)-0.58 (7.1)-37 (235)-0.12 (0.456)0.935MMF ≤ 2 years, no other ISTPlacebo23-11.7 (8.1)-0.3 (6.0)-41 (197)-0.13 (0.495)0.935Non-MMF ≤ 2 yearsPlacebo24-6.7 (6.2)-1.4 (7.87)-52 (281)-0.15 (0.357)0.931Post-hoc comparisons, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417Lenabasum 20 mg10-6.3 (6.02)-2.3 (5.58)-99 (209)-0.06 (0.498)0.811Established IST1Placebo26-6.1 (5.35)-4.6 (10.11)-170 (350)-0.17 (0.445)0.619Lenabasum 20 mg38-7.4 (5.08)-0.4 (5.70)2-21 (233)3-0.07 (0.357)0.941Established IST, subjects with ILDPlacebo22-5.9 (5.28)-3.7 (5.43)-133 (206)-0.10 (0.372)0.553Lenabasum 20 mg33-7.2 (5.70)-1.0 (10.5)-47 (365)-0.06 (0.391)0.8192 P = 0.0386 two-sample t-test; 3 P = 0.0481 two-sample t-test; other comparisons were not significant• No significant differences were seen in primary and secondary efficacy endpoints. Primary MMRM analyses with treatment-by-time-by-subgroup interactions showed that background mycophenolate (MMF) significantly influenced the outcome•oSubjects on no IST with disease duration ≤3 years were only 7% of PBO subjects and showed little improvement on PBO, in line with other dcSSc trials in which IST was restricted. Post-hoc subgroup analyses of these subjects on no IST suggested improvement in ΔmRSS and ΔHAQ-DI, for lenabasum 20 mg vs PBO•uUnexpectedly high improvement occurred in PBO subjects receiving IST, notably those on MMF started within 2 years of baseline•nPost-hoc analyses of subjects on established IST (MMF or, if no MMF, ≥ 1 non-MMF IST started > 2 years before baseline) suggested improvement in ΔFVC% (nominal P = 0.0386) and ΔFVC mL (nominal P = 0.0481) for lenabasum 20 mg vs PBO. Improvement in FVC was also seen in subjects on established IST who had ILD at baseline, lenabasum 20 mg vs PBO•mACR CRISS score demonstrated a ceiling effect and correlated most highly with ΔmRSS (r = -0.739) and moderately with MDGA (-0.432), HAQ-DI (-0.362), FVC% (0.366), and PtGA (-0.288)Conclusion:Lenabasum was safely used in this study. Unexpectedly high improvement on background IST, especially MMF, has not been previously reported at this level. The primary endpoint was not met. Post-hoc analyses showed greater improvement in lenabasum- vs PBO-treated subjects who were not on background IST and those on established IST, including subjects with ILD.Disclosure of Interests:Robert Spiera Consultant of: Abbvie, Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Formation Biologics, Mitsubishi Tanabe, Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Formation Biologics, Sanofi, Inflarx, Astra Zeneca, Kadmon, Masataka Kuwana Speakers bureau: Boehringer-Ingelheim, Chugai, Janssen, Consultant of: Boehringer-Ingelheim, Chugai, Corbus, Grant/research support from: Boehringer-Ingelheim, Chugai, MBL, Ono Pharmaceuticals, Tanabe-Mitsubishi, Dinesh Khanna Shareholder of: Eicos Sciences, Inc (less than 5%). Leadership/Equity position – Chief Medical Officer, CiviBioPharma/Eicos Sciences, Inc, Consultant of: Acceleron, Actelion, Abbvie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead, Galapagos, Genentech/Roche, GSK, Horizon, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis, and United Therapeutics, Grant/research support from: NIH, Immune Tolerance Network, Bayer, BMS, Horizon, Pfizer, Laura Hummers Consultant of: CSL Behring, Boehringer Ingelheim, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Corbus, Boehringer Ingelheim, Medpace, Kadmon, Cumberland, CSL Behring, Tracy Frech Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Wendy Stevens Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jessica Gordon Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Research funding for EICOS Pharmaceuticals and Cumberland Pharmaceuticals., Suzanne Kafaja Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Marco Matucci-Cerinic Consultant of: Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Oliver Distler Consultant of: Consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB., Eun Bong Lee Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Yair Levy Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jae-Bum Jun Consultant of: Consultant to Boehringer Ingelheim Korea, Jeil Pharma, Dae Woong Pharma, Kwangdong Pharma, and Sama Pharma., Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals, Daniel Furst Consultant of: Corbus, Galapagos, Pfizer, CSL Behring, Mitsubishi Tanabi, Actelion, Amgen, Novartis, Roche/Genentech, Gilead, Talaris, and Boehringer Ingelheim., Grant/research support from: grants from Corbus, Galapagos, GSK, Pfizer, Talaris, CSL Behring, Mitsubishi Tanabi, Christopher Denton Consultant of: Consultancy fees and/or honoraria from Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics
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Samuels-Kalow ME, Dorner S, Cash RE, Dutta S, White B, Ciccolo GE, Brown DF, Camargo CA. Neighborhood Disadvantage Measures and COVID-19 Cases in Boston, 2020. Public Health Rep 2021; 136:368-374. [PMID: 33729070 PMCID: PMC8580391 DOI: 10.1177/00333549211002837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Understanding the pattern of population risk for coronavirus disease 2019 (COVID-19) is critically important for health systems and policy makers. The objective of this study was to describe the association between neighborhood factors and number of COVID-19 cases. We hypothesized an association between disadvantaged neighborhoods and clusters of COVID-19 cases. METHODS We analyzed data on patients presenting to a large health care system in Boston during February 5-May 4, 2020. We used a bivariate local join-count procedure to determine colocation between census tracts with high rates of neighborhood demographic characteristics (eg, Hispanic race/ethnicity) and measures of disadvantage (eg, health insurance status) and COVID-19 cases. We used negative binomial models to assess independent associations between neighborhood factors and the incidence of COVID-19. RESULTS A total of 9898 COVID-19 patients were in the cohort. The overall crude incidence in the study area was 32 cases per 10 000 population, and the adjusted incidence per census tract ranged from 2 to 405 per 10 000 population. We found significant colocation of several neighborhood factors and the top quintile of cases: percentage of population that was Hispanic, non-Hispanic Black, without health insurance, receiving Supplemental Nutrition Assistance Program benefits, and living in poverty. Factors associated with increased incidence of COVID-19 included percentage of population that is Hispanic (incidence rate ratio [IRR] = 1.25; 95% CI, 1.23-1.28) and percentage of households living in poverty (IRR = 1.25; 95% CI, 1.19-1.32). CONCLUSIONS We found a significant association between neighborhoods with high rates of disadvantage and COVID-19. Policy makers need to consider these health inequities when responding to the pandemic and planning for subsequent health needs.
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Affiliation(s)
- Margaret E. Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen Dorner
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E. Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gia E. Ciccolo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David F.M. Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kashinath K, Mustafa M, Albert A, Wu JL, Jiang C, Esmaeilzadeh S, Azizzadenesheli K, Wang R, Chattopadhyay A, Singh A, Manepalli A, Chirila D, Yu R, Walters R, White B, Xiao H, Tchelepi HA, Marcus P, Anandkumar A, Hassanzadeh P. Physics-informed machine learning: case studies for weather and climate modelling. Philos Trans A Math Phys Eng Sci 2021; 379:20200093. [PMID: 33583262 DOI: 10.1098/rsta.2020.0093] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Machine learning (ML) provides novel and powerful ways of accurately and efficiently recognizing complex patterns, emulating nonlinear dynamics, and predicting the spatio-temporal evolution of weather and climate processes. Off-the-shelf ML models, however, do not necessarily obey the fundamental governing laws of physical systems, nor do they generalize well to scenarios on which they have not been trained. We survey systematic approaches to incorporating physics and domain knowledge into ML models and distill these approaches into broad categories. Through 10 case studies, we show how these approaches have been used successfully for emulating, downscaling, and forecasting weather and climate processes. The accomplishments of these studies include greater physical consistency, reduced training time, improved data efficiency, and better generalization. Finally, we synthesize the lessons learned and identify scientific, diagnostic, computational, and resource challenges for developing truly robust and reliable physics-informed ML models for weather and climate processes. This article is part of the theme issue 'Machine learning for weather and climate modelling'.
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Affiliation(s)
- K Kashinath
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
| | - M Mustafa
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
| | - A Albert
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Terrafuse Inc., Berkeley, CA, USA
| | - J-L Wu
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Caltech, Pasadena, CA, USA
| | - C Jiang
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- University of California, Berkeley, CA, USA
| | | | | | - R Wang
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- UC San Diego, La Jolla, CA, USA
| | - A Chattopadhyay
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Rice University, Houston, TX, USA
| | - A Singh
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Terrafuse Inc., Berkeley, CA, USA
| | - A Manepalli
- NERSC - Lawrence Berkeley National Lab, Berkeley, CA, USA
- Terrafuse Inc., Berkeley, CA, USA
| | - D Chirila
- Alfred Wegener Institute, Bremerhaven, Germany
| | - R Yu
- UC San Diego, La Jolla, CA, USA
| | - R Walters
- Northeastern University, Boston, MA, USA
| | - B White
- Terrafuse Inc., Berkeley, CA, USA
| | - H Xiao
- Virginia Tech, Blacksburg, VA, USA
| | | | - P Marcus
- University of California, Berkeley, CA, USA
| | - A Anandkumar
- Caltech, Pasadena, CA, USA
- NVIDIA, Santa Clara, California, USA
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Richarz S, Stevenson K, White B, Thomson PC, Jackson A, Isaak A, Kingsmore DB. Early-Cannulation Arteriovenous Grafts Are Safe and Effective in Avoiding Recurrent Tunneled Central Catheter Infection. Ann Vasc Surg 2021; 75:287-293. [PMID: 33819582 DOI: 10.1016/j.avsg.2021.01.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tunneled central venous catheter infection (TCVCi) is a common complication that often necessitates removal of the TCVC and replacement by a further TCVC. Theoretically, insertion of an early - cannulation graft (ecAVG) early after TCVC infection is possible but not widely practiced with concerns over safety and infection in the ecAVG. With 8 years of ecAVG experience, the aim of this study was to compare the outcomes following TCVC infection, comparing replacement with TCVC (TCVCr) versus immediate ecAVG (ecAVGr). DESIGN Retrospective comparison of 2 cohorts, who underwent replacement of an infected TCVC either by an early cannulation graft (n = 18) or by a further central catheter (n = 39). METHODS Data were abstracted from a prospectively completed electronic patient record and collected on patient demographics, TCVC insertion, duration and infection, including culture proven bacteriaemia and subsequent access interventions. RESULTS Eighteen of 299 patients identified from 2012 to 2020 had an ecAVG implanted as treatment for a TCVCi. In a 1-year time-period (January 1, 2015-December 31, 2015) out of 222 TCVC inserted, 39 were as a replacement following a TCVCi. No patient with an ecAVGr developed an immediate infection, nor complication from the procedure. The rate of subsequent vascular access infection was significantly more frequent for those with a TCVCr than with an ecAVGr (0.6 vs. 0.1/patient/1000 HD days, P< 0.000). The number of further TCVC required was significantly higher in the TCVCr group (7.1 vs. 0.4/patient/1000 HD days, P= 0.000). CONCLUSIONS An ecAVG early following a TCVC infection is safe, reduces the incidence of subsequent infectious complications and reduces the number of TCVC required, with a better functional patency.
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Affiliation(s)
- S Richarz
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular and Endovascular Surgery, University Hospital Basel, Basel, Switzerland.
| | - K Stevenson
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK
| | - B White
- Department of Infectious Diseases and Microbiology, Queen Elisabeth University Hospital, Glasgow, UK
| | - P C Thomson
- Department of Nephrology, Queen Elisabeth University Hospital, Glasgow, UK
| | - A Jackson
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK
| | - A Isaak
- Department of Vascular and Endovascular Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - D B Kingsmore
- Renal and Transplant Surgery, Queen Elisabeth University Hospital, Glasgow, UK; Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Gartrell B, White B. Re: Re: Surviving clinical errors in practice. N Z Vet J 2021; 69:190-191. [PMID: 33689588 DOI: 10.1080/00480169.2021.1887691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- B Gartrell
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - B White
- Wildbase, Tāwharau Ora, School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Crowe K, White B, Khanna N, Cooke B, Kingsmore DB, Jackson A, Stevenson KS, Kasthuri R, Thomson PC. Epidemiology of bloodstream infections in a Scottish haemodialysis population with focus on vascular access method. J Hosp Infect 2021; 110:37-44. [PMID: 33484781 DOI: 10.1016/j.jhin.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Infection is the second highest cause of mortality in end-stage renal disease, with a significant proportion relating to haemodialysis (HD) vascular access-related infection (VARI). AIM To report the rate and antimicrobial resistance (AMR) of all-source bloodstream infections (BSIs) by vascular access type in a Scottish HD cohort. METHODS Retrospective analysis was undertaken of data on adult patients attending seven HD units during 2017. Total HD days for each vascular access type were calculated. BSIs were analysed with rates expressed per 1000 HD days. AMR was verified using health board microbiology databases. FINDINGS Excluding contaminant organisms, there was an overall BSI rate of 0.57 per 1000 HD days. The highest all-source and vascular access-related infection (VARI) BSI rates per 1000 HD days were in the non-tunnelled central venous catheter (CVC) group (3.11 and 2.07 respectively), followed by tunnelled CVC (1.10 and 0.67), arteriovenous graft (0.51 and 0.31), and finally arteriovenous fistula (0.29 and 0.02). The non-VARI BSI rates were lowest in the arteriovenous graft group. Staphylococci comprised the majority of events, with Staphylococcus aureus implicated in 29%. Gram-negative BSIs were prevalent, particularly in CVC groups, and associated with higher mortality. Multidrug-resistant (MDR) S. aureus and carbapenem resistance were relatively low. MDR Gram-negatives were high compared with the Scottish population. CONCLUSION Arteriovenous fistula access is confirmed as having lowest all-source and VARI BSI rates, and arteriovenous graft access the lowest non-VARI BSI rates. Staphylococci remain the prevailing genus; however, the contributions of Gram-negative BSIs, the higher mortality, and proportion of MDR organisms in this group are notable.
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Affiliation(s)
- K Crowe
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - B White
- Queen Elizabeth University Hospital, Glasgow, UK
| | - N Khanna
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Cooke
- Forth Valley Royal Hospital, Larbert, UK
| | | | - A Jackson
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | - R Kasthuri
- Queen Elizabeth University Hospital, Glasgow, UK
| | - P C Thomson
- Queen Elizabeth University Hospital, Glasgow, UK
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Molina MF, Li CN, Manchanda EC, White B, Faridi MK, Espinola JA, Ashworth H, Ciccolo G, Camargo CA, Samuels-Kalow M. Prevalence of Emergency Department Social Risk and Social Needs. West J Emerg Med 2020; 21:152-161. [PMID: 33207161 PMCID: PMC7673900 DOI: 10.5811/westjem.2020.7.47796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Social risks, or adverse social conditions associated with poor health, are prevalent in emergency department (ED) patients, but little is known about how the prevalence of social risk compares to a patient’s reported social need, which incorporates patient preference for intervention. The goal of this study was to describe the relationship between social risk and social need, and identify factors associated with differential responses to social risk and social need questions. Methods We conducted a cross-sectional study with 48 hours of time-shift sampling in a large urban ED. Consenting patients completed a demographic questionnaire and assessments of social risk and social need. We applied descriptive statistics to the prevalence of social risk and social need, and multivariable logistic regression to assess factors associated with social risk, social need, or both. Results Of the 269 participants, 100 (37%) reported social risk, 83 (31%) reported social need, and 169 (63%) reported neither social risk nor social need. Although social risk and social need were significantly associated (p < 0.01), they incompletely overlapped. Over 50% in each category screened positive in more than one domain (eg, housing instability, food insecurity). In multivariable models, those with higher education (adjusted odds ratio [aOR] 0.44 [95% confidence interval {CI}, 0.24–0.80]) and private insurance (aOR 0.50 [95% CI, 0.29–0.88]) were less likely to report social risk compared to those with lower education and state/public insurance, respectively. Spanish-speakers (aOR 4.07 [95% CI, 1.17–14.10]) and non-Hispanic Black patients (aOR 5.00 [95% CI, 1.91–13.12]) were more likely to report social need, while those with private insurance were less likely to report social need (private vs state/public: aOR 0.13 [95% CI, 0.07–0.26]). Conclusion Approximately one-third of patients in a large, urban ED screened positive for at least one social risk or social need, with over half in each category reporting risk/need across multiple domains. Different demographic variables were associated with social risk vs social need, suggesting that individuals with social risks differ from those with social needs, and that screening programs should consider including both assessments.
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Affiliation(s)
- Melanie F Molina
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Caitlin N Li
- Boston Children's Hospital, Division of Emergency Medicine, Boston, Massachusetts
| | - Emily C Manchanda
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Benjamin White
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mohammad K Faridi
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Janice A Espinola
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Gia Ciccolo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Margaret Samuels-Kalow
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Samuels-Kalow M, Dorner S, Cash R, Dutta S, White B, Ciccolo G, Brown D, Camargo C. 104 Associations between Neighborhood Disadvantage Measures and COVID-19 Case Clusters. Ann Emerg Med 2020. [PMCID: PMC7598564 DOI: 10.1016/j.annemergmed.2020.09.115] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seaton RA, Ritchie ND, Robb F, Stewart L, White B, Vallance C. From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection. J Antimicrob Chemother 2020; 74:2119-2121. [PMID: 30989175 DOI: 10.1093/jac/dkz122] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Bone and joint infection contributes significantly to clinical activity within outpatient parenteral antimicrobial therapy (OPAT) services. The OVIVA (oral versus intravenous antibiotics for bone and joint infection) randomized study has challenged the practice of prolonged intravenous therapy, because non-inferiority of oral antibiotic therapy was demonstrated, thereby implying that early transition to oral therapy is an appropriate alternative to prolonged intravenous therapy. We examine the caveats to the study and discuss the implications for OPAT practice, highlighting the importance of careful oral antibiotic selection with attention to bioavailability, bone penetration, drug interactions, compliance and toxicity monitoring. We emphasize that ambulatory antibiotic therapy (whether intravenous or oral) in this patient group requires expert multidisciplinary management, monitoring and follow-up, and ideally should be undertaken within existing OPAT or, more accurately, complex outpatient antibiotic therapy (COpAT) services.
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Affiliation(s)
- R A Seaton
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - N D Ritchie
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - F Robb
- Department of Pharmacy, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - L Stewart
- Department of Pharmacy, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - B White
- Department of Infectious Diseases, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - C Vallance
- Outpatient Parenteral Antimicrobial Therapy Service, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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Jackson G, Cutrona S, White B, Reardon C, Orvek E, Nevedal A, Lindquist J, Gifford A, King H, DeLaughter K, Henderson B, Vega R, Damschroder L. Identifying, Replicating, and Spreading Health care Innovations across a Nation‐Wide Health care System: VHA Diffusion of Excellence. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13411] [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: 11/26/2022] Open
Affiliation(s)
- G. Jackson
- Durham Veterans Affairs Health Care System Durham NC United States
- Duke University Durham NC United States
| | - S. Cutrona
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. White
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Health Care System Durham NC United States
| | - C. Reardon
- VA Ann Arbor Healthcare System Ann Arbor MI United States
| | - E. Orvek
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - A. Nevedal
- VA Palo Alto Health Care System Menlo Park CA United States
| | - J. Lindquist
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - A. Gifford
- VA Boston Healthcare System Boston MA United States
- Boston University Boston MA United States
| | - H. King
- Duke University Durham NC United States
- Durham Veterans Affairs (VA) Health Care System Durham NC United States
| | - K. DeLaughter
- Bedford VA Medical Center Bedford MA United States
- University of Massachusetts Medical School Worcester MA United States
| | - B. Henderson
- United States Veterans Health Administration Innovation Ecosystem Washington DC United States
| | - R. Vega
- Veterans Health Administration (VHA) Innovation Ecosystem Washington DC United States
| | - L. Damschroder
- VA Ann Arbor Healthcare System Ann Arbor MI United States
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Watson M, White B, Lanigan J, Slatter T, Lewis R. The composition and friction-reducing properties of leaf layers. Proc Math Phys Eng Sci 2020; 476:20200057. [PMID: 32831605 PMCID: PMC7426055 DOI: 10.1098/rspa.2020.0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022] Open
Abstract
Every autumn rail networks across the world suffer delays, accidents and schedule changes due to low friction problems caused by leaves landing on the rails. These leaves form a layer that can reduce the friction between the wheel and the rail to a similar level as that between ice and an ice-skate ( μ = 0.01 - 0.05 ). Previous works have generated several hypotheses for the chemical reactions and low friction mechanism associated with these layers. In this work, the reaction between an aqueous extract of sycamore leaves and metallic iron is investigated. This reaction has been shown to produce a black precipitate, which matches field observations of leaf layers, while friction tests with these extracts produce characteristic ultra low friction. The reaction is investigated through FTIR, XPS, CHNS and ICP-MS analysis as well as wet chemical testing. The impact of the reaction on friction is investigated through three rounds of tribological testing. The results indicate that the black precipitate produced is iron tannate, formed by complexation of tannins with dissolved iron ions. Friction testing showed that eliminating tannins from the leaf extract resulted in a significant increase in the friction coefficient compared with the control.
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Affiliation(s)
- Michael Watson
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
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Jaffe TA, Kim J, DePesa C, White B, Kaafarani HMA, Saillant N, Mendoza A, King D, Fagenholz P, Velmahos G, Lee J. One-way-street revisited: Streamlined admission of critically-ill trauma patients. Am J Emerg Med 2020; 38:2028-2033. [PMID: 33142169 DOI: 10.1016/j.ajem.2020.06.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Emergency department (ED) crowding is associated with increased mortality and delays in care. We developed a rapid admission pathway targeting critically-ill trauma patients in the ED. This study investigates the sustainability of the pathway, as well as its effectiveness in times of increased ED crowding. MATERIALS & METHODS This was a retrospective cohort study assessing the admission of critically-ill trauma patients with and without the use of a rapid admission pathway from 2013 to 2018. We accessed demographic and clinical data from trauma registry data and ED capacity logs. Statistical analyses included univariate and multivariate testing. RESULTS A total of 1700 patients were included. Of this cohort, 434 patients were admitted using the rapid admission pathway, whereas 1266 were admitted using the traditional pathway. In bivariate analysis, mean ED LOS was 1.54 h (95% Confidence Interval [CI]: 1.41, 1.66) with the rapid pathway, compared with 5.88 h (95% CI: 5.64, 6.12) with the traditional pathway (p < 0.01). We found no statistically significant relationship between rapid admission pathway use and survival to hospital discharge. During times of increased crowding, rapid pathway use continued to be associated with reduction in ED LOS (p < 0.01). The reduction in ED LOS was sustained when comparing initial results (2013-2014) to recent data (2015-2018). CONCLUSION This study found that a streamlined process to admit critically-ill trauma patients is sustainable and associated with reduction in ED LOS. As ED crowding remains pervasive, these findings support restructured care processes to limit prolonged ED boarding times for critically-ill patients.
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Affiliation(s)
- Todd A Jaffe
- Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women's Hospital, United States of America
| | - Jungyeon Kim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Christopher DePesa
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - Benjamin White
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - April Mendoza
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jarone Lee
- Harvard Affiliated Emergency Medicine Residency at Massachusetts General Hospital and Brigham and Women's Hospital, United States of America; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, United States of America; Department of Emergency Medicine, Harvard Medical School, Boston, MA, United States of America.
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Chintalacharuvu S, Zang P, White B, Atamas S. AB0152 LENABASUM, A CB2 AGONIST, INHIBITS INFLAMMASOME ACTIVATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Upregulation of the innate immune response via the activity of Toll-like receptors and the NLRP3 inflammasome have been suggested as initiating events that can drive fibrosis in systemic sclerosis (SSc) (Pharmacol Ther. 2018;192:163). Lenabasum, a cannabinoid receptor type 2 agonist, is known to activate the resolution phase of acute human innate immune responses triggered through Toll-like receptor activation, favoring production of pro-resolving lipid mediators, reducing inflammatory infiltrates, and increasing bacterial clearance (Clin Pharmacol Ther. 2018;104:675). Given the potential importance of inflammasome activation in the pathogenesis of SSc, the question remained whether lenabasum inhibits inflammasome activation.Objectives:Assess effects of lenabasum on IL-1β and IL-18 production induced by inflammasome activation.Methods:Primary human macrophages were derived from monocytes, stimulated with LPS and ATP to active inflammasomes and cultured with lenabasum. Levels of IL-1β and IL-18 were measured in cell supernatants by ELISA. Separately, human PBMC were activated with 0.1 µg/ml LPS ± 10 µM lenabasum for 24 hours, and effects of lenabasum on the levels of IL-1β and other pro-inflammatory cytokines were measured.Results:Lenabasum significantly inhibited IL-1β and IL-18 secretion by monocyte-derived macrophages, with IC50= 66.73 ± 3.92 nM and 349.23 ± 21.27 nM, respectively. A control inflammasome activation inhibitor, MCC950, which showed IC50= 18.33 ± 1.22 nM for IL-1 β inhibition and IC50= 21.43 ± 0.81 nM for IL-8 inhibition.Conclusion:Lenabasum inhibits inflammasome activation, which could contribute to potential therapeutic efficacy in SSc and other autoimmune diseases.References:[1]Henderson, J., S. Bhattacharyya, J. Varga, and S. O’Reilly. 2018. ‘Targeting TLRs and the inflammasome in systemic sclerosis’, Pharmacol Ther, 192: 163-69.[2]Motwani, M. P., F. Bennett, P. C. Norris, A. A. Maini, M. J. George, J. Newson, A. Henderson, A. J. Hobbs, M. Tepper, B. White, C. N. Serhan, R. MacAllister, and D. W. Gilroy. 2018. ‘Potent Anti-Inflammatory and Pro-Resolving Effects of Anabasum in a Human Model of Self-Resolving Acute Inflammation’, Clin Pharmacol Ther, 104: 675-86.Disclosure of Interests:Subba Chintalacharuvu Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Ping Zang Employee of: Corbus Pharmaceuticals, Inc., Barbara White Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Sergei Atamas Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc.
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Denton C, Bloom B, Dgetluck N, White B, Spiera R. AB0568 BASELINE EUROPEAN PATIENT DEMOGRAPHICS AND DISEASE CHARACTERISTICS IN A PHASE 3 STUDY OF SAFETY AND EFFICACY OF LENABASUM, A CB2 AGONIST, IN DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:We previously presented on the baseline characteristics of a large cohort of diffuse cutaneous systemic sclerosis (dcSSc) patients enrolled in a Phase 3 trial of lenabasum, a selective cannabinoid receptor type 2 (CB2) agonist. Lenabasum, was safe and well-tolerated in a prior Phase 2 study in dcSSc patients and associated with improvements in ACR Combined Response Index Systemic Sclerosis (CRISS) score and multiple secondary efficacy outcomes.Objectives:We now report on the background standard of care and baseline disease characteristics of European (EU) patients in order to assess variability by geographic regions.Methods:The RESOLVE-1 Phase 3 study was designed with input from study investigators and regulatory authorities. An important intent of the design was to have eligibility criteria that allow testing of efficacy and safety of lenabasum in an inclusive group of dcSSc subjects to maximize relevance to patients in current practice. The study is ongoing and remains blinded.Results:Primary efficacy outcome is the ACR CRISS score at 12 months, comparing lenabasum 20 mg BID to placebo. Key inclusion criteria are males and females ≥ 18 years of age with dcSSc and disease duration ≤ 6 years who are on stable standard of care medicines, with background stable immunosuppressive mediations allowed. Baseline mRSS needed to be ≥ 15 if disease duration was > 3 to ≤ 6 years at enrollment. The study enrolled 110 EU subjects over 15 months who received ≥ 1 dose of study drug at 20 sites in 7 countries. Baseline characteristics as shown in Table 1. The majority were middle-aged, female, and white, and 80% were on immunosuppressive drugs in EU region; methotrexate (MTX) used in 30% of subjects, mycophenolate/mycophenolic acid (MMF) used in 46% of subjects, and 43% of subjects took ≥ 2 concurrent immunosuppressive drugs. There were regional differences in background immunosuppressive with use of MTX, MMF and corticosteroids highest in EU, NA and Asia, respectively.Table 1.Patient Baseline Demographics and Disease Characteristics by Regions (Blinded)Characteristic at First DoseMean (SD) or %RegionEuropeUS, CA, AU, ILAsiaN =110 (30.1%)N = 189 (51.8%)N = 66 (18.1%)Years of age51 ± 11.751 ± 13.549 ± 13.2Female75%78%71%ILD55%40%58%Caucasian101 (91.8%)148 (78.3%)0 (0.0%)Asian2 (1.8%)10 (5.3%)66 (100.0%)Black2 (1.8%)16 (8.5%)0 (0.0%)Other5 (4.6%)15 (7.9%)0 (0.0%)Any immunosuppressive drug80%89%79%≥ 2 immunosuppressive drugs43%48%38%Mycophenolate46%70%26%Corticosteroids31%31%53%Methotrexate30%22%23%Other31%41%26%Modified Rodnan Skin Score21.9 ± 7.7523.8 ± 8.4120.0 ± 7.72Physician Global Assessment5.9 ± 1.575.3 ± 1.565.0 ± 1.50Patient Global Assessment4.9 ± 2.025.0 ± 2.254.8 ± 1.89HAQ-DI with aids/devices1.0 ± 0.691.3 ± 0.760.7 ± 0.77Forced vital capacity % predicted83.2 ± 18.9277.5 ± 16.4182.5 ± 14.73Conclusion:This is the first Phase 3 study to use ACR CRISS as the primary efficacy outcome, a composite outcome of multiple clinically relevant measures of SSc, and the largest interventional study to date in diffuse cutaneous SSc. While the use of background immunosuppressive therapies is significant irrespective of geographic regions, MTX use is highest in the EU. Benefits of having inclusive eligibility criteria are that they facilitated timely full enrollment and will make the study more relevant to real-world practice. This study provides a model for future Phase 3 trials in dcSSc and will afford valuable information regarding scleroderma care in practice as well as evaluating the efficacy and safety of lenabasum.Disclosure of Interests:Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Bradley Bloom Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Nancy Dgetluck Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Barbara White Shareholder of: Corbus Pharmaceuticals, Inc., Employee of: Corbus Pharmaceuticals, Inc., Robert Spiera Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Forbius, Sanofi, Inflarx, Consultant of: Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Forbius, Mistubishi Tanabe
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White B, Billari W, Musiol J, Anderson C. 3:09 PM Abstract No. 43 Below-the-ankle interventions for critical limb ischemia: safety and efficacy in an office-based practice. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lu VM, Crawshay-Williams F, White B, Elliot A, Hill MA, Townley HE. Cytotoxicity, dose-enhancement and radiosensitization of glioblastoma cells with rare earth nanoparticles. Artif Cells Nanomed Biotechnol 2019; 47:132-143. [PMID: 30663430 DOI: 10.1080/21691401.2018.1544564] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/17/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
Glioblastoma is a heterogeneous disease with multiple genotypic origins. Despite treatment protocols such as surgery, radiotherapy and chemotherapy, the prognosis for patients remains poor. This study investigates the cytotoxic and radiation dose-enhancing and radiosensitizing ability of five rare earth oxide nanoparticles, in two different immortalized mammalian cell lines; U-87 MG and Mo59K. Significant cytotoxicity was observed in U-87 MG cells when exposed to Nd2O3 and La2O3. Autophagy was also detected in cells after incubation with Nd2O3. Radiosensitization was observed in U-87 MG when incubated with Gd2O3, CeO2-Gd and Nd2O3:Si. Importantly, these elements did not cause any intrinsic toxicity in the absence of irradiation and so could be considered biocompatible. The Gd2O3 and CeO2-Gd nanoparticles were also seen to generate ROS in U-87 MG cells after irradiation. Furthermore, the Mo59K and U-87 MG cells responded very differently to exposure to the rare earth nanoparticles. This may indicate the importance of the genotype of cells in the successful use of rare earth oxides for treatment.
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Affiliation(s)
- Victor M Lu
- a Nuffield department of Women's and Reproductive Health , Women's Centre, John Radcliffe Hospital, University of Oxford , Oxford , UK
| | - Felicity Crawshay-Williams
- a Nuffield department of Women's and Reproductive Health , Women's Centre, John Radcliffe Hospital, University of Oxford , Oxford , UK
| | - Benjamin White
- a Nuffield department of Women's and Reproductive Health , Women's Centre, John Radcliffe Hospital, University of Oxford , Oxford , UK
| | - Amy Elliot
- b Gray Laboratories, CRUK/MRC Oxford Institute for Radiation Oncology , University of Oxford , Oxford , UK
| | - Mark A Hill
- b Gray Laboratories, CRUK/MRC Oxford Institute for Radiation Oncology , University of Oxford , Oxford , UK
| | - Helen E Townley
- a Nuffield department of Women's and Reproductive Health , Women's Centre, John Radcliffe Hospital, University of Oxford , Oxford , UK
- c Department of Engineering Science , University of Oxford , Oxford , UK
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White B, Nordin A, Fry A, Ahmad A, McPhail S, Roe C, Rous B, Smittenaar R, Shelton J. Geographic variation in the use of lymphadenectomy and external-beam radiotherapy for endometrial cancer: a cross-sectional analysis of population-based data. BJOG 2019; 126:1456-1465. [PMID: 31449731 DOI: 10.1111/1471-0528.15914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To quantify geographic variation in the use of lymphadenectomy and/or external-beam radiotherapy (EBRT) for endometrial cancer in England. DESIGN Cross-sectional analysis of population-based data. SETTING English cancer registry data, linked to chemotherapy, radiotherapy and hospital episodes statistics data. POPULATION Twenty-two thousand four hundred and eighty-three women with endometrial cancer presenting without clinical or radiological evidence of distant metastatic spread, diagnosed in England from 2013 to 2016. METHODS Proportions of patients receiving lymphadenectomy and/or EBRT were compared across 19 Cancer Alliances, to identify variations in clinical practice. Two separate logistic regression models assessed the impact on variation of adjustment for tumour and patient characteristics. MAIN OUTCOME MEASURES Receipt of lymphadenectomy, receipt of EBRT. RESULTS There was substantial variation by Cancer Alliance in the adjusted proportion of women with endometrial cancer receiving lymphadenectomy (range 5% [95% CI 4-6%] to 48% [95% CI 45-52%]) and EBRT (range 10% [95% CI 7-12%] to 31% [95% CI 28-33%]), after adjusting for variation in pathological grade, age, comorbidities, deprivation, ethnic group and (EBRT only) FIGO stage. Different approaches to clinical practice were identified; (i) one Cancer Alliance had significantly higher than average lymphadenectomy and significantly lower than average EBRT use, (ii) three had high use of both lymphadenectomy and EBRT, (iii) one had low lymphadenectomy use and high EBRT use, and (iv) three had low use of both lymphadenectomy and EBRT. CONCLUSIONS Lymphadenectomy is probably used to triage for EBRT when lymphadenectomy use is high and EBRT use is low. This is probably a result of variation in local endometrial cancer management guidelines, suggesting that UK recommendations should be clarified. TWEETABLE ABSTRACT There is geographic variation in England in the use of lymphadenectomy and radiotherapy to treat endometrial cancer.
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Affiliation(s)
- B White
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Research UK, London, UK
| | - A Nordin
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,East Kent Hospitals University Foundation NHS Trust, Queen Elizabeth The Queen Mother Hospital, Margate, UK
| | - A Fry
- National Cancer Registration and Analysis Service, Public Health England, London, UK.,Cancer Research UK, London, UK
| | - A Ahmad
- Cancer Research UK, London, UK
| | - S McPhail
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - C Roe
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - B Rous
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - R Smittenaar
- National Cancer Registration and Analysis Service, Public Health England, London, UK
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Pullatt R, White B. A655 Accidental Stapling of Temperature probe during Sleeve Gastrectomy. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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42
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Fodor P, White B, Khan R. Inflammation-The role of ATP in pre-eclampsia. Microcirculation 2019; 27:e12585. [PMID: 31424615 DOI: 10.1111/micc.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/23/2019] [Accepted: 08/15/2019] [Indexed: 12/20/2022]
Abstract
Sterile inflammation may be initiated by molecules in the host organism that signal "damage" or "danger" also known as danger-associated molecular pattern (DAMPs). In pre-eclampsia (PE), a variety of DAMPs may be involved in the etiology or exacerbation of the disorder. Adenosine 5'-triphosphate (ATP) is a key intracellular energy molecule as well as a ligand for purinergic receptors. In humans, under physiological conditions, extracellular ATP (eATP) levels are distinctly low, but can rise to several hundred fold when cells become injured, stressed, or even necrotic. This often initiates a sterile inflammatory response with eATP acting as a DAMP. Extracellular ATP and its derivative nucleotides synthetized by endonucleotidases exhibit many of their effects through purinergic receptors, via inflammatory cascades and the production of proinflammatory molecules. This is clearly seen in the P2X7 gated receptor, which is linked to release of cytokines of the interleukin-1 family. Considering its fundamental role in innate immunity, an imbalance of P2X7 receptor activation may lead to deleterious effects in the coordination of placental vessel tone via the synthesis of various proinflammatory cytokines. This review explores the implication of DAMPs, specifically ATP and uric acid in the inflammation associated with PE.
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Affiliation(s)
- Paul Fodor
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
| | - Benjamin White
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
| | - Raheela Khan
- Division of Medical Science and Graduate Entry Medicine, School of Medicine, University of Nottingham, Medical School, Royal Derby Hospital Centre, Derby, UK
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44
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Kabrhel C, Rosovsky R, Baugh C, Connors J, White B, Giordano N, Torrey J, Deadmon E, Parry BA, Hagan S, Zheng H. Multicenter Implementation of a Novel Management Protocol Increases the Outpatient Treatment of Pulmonary Embolism and Deep Vein Thrombosis. Acad Emerg Med 2019; 26:657-669. [PMID: 30341928 DOI: 10.1111/acem.13640] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective was to determine whether a protocol combining risk stratification, treatment with the direct-acting oral anticoagulant rivaroxaban, and defined follow-up is associated with a greater proportion of patients with venous thromboembolism (VTE) treated as outpatients, without hospital admission. METHODS We performed a multicenter study of patients diagnosed with VTE (pulmonary embolism [PE] or deep vein thrombosis [DVT]) in two urban EDs, 18 months before and 18 months after implementation of an outpatient VTE treatment protocol. Patients with radiographically confirmed acute VTE were eligible. Our primary outcome was the proportion of VTE patients discharged from the ED or observation unit (i.e., without hospital admission). We performed subgroup analyses according to hospital, DVT and PE, and low-risk PE. We also assessed 7- and 30-day mortality, major bleeding, and returns to the ED. We compared proportions using chi-square and Fisher's exact tests. RESULTS We enrolled 2,212 patients, 1,081 (49%) before protocol and 1,131 (51%) after protocol. Mean age (59 years vs. 60 years), female sex (49% vs. 49%), other demographics, comorbid illness, and PE risk stratification were similar before and after. After protocol, more VTE (35% from 26%, p < 0.001), PE (18% from 12%, p = 0.002), low-risk PE (28% from 18%, p < 0.001), and DVT (60% from 49%, p = 0.002) patients were treated as outpatients. Mortality, bleeding, and returns to ED were rare and did not increase after protocol. CONCLUSIONS A treatment protocol combining risk-stratification, rivaroxaban treatment and defined follow-up is associated with an increase in PE and DVT patients treated as outpatients, with no increase in adverse outcomes.
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Affiliation(s)
- Christopher Kabrhel
- Center for Vascular Emergencies Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MAUSA
| | - Rachel Rosovsky
- Division of Hematology / Oncology Department of Medicine Massachusetts General Hospital Harvard Medical School BostonMA USA
| | - Christopher Baugh
- Department of Emergency Medicine Brigham and Women's Hospital Harvard Medical School Boston MAUSA
| | - Jean Connors
- Division of Hematology / Oncology Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MAUSA
| | - Benjamin White
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MAUSA
| | - Nicholas Giordano
- Center for Vascular Emergencies Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MAUSA
| | - Jasmine Torrey
- Center for Vascular Emergencies Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MAUSA
| | - Erin Deadmon
- Center for Vascular Emergencies Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MAUSA
| | - Blair Alden Parry
- Center for Vascular Emergencies Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston MAUSA
| | - Sean Hagan
- Department of Emergency Medicine Brigham and Women's Hospital Harvard Medical School Boston MAUSA
| | - Hui Zheng
- Department of Biostatistics Massachusetts General Hospital Boston MA USA
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45
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Werth V, Pearson D, Okawa J, Feng R, Concha J, Patel B, Hejazi E, Cornwall C, Constantine S, White B. 610 Safety and efficacy of lenabasum in refractory skin-predominant dermatomyositis subjects treated on an open-label extension of trial JBT101-DM-001. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.686] [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: 10/27/2022]
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46
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Hussein K, White B, Sampson M, Gupta S. Pictorial review of Morel-Lavallée lesions. J Med Imaging Radiat Oncol 2019; 63:212-215. [PMID: 30652431 DOI: 10.1111/1754-9485.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
Abstract
A Morel-Lavallée lesion is a post-traumatic soft tissue degloving injury which presents as a haemolymphatic mass or collection. Morel-Lavallée lesions are the result of direct trauma or shearing forces abruptly separating skin and subcutaneous tissue from underlying fascia causing disruption of perforating vessels and nerves, creating a potential space that may fill with blood, lymph and debris forming a collection. Morel-Lavallée lesions usually occur adjacent to osseous protuberances, most commonly along the greater trochanter. Early diagnosis and management is essential to prevent complications. We present this pictorial review to highlight the imaging characteristics of Morel-Lavallée lesions across imaging modalities to improve recognition, early diagnosis and management.
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Affiliation(s)
- Karim Hussein
- Radiology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Benjamin White
- Flinders Medical Centre and Flinders University, Benson Radiology, Adelaide, South Australia, Australia
| | - Matthew Sampson
- Flinders Medical Centre and Flinders University, Benson Radiology, Adelaide, South Australia, Australia
| | - Sunil Gupta
- Women and Children Hospital Adelaide, Benson Radiology, Adelaide, South Australia, Australia
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47
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Ashenfelter J, Balantekin AB, Baldenegro C, Band HR, Bass CD, Bergeron DE, Berish D, Bignell LJ, Bowden NS, Bricco J, Brodsky JP, Bryan CD, Bykadorova Telles A, Cherwinka JJ, Classen T, Commeford K, Conant AJ, Cox AA, Davee D, Dean D, Deichert G, Diwan MV, Dolinski MJ, Erickson A, Febbraro M, Foust BT, Gaison JK, Galindo-Uribarri A, Gilbert CE, Gilje KE, Glenn A, Goddard BW, Hackett BT, Han K, Hans S, Hansell AB, Heeger KM, Heffron B, Insler J, Jaffe DE, Ji X, Jones DC, Koehler K, Kyzylova O, Lane CE, Langford TJ, LaRosa J, Littlejohn BR, Lopez F, Lu X, Martinez Caicedo DA, Matta JT, McKeown RD, Mendenhall MP, Miller HJ, Minock JM, Mueller PE, Mumm HP, Napolitano J, Neilson R, Nikkel JA, Norcini D, Nour S, Pushin DA, Qian X, Romero-Romero E, Rosero R, Sarenac D, Seilhan BS, Sharma R, Surukuchi PT, Trinh C, Tyra MA, Varner RL, Viren B, Wagner JM, Wang W, White B, White C, Wilhelmi J, Wise T, Yao H, Yeh M, Yen YR, Zhang A, Zhang C, Zhang X, Zhao M. First Search for Short-Baseline Neutrino Oscillations at HFIR with PROSPECT. Phys Rev Lett 2018; 121:251802. [PMID: 30608854 DOI: 10.1103/physrevlett.121.251802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Indexed: 06/09/2023]
Abstract
This Letter reports the first scientific results from the observation of antineutrinos emitted by fission products of ^{235}U at the High Flux Isotope Reactor. PROSPECT, the Precision Reactor Oscillation and Spectrum Experiment, consists of a segmented 4 ton ^{6}Li-doped liquid scintillator detector covering a baseline range of 7-9 m from the reactor and operating under less than 1 m water equivalent overburden. Data collected during 33 live days of reactor operation at a nominal power of 85 MW yield a detection of 25 461±283 (stat) inverse beta decays. Observation of reactor antineutrinos can be achieved in PROSPECT at 5σ statistical significance within 2 h of on-surface reactor-on data taking. A reactor model independent analysis of the inverse beta decay prompt energy spectrum as a function of baseline constrains significant portions of the previously allowed sterile neutrino oscillation parameter space at 95% confidence level and disfavors the best fit of the reactor antineutrino anomaly at 2.2σ confidence level.
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Affiliation(s)
- J Ashenfelter
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - A B Balantekin
- Department of Physics, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - C Baldenegro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - H R Band
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - C D Bass
- Department of Physics, Le Moyne College, Syracuse, New York 13214, USA
| | - D E Bergeron
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - D Berish
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - L J Bignell
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - N S Bowden
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Bricco
- Physical Sciences Laboratory, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - J P Brodsky
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C D Bryan
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - A Bykadorova Telles
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J J Cherwinka
- Physical Sciences Laboratory, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - T Classen
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - K Commeford
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - A J Conant
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - A A Cox
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - D Davee
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - D Dean
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - G Deichert
- High Flux Isotope Reactor, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - M V Diwan
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - A Erickson
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - M Febbraro
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - B T Foust
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J K Gaison
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - A Galindo-Uribarri
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C E Gilbert
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - K E Gilje
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - A Glenn
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B W Goddard
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - B T Hackett
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - K Han
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - S Hans
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A B Hansell
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - K M Heeger
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - B Heffron
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - J Insler
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - D E Jaffe
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - X Ji
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D C Jones
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - K Koehler
- Physical Sciences Laboratory, University of Wisconsin, Madison, Madison, Wisconsin 53706, USA
| | - O Kyzylova
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - C E Lane
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - T J Langford
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J LaRosa
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - B R Littlejohn
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - F Lopez
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - X Lu
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - D A Martinez Caicedo
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - J T Matta
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - R D McKeown
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - M P Mendenhall
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H J Miller
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - J M Minock
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - P E Mueller
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - H P Mumm
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - J Napolitano
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - R Neilson
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J A Nikkel
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - D Norcini
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - S Nour
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - D A Pushin
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - X Qian
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - E Romero-Romero
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - R Rosero
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - D Sarenac
- Institute for Quantum Computing and Department of Physics and Astronomy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
| | - B S Seilhan
- Nuclear and Chemical Sciences Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Sharma
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - P T Surukuchi
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - C Trinh
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - M A Tyra
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - R L Varner
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - B Viren
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - J M Wagner
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - W Wang
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - B White
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - C White
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - J Wilhelmi
- Department of Physics, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Wise
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - H Yao
- Department of Physics, College of William and Mary, Williamsburg, Virginia 23185, USA
| | - M Yeh
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - A Zhang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Zhang
- Brookhaven National Laboratory, Upton, New York 11973, USA
| | - X Zhang
- Department of Physics, Illinois Institute of Technology, Chicago, Illinois 60616, USA
| | - M Zhao
- Brookhaven National Laboratory, Upton, New York 11973, USA
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Pullatt R, Byrne KT, White B, Allen S, Crowley NM, Axiotis D. Laparoscopic Roux-en-Y Fistulojejunostomy for a Chronic sleeve leak with Bronchopleural fistula. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.151] [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: 10/27/2022]
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Abstract
Emergency department (ED) patient experience continues to be a growing area of focus for ED physicians, administrators, and regulatory agencies. Recent literature has suggested a strong correlation between positive ratings of patient experience and important health system goals, including improved clinical outcomes and care quality, increased staff satisfaction, and reduced medicolegal risk. However, given the myriad of factors driving ED patient experience, identifying effective and synergistic interventions can present a challenge, especially in the setting of limited ED resources. Utilizing the themes identified in a recent systematic review of the ED patient experience literature, we developed a conceptual “logic model” of ED patient experience in order to provide a broadly applicable framework for practical intervention and to guide further study of ED patient experience interventions. The logic model was modified in an iterative fashion through review by local patient and staff groups as well as a national interest group until arriving at the current, comprehensive version. Here, we describe the creation of the logic model and, with the aim of providing a framework for readers to develop similar models for their practice settings, provide a case discussion of its use by an ED medical director.
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Affiliation(s)
- Jonathan D Sonis
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily L Aaronson
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Castagna
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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50
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Fogarty H, Byrne M, O’Connell NM, Ryan K, White B, O’Donnell JS, Lavin M. Acquired Factor Xiii Deficiency: An Uncommon But Easily Missed Cause Of Severe Bleeding. Ir Med J 2018; 111:757. [PMID: 30489053] [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: 06/09/2023]
Abstract
Factor XIII (FXIII) is a plasma clotting protein involved in clot stabilization. Severe FXIII deficiency may present with severe, even fatal bleeding. Critically however, routine coagulation assays may be normal and only specific FXIII assays will detect the abnormality. Herein we discuss a case report of a patient with acquired FXIII deficiency in order to highlight the clinical challenges associated with establishing the diagnosis and discuss the treatment approach. A 70-year-old man presented with a gluteal haematoma despite no preceding personal history of bleeding. Extensive initial haemostatic investigations were normal until a specific FXIII assay showed a marked reduction in FXIII levels. With directed treatment, bleeding episodes ceased and remission was achieved. Clinical awareness of FXIII deficiency is important, so appropriate testing can be implemented in patients with unexplained bleeding diatheses, particularly those in whom bleeding responds poorly to standard replacement therapy.
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Affiliation(s)
- H Fogarty
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - M Byrne
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - N M O’Connell
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - K Ryan
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - B White
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
| | - J S O’Donnell
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
- Haemostasis Research Group, Irish Centre for Vascular Biology, Royal College of Surgeons Ireland, Dublin, Ireland
| | - M Lavin
- National Coagulation Centre, St. James’s Hospital, Dublin, Ireland
- Haemostasis Research Group, Irish Centre for Vascular Biology, Royal College of Surgeons Ireland, Dublin, Ireland
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