1
|
Sanyal AJ, Munoz B, Cusi K, Barritt AS, Muthiah M, Mospan AR, Reddy KR, Firpi-Morell R, Thuluvath PJ, Bhamidimarri KR, Fried MW. Validation of a Clinical Risk-based Classification System in a Large Nonalcoholic Fatty Liver Disease Real-world Cohort. Clin Gastroenterol Hepatol 2023; 21:2889-2900.e10. [PMID: 36871772 DOI: 10.1016/j.cgh.2023.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND & AIMS There is an unmet need to validate simple and easily available methods that can be used in routine practice to identify those at risk of adverse outcomes from nonalcoholic fatty liver disease (NAFLD). A retrospective-prospective analysis of NAFLD patients enrolled in a longitudinal noninterventional study (TARGET-NASH) was performed to validate the prognostic utility of the following risk-categories: (A) Fibrosis-4 (FIB-4) <1.3 and/or liver-stiffness measurement (LSM) measured by Fibroscan <8 kp, (B) FIB-4 1.31‒2.6 and/or LSM 8.1-12.5 kp, and (C) FIB-4 >2.6 and/or LSM >12.5 kp. METHODS Those in class A with aspartate transaminase:alanine transaminase ratio >1 or platelets <150,000/mm3, or class B with aspartate transaminase:alanine transaminase ratio >1 or platelets <150,000/mm3 were upstaged by one class. Fine-Gray competing risk analyses were performed for all outcomes. RESULTS A total of 2523 individuals (class A = 555, B = 879, C = 1089) were followed for a median duration of 3.74 years. Adverse outcomes increased from class A to C in all-cause mortality (0.07 vs 0.3 vs 2.5/100 person-years [PY], hazard ratio [HR], 3.0 and 16.3 class B and C vs A), liver-associated clinical events (0.2 vs 1 vs 8/100 PY, HR, 4.3 and 36.6 B and C vs A), major adverse cardiovascular events (0.69 vs 0.87 vs 2.02/100 PY, HR, 0.78 and 1.55 B and C vs A), hepatocellular carcinoma (0 vs 0.09 vs 0.88/100 PY, HR, 8.32 C vs B), and chronic kidney disease (1.24 vs 2.48 vs 3.51/100 PY). Those who were upstaged had outcome rates similar to the lower class defined by their FIB-4. CONCLUSIONS These data support a FIB-4-based risk-stratification of NAFLD that can be used in routine clinical practice. CLINICALTRIALS gov Identifier: NCT02815891.
Collapse
Affiliation(s)
- Arun J Sanyal
- Virginia Commonwealth University, Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Richmond, VA.
| | | | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL
| | - A Sidney Barritt
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark Muthiah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore and Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore
| | | | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Roberto Firpi-Morell
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
| | - Paul J Thuluvath
- Division of Gastroenterology, Mercy Medical Center & University of Maryland School of Medicine, Baltimore, MD
| | | | | |
Collapse
|
2
|
Silverberg JI, Simpson B, Abuabara K, Guttman-Yassky E, Calimlim B, Wegzyn C, Krueger W, Gamelli A, Munoz B, Faller RW, Crawford JM, Grada A, Eichenfield LF. Prevalence and burden of atopic dermatitis involving the head, neck, face, and hand: A cross sectional study from the TARGET-DERM AD cohort. J Am Acad Dermatol 2023; 89:519-528. [PMID: 37150299 DOI: 10.1016/j.jaad.2023.04.052] [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: 11/01/2022] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is severely burdensome, and there has been poor characterization of any differences in impact based on the area affected. OBJECTIVE To estimate the prevalence and HRQoL impact of head/face/neck/hand (HFNH) involvement among patients with moderate-to-severe atopic dermatitis. METHODS All TARGET-DERM AD registry patients with moderate/severe Investigator Global Assessment (vIGA-AD) were assessed using the Patient Oriented SCORing Atopic Dermatitis, Patient Oriented Eczema Measure (POEM) and the (Children's) Dermatology Life Quality Index ((C)DLQI). RESULTS 541 participants met the criteria (75.0% adults) and 84% (N = 453) reported HFNH involvement. HFNH and non-HFNH involved participants had similar characteristics; 55.2% female and 46.9% White. Compared to the non-HFNH involved, the involved had severe vIGA-AD (28.5% vs 16.3%, P = .02) and higher median body surface area affected (15% vs 10%, P ≤ .01) and were twice as likely to have higher (C)DLQI and POEM scores. LIMITATIONS This was an analysis of real-world and patient reported outcome data. CONCLUSION Real-world HFNH involved AD patients were associated with significantly worse quality of life, POEM/(C)DLQI, and more severe disease. Detailed assessments of specific areas affected by AD are needed to personalize treatment.
Collapse
Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University, Washington, District of Columbia.
| | | | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | - Breda Munoz
- Target RWE Health Evidence Solutions, Durham, North Carolina
| | - Rachel W Faller
- Target RWE Health Evidence Solutions, Durham, North Carolina
| | | | | | | |
Collapse
|
3
|
Guttman-Yassky E, Bar J, Rothenberg-Lausell C, Eichenfield L, Grada A, Abuabara K, Chapman M, Calimlim B, Wegzyn C, Gamelli A, Krueger W, Munoz B, Knapp K, Faller R, Crawford J, Silverberg J. Do Atopic Dermatitis Patient-Reported Outcomes Correlate With Validated Investigator Global Assessment? Insights From TARGET-AD Registry. J Drugs Dermatol 2023; 22:344-354. [PMID: 37026893 DOI: 10.36849/jdd.7473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Research examining associations between the clinician-reported validated Investigator Global Assessment for AD (vIGA-AD) and patient-reported disease burden is sparse. This study aims to evaluate the relationship between vIGA-AD with patient-reported disease severity and quality of life (QoL). METHODS A cross-sectional analysis was conducted using a September 2021 data cut from the TARGET-DERM AD study, a real-world, longitudinal cohort of children, adolescents, and adults with AD enrolled at 44 academic and community dermatology and allergy sites in the US. Clinical AD severity was measured using vIGA-AD while disease severity and QoL were assessed by the Patient Oriented Eczema Measure (POEM) and (Children’s) Dermatology Life Quality Index (C/DLQI), respectively. Patient characteristics, clinical- and patient reported-outcomes were assessed by stratified POEM and C/DLQI categories using descriptive statistics. Associations with vIGA-AD were evaluated using unadjusted and adjusted ordinal logistic regression and linear regression models. RESULTS The analysis cohort (n=1,888) primarily consisted of adults (57%), females (56%), and patients with private insurance (63%). Unadjusted analyses suggest that clinical AD severity was associated with age, with more adolescents and adults having moderate/severe vIGA-AD than pediatric patients. Clinical AD severity was also associated with disease severity, with greater POEM scores observed at greater vIGA-AD severity levels (r = 0.496 and 0.45 for adults and pediatrics, respectively). Clinical AD severity and QoL were positively correlated, with greater CDLQI/DLQI scores at greater vIGA-AD severity levels (r = 0.458 and 0.334 for DLQI and CDLQI, respectively). After adjusting for demographics and other risk factors, vIGA-AD continued to show significant associations with POEM and DLQI/CDLQI. Compared to patients with clear/almost clear disease, adults and pediatrics with moderate-to-severe AD were 8.19 and 5.78 times as likely to be in a more severe POEM category, respectively. Similarly, compared to patients with clear/almost clear disease, adults and pediatrics with moderate/severe AD were 6.69 and 3.74 times as likely to be in a more severe DLQI/CDLQI category. Adjusted linear regression analyses of DLQI in adults showed significant differences by vIGA-AD level, with mild AD and moderate/severe AD associated with a 2.26-point and 5.42-point greater DLQI relative to clear/almost clear AD. CONCLUSIONS In this real-world study of patients with AD, greater clinician-reported disease severity is positively correlated with higher patient-reported disease severity and lower QoL. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7473 Access Supplementary Material here Citation: Guttman-Yassky E, Bar J, Rothenberg Lausell C, et al. Do atopic dermatitis patient-reported outcomes correlate with validated investigator global assessment? Insights from TARGET-AD registry. J Drugs Dermatol. 2023;22(4):344-355. doi:10.36849/JDD.7473.
Collapse
|
4
|
Abuabara K, Eichenfield LF, Bissonnette R, Silverberg JI, Bagel J, Guttman-Yassky E, Thaci D, Simpson EL, Harris JE, Krueger J, Myers DE, Gamelli A, Milutinovic M, Parneix A, Crawford JM, Hildebrand JS, Munoz B, Paller AS. Real-world evidence on atopic dermatitis: Baseline characteristics and predictors of treatment choice in the TARGET cohort. J Am Acad Dermatol 2022:S0190-9622(22)02792-X. [PMID: 36521798 DOI: 10.1016/j.jaad.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Katrina Abuabara
- UCSF Department of Dermatology and UC Berkeley Division of Epidemiology and Biostatistics, San Francisco, California.
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California
| | | | | | - Jerry Bagel
- Eczema Treatment Center of New Jersey, New Jersey
| | - Emma Guttman-Yassky
- Ichan School of Medicine at Mount Sinai, The Kimberly and Eric J. Waldman Department of Dermatology, New York, New York
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - John E Harris
- UMass Chan Medical School, Department of Dermatology, Worcester, Massachusetts
| | | | | | | | | | | | | | | | | | - Amy S Paller
- Northwestern Feinberg School of Medicine, NMH/Arkes Family Pavilion, Chicago, Illinois
| |
Collapse
|
5
|
Malespin MH, Barritt AS, Watkins SE, Schoen C, Tincopa MA, Corbin KD, Mospan AR, Munoz B, Trinh HN, Weiss LM, Reddy KR, Loomba R, Kemmer N, Lok AS. Weight Loss and Weight Regain in Usual Clinical Practice: Results From the TARGET-NASH Observational Cohort. Clin Gastroenterol Hepatol 2022; 20:2393-2395.e4. [PMID: 33486083 DOI: 10.1016/j.cgh.2021.01.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
First-line treatment for nonalcoholic fatty liver disease (NAFLD) focuses on weight loss through lifestyle modifications.1,2 Weight loss ≥5% results in reduction of steatosis and weight loss ≥10% has been associated with improvement in hepatic inflammation and fibrosis.3 The incidence and sustainability of weight loss among patients with NAFLD were estimated and associating factors identified.
Collapse
Affiliation(s)
| | - Alfred Sidney Barritt
- Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Monica A Tincopa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karen D Corbin
- AdventHealth Translational Research Institute, Orlando, Florida
| | | | | | - Huy N Trinh
- San Jose Gastroenterology, San Jose, California
| | | | - K Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California at San Diego, San Diego, California
| | | | - Anna S Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
6
|
Castillo-Leon E, Morris HL, Schoen C, Bilhartz J, McKiernan P, Miloh T, Palle S, Kabbany MN, Munoz B, Mospan AR, Rudolph B, Xanthakos SA, Vos MB. Variation in Alanine Aminotransferase in Children with Non-Alcoholic Fatty Liver Disease. Children (Basel) 2022; 9:children9030374. [PMID: 35327746 PMCID: PMC8946883 DOI: 10.3390/children9030374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Background: Pediatric non-alcoholic fatty liver disease (NAFLD) is a major public health concern. Aminotransferase (ALT) is frequently used for screening and monitoring, but few studies have reported typical patterns of ALT elevation in children. Methods: TARGET-NASH is a real-world longitudinal observational cohort of patients with NAFLD receiving care across the United States. Analyses included children enrolled between 1 August 2016, and 12 October 2020, with at least one ALT measurement after enrollment. Peak ALT was based on the first and last available record and categorized into clinical cut points: <70 IU/L, >70−<250 IU/L, and >250 IU/L. A chi-squared test was used to compare differences in proportions, and a Kruskal−Wallis test was used to compare the medians and distributions of continuous responses. Results: Analyses included 660 children with a median age of 13 years. Of the 660, a total of 187 had undergone a biopsy and were more likely to be Hispanic or Latino (67% vs. 57%, p = 0.02) and to have cirrhosis (10% vs. 1%, p < 0.001). The highest ALT scores ranged from 28 U/L to 929 U/L; however, these scores varied across time. The prevalence of cirrhosis or any liver fibrosis stage was most common among children with a peak ALT > 70 U/L. Conclusions: Large variability was seen in ALT among children, including many values > 250 U/L. Higher levels of ALT were associated with increased prevalence of comorbidities and more advanced stages of NAFLD. These findings support an increased need for therapeutics and disease severity assessment in children with peak ALT > 70 U/L.
Collapse
Affiliation(s)
- Eduardo Castillo-Leon
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA;
- Department of Pediatrics, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Heather L. Morris
- Target RWE, Durham, NC 27703, USA; (H.L.M.); (C.S.); (B.M.); (A.R.M.)
| | - Cheryl Schoen
- Target RWE, Durham, NC 27703, USA; (H.L.M.); (C.S.); (B.M.); (A.R.M.)
| | - Jacob Bilhartz
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA;
| | | | - Tamir Miloh
- Pediatric Gastroenterology, Pediatric Transplant Hepatology, Miami Transplant Institute, Miami, FL 33136, USA;
| | - Sirish Palle
- Division of Gastroenterology, OU Medicine, Oklahoma City, OK 73104, USA;
| | - Mohammad Nasser Kabbany
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Breda Munoz
- Target RWE, Durham, NC 27703, USA; (H.L.M.); (C.S.); (B.M.); (A.R.M.)
| | - Andrea R. Mospan
- Target RWE, Durham, NC 27703, USA; (H.L.M.); (C.S.); (B.M.); (A.R.M.)
| | - Bryan Rudolph
- The Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY 10467, USA;
| | - Stavra A. Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s, Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45229, USA;
| | - Miriam B. Vos
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA 30322, USA
- Correspondence:
| | | |
Collapse
|
7
|
Fried MW, Crawford JM, Mospan AR, Watkins SE, Munoz B, Zink RC, Elliott S, Burleson K, Landis C, Reddy KR, Brown RS. Reply to Roussel et al. Clin Infect Dis 2021; 72:e929. [PMID: 33086377 DOI: 10.1093/cid/ciaa1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Breda Munoz
- TARGET PharmaSolutions, Inc, Durham, North Carolina, USA
| | - Richard C Zink
- TARGET PharmaSolutions, Inc, Durham, North Carolina, USA
| | - Sherry Elliott
- Elliott Health Information Pros, Inc, Cary, North Carolina, USA
| | - Kyle Burleson
- TARGET PharmaSolutions, Inc, Durham, North Carolina, USA
| | - Charles Landis
- Liver Care and Transplantation Services at University of Washington Medical Center, Seattle, Washington, USA
| | - K Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert S Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine Center for Liver Disease, New York, New York, USA
| |
Collapse
|
8
|
Fried MW, Crawford JM, Mospan AR, Watkins SE, Munoz B, Zink RC, Elliott S, Burleson K, Landis C, Reddy KR, Brown RS. Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States. Clin Infect Dis 2021; 72:e558-e565. [PMID: 32856034 PMCID: PMC7499515 DOI: 10.1093/cid/ciaa1268] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND As COVID-19 disseminates throughout the US, a better understanding of patient characteristics associated with hospitalization, morbidity and mortality in diverse geographic regions is essential. METHODS Hospital chargemaster data on adult patients with COVID-19 admitted to 245 hospitals across 38 states between February 15 and April 20, 2020 were assessed. Clinical course from admission through hospitalization to discharge or death was analyzed. RESULTS A total of 11,721 patients were included (majority were >60 years of age [59.9%] and male [53.4%]). Comorbidities included hypertension (46.7%), diabetes (27.8%), cardiovascular disease (18.6%), obesity (16.1%), and chronic kidney disease (12.2%). Mechanical ventilation was required by 1,967 patients (16.8%). Mortality among hospitalized patients was 21.4% and increased to 70.5% among those on mechanical ventilation. Male sex, older age, obesity, geographic region, and the presence of chronic kidney disease or preexisting cardiovascular disease were associated with an increased odds of mechanical ventilation. All aforementioned risk factors, with the exception of obesity, were associated with an increased odds of death (all p& 0.001). Many patients received investigational medications for treatment of COVID-19, including 48 patients on remdesivir and 4,232 on hydroxychloroquine. CONCLUSION This large observational cohort describes the clinical course and identifies factors associated with outcomes of hospitalized patients with COVID-19 across the US. These data can inform strategies to prioritize prevention and treatment for this disease.
Collapse
Affiliation(s)
| | | | | | | | - Breda Munoz
- TARGET PharmaSolutions Inc., Durham, North Carolina, USA
| | - Richard C Zink
- TARGET PharmaSolutions Inc., Durham, North Carolina, USA
| | - Sherry Elliott
- Elliott Health Information Pros Inc., Cary, North Carolina, USA
| | - Kyle Burleson
- TARGET PharmaSolutions Inc., Durham, North Carolina, USA
| | - Charles Landis
- Liver Care and Transplantation Services at University of Washington Medical Center, Seattle, Washington, USA
| | - K Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert S Brown
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine Center for Liver Disease, New York, New York, USA
| |
Collapse
|
9
|
Verna EC, Landis C, Brown, Jr RS, Mospan AR, Crawford JM, Hildebrand JS, Morris HL, Munoz B, Fried MW, Reddy KR. Factors Associated With Readmission in the United States Following Hospitalization With Coronavirus Disease 2019. Clin Infect Dis 2021; 74:1713-1721. [PMID: 34015106 PMCID: PMC8240865 DOI: 10.1093/cid/ciab464] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patients hospitalized for coronavirus disease 2019 (COVID-19) may experience complications following hospitalization and require readmission. In this analysis, we estimated the rate and risk factors associated with COVID-19-related readmission and inpatient mortality. METHODS In this retrospective cohort study, we used deidentified chargemaster data from 297 hospitals across 40 US states on patients hospitalized with COVID-19 from 15 February 2020 through 9 June 2020. Demographics, comorbidities, acute conditions, and clinical characteristics of first hospitalization are summarized. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission and in-hospital mortality. RESULTS Among 29 659 patients, 1070 (3.6%) were readmitted. Readmitted patients were more likely to have diabetes, hypertension, cardiovascular disease (CVD), or chronic kidney disease (CKD) vs those not readmitted (P < .0001) and to present on first admission with acute kidney injury (15.6% vs 9.2%), congestive heart failure (6.4% vs 2.4%), or cardiomyopathy (2.1% vs 0.8%) (P < .0001). Higher odds of readmission were observed in patients aged >60 vs 18-40 years (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.48-2.50) and those admitted in the Northeast vs West (OR, 1.43; 95% CI, 1.14-1.79) or South (OR, 1.28; 95% CI, 1.11-1.49). Comorbidities including diabetes (OR, 1.34; 95% CI, 1.12-1.60), CVD (OR, 1.46; 95% CI, 1.23-1.72), CKD stage 1-5 (OR, 1.51; 95% CI, 1.25-1.81), and CKD stage 5 (OR, 2.27; 95% CI, 1.81-2.86) were associated with higher odds of readmission; 12.3% of readmitted patients died during second hospitalization. CONCLUSIONS Among this large US population of patients hospitalized with COVID-19, readmission was associated with certain comorbidities and acute conditions during first hospitalization. These findings may inform strategies to mitigate risks of readmission due to COVID-19 complications.
Collapse
Affiliation(s)
- Elizabeth C Verna
- Columbia University Irving Medical Center, New
York, NY, USA,Corresponding Author: Elizabeth C. Verna, MD, Associate Professor
of Medicine, Director of Clinical Research, Transplant Clinical Research Center,
Center for Liver Disease and Transplantation, Columbia University Vagelos
College of Physicians and Surgeons, Columbia University Irving Medical Center,
622 West 168th St, PH 14-105, New York, NY 10032, USA, phone: 212-305-0662,
| | | | | | | | - Julie M Crawford
- Target RWE Health Evidence Solutions,
Durham, NC, USA,Alternate Corresponding Author: Julie M. Crawford, MD, Senior
Director of Scientific & Medical Affairs, Target RWE Health Evidence
Solutions, 5001 S Miami Blvd, Ste 100, Durham, NC 27703, USA, phone:
303-905-6896,
| | | | | | - Breda Munoz
- Target RWE Health Evidence Solutions,
Durham, NC, USA
| | | | | |
Collapse
|
10
|
Ruzante JM, Olin K, Munoz B, Nawrocki J, Selvarangan R, Meyers L. Real-time gastrointestinal infection surveillance through a cloud-based network of clinical laboratories. PLoS One 2021; 16:e0250767. [PMID: 33930062 PMCID: PMC8087049 DOI: 10.1371/journal.pone.0250767] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/14/2021] [Indexed: 02/04/2023] Open
Abstract
Acute gastrointestinal infection (AGI) represents a significant public health concern. To control and treat AGI, it is critical to quickly and accurately identify its causes. The use of novel multiplex molecular assays for pathogen detection and identification provides a unique opportunity to improve pathogen detection, and better understand risk factors and burden associated with AGI in the community. In this study, de-identified results from BioFire® FilmArray® Gastrointestinal (GI) Panel were obtained from January 01, 2016 to October 31, 2018 through BioFire® Syndromic Trends (Trend), a cloud database. Data was analyzed to describe the occurrence of pathogens causing AGI across United States sites and the relative rankings of pathogens monitored by FoodNet, a CDC surveillance system were compared. During the period of the study, the number of tests performed increased 10-fold and overall, 42.6% were positive for one or more pathogens. Seventy percent of the detections were bacteria, 25% viruses, and 4% parasites. Clostridium difficile, enteropathogenic Escherichia coli (EPEC) and norovirus were the most frequently detected pathogens. Seasonality was observed for several pathogens including astrovirus, rotavirus, and norovirus, EPEC, and Campylobacter. The co-detection rate was 10.2%. Enterotoxigenic E. coli (ETEC), Plesiomonas shigelloides, enteroaggregative E. coli (EAEC), and Entamoeba histolytica were detected with another pathogen over 60% of the time, while less than 30% of C. difficile and Cyclospora cayetanensis were detected with another pathogen. Positive correlations among co-detections were found between Shigella/Enteroinvasive E. coli with E. histolytica, and ETEC with EAEC. Overall, the relative ranking of detections for the eight GI pathogens monitored by FoodNet and BioFire Trend were similar for five of them. AGI data from BioFire Trend is available in near real-time and represents a rich data source for the study of disease burden and GI pathogen circulation in the community, especially for those pathogens not often targeted by surveillance.
Collapse
Affiliation(s)
- Juliana M Ruzante
- Center for Environmental Health, Risk and Sustainability, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Katherine Olin
- Biomathematics, BioFire Diagnostics, Salt Lake City, Utah, United States of America
| | - Breda Munoz
- Center for Environmental Health, Risk and Sustainability, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jeff Nawrocki
- Biomathematics, BioFire Diagnostics, Salt Lake City, Utah, United States of America
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, Missouri, United States of America
| | - Lindsay Meyers
- Medical Data Systems, BioFire Diagnostics, Salt Lake City, Utah, United States of America
| |
Collapse
|
11
|
Rhea S, Jones K, Endres-Dighe S, Munoz B, Weber DJ, Hilscher R, MacFarquhar J, Sickbert-Bennett E, DiBiase L, Marx A, Rineer J, Lewis J, Bobashev G. Modeling inpatient and outpatient antibiotic stewardship interventions to reduce the burden of Clostridioides difficile infection in a regional healthcare network. PLoS One 2020; 15:e0234031. [PMID: 32525887 PMCID: PMC7289388 DOI: 10.1371/journal.pone.0234031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
Antibiotic exposure can lead to unintended outcomes, including drug-drug interactions, adverse drug events, and healthcare-associated infections like Clostridioides difficile infection (CDI). Improving antibiotic use is critical to reduce an individual's CDI risk. Antibiotic stewardship initiatives can reduce inappropriate antibiotic prescribing (e.g., unnecessary antibiotic prescribing, inappropriate antibiotic selection), impacting both hospital (healthcare)-onset (HO)-CDI and community-associated (CA)-CDI. Previous computational and mathematical modeling studies have demonstrated a reduction in CDI incidence associated with antibiotic stewardship initiatives in hospital settings. Although the impact of antibiotic stewardship initiatives in long-term care facilities (LTCFs), including nursing homes, and in outpatient settings have been documented, the effects of specific interventions on CDI incidence are not well understood. We examined the relative effectiveness of antibiotic stewardship interventions on CDI incidence using a geospatially explicit agent-based model of a regional healthcare network in North Carolina. We simulated reductions in unnecessary antibiotic prescribing and inappropriate antibiotic selection with intervention scenarios at individual and network healthcare facilities, including short-term acute care hospitals (STACHs), nursing homes, and outpatient locations. Modeled antibiotic prescription rates were calculated using patient-level data on antibiotic length of therapy for the 10 modeled network STACHs. By simulating a 30% reduction in antibiotics prescribed across all inpatient and outpatient locations, we found the greatest reductions on network CDI incidence among tested scenarios, namely a 17% decrease in HO-CDI incidence and 7% decrease in CA-CDI. Among intervention scenarios of reducing inappropriate antibiotic selection, we found a greater impact on network CDI incidence when modeling this reduction in nursing homes alone compared to the same intervention in STACHs alone. These results support the potential importance of LTCF and outpatient antibiotic stewardship efforts on network CDI burden and add to the evidence that a coordinated approach to antibiotic stewardship across multiple facilities, including inpatient and outpatient settings, within a regional healthcare network could be an effective strategy to reduce network CDI burden.
Collapse
Affiliation(s)
- Sarah Rhea
- RTI International, Research Triangle Park, North Carolina
- * E-mail:
| | - Kasey Jones
- RTI International, Research Triangle Park, North Carolina
| | | | - Breda Munoz
- RTI International, Research Triangle Park, North Carolina
| | | | | | - Jennifer MacFarquhar
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Ashley Marx
- UNC Health Care, Chapel Hill, North Carolina
- UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - James Rineer
- RTI International, Research Triangle Park, North Carolina
| | - James Lewis
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | | |
Collapse
|
12
|
Rhea S, Hilscher R, Rineer JI, Munoz B, Jones K, Endres-Dighe SM, DiBiase LM, Sickbert-Bennett EE, Weber DJ, MacFarquhar JK, Dubendris H, Bobashev G. Creation of a Geospatially Explicit, Agent-based Model of a Regional Healthcare Network with Application to Clostridioides difficile Infection. Health Secur 2020; 17:276-290. [PMID: 31433281 DOI: 10.1089/hs.2019.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Agent-based models (ABMs) describe and simulate complex systems comprising unique agents, or individuals, while accounting for geospatial and temporal variability among dynamic processes. ABMs are increasingly used to study healthcare-associated infections (ie, infections acquired during admission to a healthcare facility), including Clostridioides difficile infection, currently the most common healthcare-associated infection in the United States. The overall burden and transmission dynamics of healthcare-associated infections, including C difficile infection, may be influenced by community sources and movement of people among healthcare facilities and communities. These complex dynamics warrant geospatially explicit ABMs that extend beyond single healthcare facilities to include entire systems (eg, hospitals, nursing homes and extended care facilities, the community). The agents in ABMs can be built on a synthetic population, a model-generated representation of the actual population with associated spatial (eg, home residence), temporal (eg, change in location over time), and nonspatial (eg, sociodemographic features) attributes. We describe our methods to create a geospatially explicit ABM of a major regional healthcare network using a synthetic population as microdata input. We illustrate agent movement in the healthcare network and the community, informed by patient-level medical records, aggregate hospital discharge data, healthcare facility licensing data, and published literature. We apply the ABM output to visualize agent movement in the healthcare network and the community served by the network. We provide an application example of the ABM to C difficile infection using a natural history submodel. We discuss the ABM's potential to detect network areas where disease risk is high; simulate and evaluate interventions to protect public health; adapt to other geographic locations and healthcare-associated infections, including emerging pathogens; and meaningfully translate results to public health practitioners, healthcare providers, and policymakers.
Collapse
Affiliation(s)
- Sarah Rhea
- Sarah Rhea, DVM, PhD, is a Research Epidemiologist, Center for Applied Public Health Research; Rainer Hilscher, PhD, is a Research Data Scientist, Center for Data Science; James I. Rineer, MS, is Director, Geospatial Science and Technology; Breda Munoz, PhD, is a Research Statistician, Center for Applied Public Health Research; Kasey Jones, MS, is a Research Data Scientist, Center for Data Science; and Stacy M. Endres-Dighe, MPH, is a Research Epidemiologist, Center for Applied Public Health Research; all at RTI International, Research Triangle Park, NC
| | - Rainer Hilscher
- Sarah Rhea, DVM, PhD, is a Research Epidemiologist, Center for Applied Public Health Research; Rainer Hilscher, PhD, is a Research Data Scientist, Center for Data Science; James I. Rineer, MS, is Director, Geospatial Science and Technology; Breda Munoz, PhD, is a Research Statistician, Center for Applied Public Health Research; Kasey Jones, MS, is a Research Data Scientist, Center for Data Science; and Stacy M. Endres-Dighe, MPH, is a Research Epidemiologist, Center for Applied Public Health Research; all at RTI International, Research Triangle Park, NC
| | - James I Rineer
- Sarah Rhea, DVM, PhD, is a Research Epidemiologist, Center for Applied Public Health Research; Rainer Hilscher, PhD, is a Research Data Scientist, Center for Data Science; James I. Rineer, MS, is Director, Geospatial Science and Technology; Breda Munoz, PhD, is a Research Statistician, Center for Applied Public Health Research; Kasey Jones, MS, is a Research Data Scientist, Center for Data Science; and Stacy M. Endres-Dighe, MPH, is a Research Epidemiologist, Center for Applied Public Health Research; all at RTI International, Research Triangle Park, NC
| | - Breda Munoz
- Sarah Rhea, DVM, PhD, is a Research Epidemiologist, Center for Applied Public Health Research; Rainer Hilscher, PhD, is a Research Data Scientist, Center for Data Science; James I. Rineer, MS, is Director, Geospatial Science and Technology; Breda Munoz, PhD, is a Research Statistician, Center for Applied Public Health Research; Kasey Jones, MS, is a Research Data Scientist, Center for Data Science; and Stacy M. Endres-Dighe, MPH, is a Research Epidemiologist, Center for Applied Public Health Research; all at RTI International, Research Triangle Park, NC
| | - Kasey Jones
- Sarah Rhea, DVM, PhD, is a Research Epidemiologist, Center for Applied Public Health Research; Rainer Hilscher, PhD, is a Research Data Scientist, Center for Data Science; James I. Rineer, MS, is Director, Geospatial Science and Technology; Breda Munoz, PhD, is a Research Statistician, Center for Applied Public Health Research; Kasey Jones, MS, is a Research Data Scientist, Center for Data Science; and Stacy M. Endres-Dighe, MPH, is a Research Epidemiologist, Center for Applied Public Health Research; all at RTI International, Research Triangle Park, NC
| | - Stacy M Endres-Dighe
- Sarah Rhea, DVM, PhD, is a Research Epidemiologist, Center for Applied Public Health Research; Rainer Hilscher, PhD, is a Research Data Scientist, Center for Data Science; James I. Rineer, MS, is Director, Geospatial Science and Technology; Breda Munoz, PhD, is a Research Statistician, Center for Applied Public Health Research; Kasey Jones, MS, is a Research Data Scientist, Center for Data Science; and Stacy M. Endres-Dighe, MPH, is a Research Epidemiologist, Center for Applied Public Health Research; all at RTI International, Research Triangle Park, NC
| | - Lauren M DiBiase
- Lauren M. DiBiase, MS, is Associate Director, Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| | - Emily E Sickbert-Bennett
- Emily E. Sickbert-Bennett, PhD, MS, is Director, Infection Prevention, University of North Carolina Hospitals, Chapel Hill, NC
| | - David J Weber
- David J. Weber, MD, MPH, is Professor of Medicine, Pediatrics and Epidemiology, UNC School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jennifer K MacFarquhar
- Jennifer K. MacFarquhar, MPH, is a Career Epidemiology Field Officer, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, and Communicable Disease Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Heather Dubendris
- Heather Dubendris, MSPH, is an Epidemiologist, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
| | - Georgiy Bobashev
- Georgiy Bobashev, PhD, MSc, is an RTI Fellow, RTI International, and Professor of Statistics and Biostatistics, North Carolina State University, Raleigh, NC
| |
Collapse
|
13
|
Yu F, Munoz B, Bienkowski PR, Sayler GS. Bayesian estimation and sensitivity analysis of toluene and trichloroethylene biodegradation kinetic parameters. J Environ Qual 2020; 49:640-653. [PMID: 33016407 DOI: 10.1002/jeq2.20064] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 06/11/2023]
Abstract
Parameter estimation is needed for process management, design, and reactor scaling when values from the literature vary tremendously or are unavailable. A Bayesian approach, implemented via Markov chain Monte Carlo (MCMC) simulations using SAS software, was used to estimate the kinetic parameters of toluene and trichloroethylene (TCE) biodegradation by the microorganism Pseudomonas putida F1 in batch cultures. The prediction capabilities of Bayesian estimation were illustrated by comparing predicted and observed data and reported in goodness-of-fit statistics. The sensitivity analysis showed that the parameters obtained using this approach were consistent under the designated toluene and TCE concentration range. Moreover, the impact of TCE on toluene degradation kinetics was numerically exhibited, verifying the fact that TCE was able to stimulate toluene degradation; hence, TCE's presence increased the apparent maximum toluene-specific rate. Various kinetic models were explored at different degrees of complexity. At a low TCE concentration range (e.g., <2 mg L-1 ), a simplified Michaelis-Menten model (i.e., substrate half-saturation parameters approximated the inhibition parameters) was adequate to describe the reaction kinetics. However, at a higher TCE range (e.g., 5 mg L-1 ), a full-scale Michaelis-Menten model was needed to discriminate among the inhibition parameters in the model. The results demonstrated that a Bayesian estimation method is particularly useful for determining complex bioreaction kinetic parameters in the presence of a small volume of experimental data.
Collapse
Affiliation(s)
- Feng Yu
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Breda Munoz
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Paul R Bienkowski
- Dep. of Chemical and Biomolecular Engineering (retired), Univ. of Tennessee, Knoxville, TN, 37996, USA
| | - Gary S Sayler
- Center for Environmental Biotechnology, Univ. of Tennessee, Knoxville, TN, 37996, USA
| |
Collapse
|
14
|
Rae Olmsted KL, Bartoszek M, Mulvaney S, McLean B, Turabi A, Young R, Kim E, Vandermaas-Peeler R, Morgan JK, Constantinescu O, Kane S, Nguyen C, Hirsch S, Munoz B, Wallace D, Croxford J, Lynch JH, White R, Walters BB. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:130-138. [PMID: 31693083 PMCID: PMC6865253 DOI: 10.1001/jamapsychiatry.2019.3474] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. OBJECTIVE To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. DESIGN, SETTING, AND PARTICIPANTS This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. INTERVENTIONS Paired right-sided SGB or sham procedures at weeks 0 and 2. MAIN OUTCOMES AND MEASURES Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). RESULTS Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was -12.6 points (95% CI, -15.5 to -9.7 points) for the group receiving SGB treatments, compared with -6.1 points (95% CI, -9.8 to -2.3 points) for those receiving sham treatment (P = .01). CONCLUSIONS AND RELEVANCE In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03077919.
Collapse
Affiliation(s)
| | | | - Sean Mulvaney
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Ali Turabi
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ryan Young
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Eugene Kim
- Womack Army Medical Center, Fort Bragg, North Carolina
| | | | | | | | - Shawn Kane
- John F. Kennedy Special Warfare Center and School, Fort Bragg, North Carolina
| | | | - Shawn Hirsch
- RTI International, Research Triangle Park, North Carolina
| | - Breda Munoz
- RTI International, Research Triangle Park, North Carolina
| | - Dennis Wallace
- RTI International, Research Triangle Park, North Carolina
| | - Julie Croxford
- RTI International, Research Triangle Park, North Carolina
| | - James H. Lynch
- US Army Special Operations Command, Fort Bragg, North Carolina
| | - Ronald White
- Landstuhl Regional Medical Center, Landstuhl, Germany
| | | |
Collapse
|
15
|
Rhea S, Jones K, Bobashev G, Munoz B, Rineer J, Hilscher R, DiBiase L, Sickbert-Bennett E, Weber DJ. 2440. Using a geospatially explicit agent-based model of a regional healthcare network to assess varied antibiotic risk on Clostridioides difficile infection incidence. Open Forum Infect Dis 2019. [PMCID: PMC6810361 DOI: 10.1093/ofid/ofz360.2118] [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] [Indexed: 11/15/2022] Open
Abstract
Background Different antibiotic classes are associated with different Clostridioides difficile infection (CDI) risk. The impact of varied antibiotic risk on CDI incidence can be explored using agent-based models (ABMs). ABMs can simulate complete systems (e.g., regional healthcare networks) comprised of discrete, unique agents (e.g., patients) which can be represented using a synthetic population, or model-generated representation of the population. We used an ABM of a North Carolina (NC) regional healthcare network to assess the impact of increasing antibiotic risk ratios (RRs) across network locations on healthcare-associated (HA) and community-associated (CA) CDI incidence. Methods The ABM describes CDI acquisition and patient movement across 14 network locations (i.e., nodes) (11 short-term acute care hospitals, 1 long-term acute care hospital, 1 nursing home, and the community). We used a sample of 2 million synthetic NC residents as ABM microdata. We updated agent states (i.e., location, antibiotic exposure, C. difficile colonization, CDI status) daily. We applied antibiotic RRs of 1, 5, 8.9 (original model RR), 15, and 20 to agents across the network to simulate varied risk corresponding to different antibiotic classes. We determined network HA-CDI and CA-CDI incidence and percent mean change for each RR. Results In this simulation study, HA-CDI incidence increased with increasing antibiotic risk, ranging from 11.3 to 81.4 HA-CDI cases/100,000 person-years for antibiotic RRs of 1 to 20, respectively. On average, the per unit increase in antibiotic RR was 33% for HA-CDI and 6% for CA-CDI (figure). Conclusion We used a geospatially explicit ABM to simulate increasing antibiotic risk, corresponding to different antibiotic classes, and to explore the impact on CDI incidence. The per unit increase in antibiotic risk was greater for HA-CDI than CA-CDI due to the higher probability of receiving antibiotics and higher concentration of agents with other CDI risk factors in the healthcare facilities of the ABM. These types of analyses, which demonstrate the interconnectedness of network healthcare facilities and the associated community served by the network, might help inform targeted antibiotic stewardship efforts in certain network locations. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Sarah Rhea
- RTI International, Research Triangle Park, North Carolina
| | - Kasey Jones
- RTI International, Research Triangle Park, North Carolina
| | | | - Breda Munoz
- RTI International, Research Triangle Park, North Carolina
| | - James Rineer
- RTI International, Research Triangle Park, North Carolina
| | | | | | | | - David J Weber
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
16
|
Subramanian S, Hilscher R, Gakunga R, Munoz B, Ogola E. Cost-effectiveness of risk stratified medication management for reducing premature cardiovascular mortality in Kenya. PLoS One 2019; 14:e0218256. [PMID: 31237910 PMCID: PMC6592597 DOI: 10.1371/journal.pone.0218256] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 05/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a major contributor to the burden from non-communicable diseases in Sub-Saharan Africa and hypertension is the leading risk factor for CVD. The objective of this modeling study is to assess the cost-effectiveness of a risk stratified approach to medication management in Kenya in order to achieve adequate blood pressure control to reduce CVD events. Methods We developed a microsimulation model to evaluate CVD risk over the lifetime of a cohort of individuals. Risk groups were assigned utilizing modified Framingham study distributions based on individual level risk factors from the Kenya STEPwise survey which collected details on blood pressure, blood glucose, tobacco and alcohol use and cholesterol levels. We stratified individuals into 4 risk groups: very low, low, moderate and high risk. Mortality could occur due to acute CVD events, subsequent future events (for individual who survive the initial event) and other causes. We present cost and DALYs gained due to medication management for men and women 25 to 69 years. Results Treating high risk individuals only was generally more cost-effective that treating high and moderate risk individuals. At the anticipated base levels of effectiveness, medication management was only cost-effective under the low cost scenario. The incremental cost per DALY gained with low cost ranged from $1,505 to $3,608, which is well under $4,785 (3 times GPD per capita) threshold for Kenya. Under the low cost scenario, even lower levels of effectiveness of medication management are likely to be cost-effective for high-risk men and women. Conclusions In Kenya, our results indicate that the risk stratified approach to treating hypertension may be cost-effective especially for men and women at a high risk for CVD events, but these results are highly sensitive to the cost of medications. Medication management would require significant financial investment and therefore other interventions, including lifestyle changes, should be evaluated especially for those with elevated blood pressure and overall 10-year risk that is less than 20%.
Collapse
Affiliation(s)
- Sujha Subramanian
- RTI International, Waltham, Massachusetts, United States of America
- * E-mail:
| | - Rainer Hilscher
- RTI International, Waltham, Massachusetts, United States of America
| | - Robai Gakunga
- RTI International, Waltham, Massachusetts, United States of America
| | - Breda Munoz
- RTI International, Waltham, Massachusetts, United States of America
| | - Elijah Ogola
- University of Nairobi and Kenyatta National Hospital, Nairobi, Kenya
| |
Collapse
|
17
|
Laptook A, Tyson JE, Pedroza C, Shankaran S, Bell EF, Goldberg R, Ambalavanan N, Munoz B, Das A. Response to a different view concerning the NICHD neonatal research network late hypothermia trial. Acta Paediatr 2019; 108:772-773. [PMID: 30664824 DOI: 10.1111/apa.14725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Abbot Laptook
- Women & Infants Hospital of Rhode Island; Warren Alpert Medical School of Brown University-Pediatrics; Providence RI USA
| | - Jon E. Tyson
- McGovern Medical School; University of Texas Health Science Center at Houston-Pediatrics; Houston TX USA
| | - Claudia Pedroza
- McGovern Medical School; University of Texas Health Science Center at Houston-Pediatrics; Houston TX USA
| | - Seetha Shankaran
- Department of Pediatrics; Wayne State University; Detroit MI USA
| | - Edward F. Bell
- Department of Pediatrics; University of Iowa; Iowa City IA USA
| | | | | | - Breda Munoz
- RTI International - Biostatistics and Epidemiology; Research Triangle Park NC USA
| | - Abhik Das
- RTI International - Biostatistics and Epidemiology; Rockville MD USA
| |
Collapse
|
18
|
Patel M, Mukherjee D, Farsiu S, Munoz B, Blood AB, Wilson CG, Griffin JB. Estimation of Gestational Age via Image Analysis of Anterior Lens Capsule Vascularity in Preterm Infants: A Pilot Study. Front Pediatr 2019; 7:43. [PMID: 30842940 PMCID: PMC6391335 DOI: 10.3389/fped.2019.00043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/01/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Anterior lens capsule vascularity (ALCV) is resorbed in the developing fetus from 27 to 35 weeks gestation. In this pilot study, we evaluated the feasibility and validity of combining smartphone ophthalmoscope videos of ALCV and image analysis for gestational age estimation. Methods: ALCV videos were captured longitudinally in preterm neonates from delivery using a PanOptic® Ophthalmoscope with an iExaminer® adapter (Welch-Allyn). ALCV video frames were manually selected and quantified using semi-automatic image analysis. A predictive model based on ALCV features was compared to gold-standard ultrasound gestational age estimates. Results: A total of 64 image-capture sessions were carried out in 24 neonates. Ultrasound-estimated gestational age and ALCV-predicted gestational age estimates indicate that the two methods are similar (r = 0.78, p < 0.0001). ALCV estimates of gestational age were within 0.11 ± 1.3 weeks of ultrasound estimates. In the final model, gestational age was predicted within ± 1 week for 54% and within ± 2 weeks for 86% of the measures. Conclusions: This novel application of smartphone ophthalmoscopy and ALCV image analysis may provide a safe, accurate and non-invasive technology to estimate postnatal gestational age, especially in low income countries where gestational age may not be known at birth.
Collapse
Affiliation(s)
- Monalisa Patel
- Department of Pediatrics, Loma Linda University, Loma Linda, CA, United States
| | - Dibyendu Mukherjee
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, United States.,Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Breda Munoz
- Applied Public Health Research Center, RTI International, Research Triangle Park, Durham, NC, United States
| | - Arlin B Blood
- Department of Pediatrics, Loma Linda University, Loma Linda, CA, United States.,Lawrence D. Longo Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Christopher G Wilson
- Department of Pediatrics, Loma Linda University, Loma Linda, CA, United States.,Department of Ophthalmology, Loma Linda University, Loma Linda, CA, United States
| | - Jennifer B Griffin
- Center for Global Health, RTI International, Research Triangle Park, Durham, NC, United States
| |
Collapse
|
19
|
Latzman NE, Ringeisen H, Forman-Hoffman VL, Munoz B, Miller S, Hedden SL. Trends in mental health service use by age among adults with serious mental illness. Ann Epidemiol 2018; 30:71-73. [PMID: 30578125 DOI: 10.1016/j.annepidem.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/25/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study examines trends in mental health service use among 18- to 64-year-old adults with serious mental illness (SMI). METHODS Data are from approximately 22,200 adults with SMI who participated in the National Survey on Drug Use and Health, an annual nationally representative survey of the U.S. civilian, noninstitutionalized population. A regression restricted spline modeled the trend in mental health service use by age among adults with SMI. RESULTS Approximately 20 to 50% of adults with SMI did not receive past-year mental health services. The odds of past-year service use increased by 3% per year until age 52 years. CONCLUSIONS From age 18 to 52 years, age incrementally increases the likelihood that an adult with SMI makes treatment contact.
Collapse
Affiliation(s)
| | | | | | - Breda Munoz
- RTI International, Research Triangle Park, NC
| | | | - Sarra L Hedden
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| |
Collapse
|
20
|
Laptook AR, Shankaran S, Tyson JE, Munoz B, Bell EF, Goldberg RN, Parikh NA, Ambalavanan N, Pedroza C, Pappas A, Das A, Chaudhary AS, Ehrenkranz RA, Hensman AM, Van Meurs KP, Chalak LF, Khan AM, Hamrick SEG, Sokol GM, Walsh MC, Poindexter BB, Faix RG, Watterberg KL, Frantz ID, Guillet R, Devaskar U, Truog WE, Chock VY, Wyckoff MH, McGowan EC, Carlton DP, Harmon HM, Brumbaugh JE, Cotten CM, Sánchez PJ, Hibbs AM, Higgins RD. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial. JAMA 2017; 318:1550-1560. [PMID: 29067428 PMCID: PMC5783566 DOI: 10.1001/jama.2017.14972] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks' or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. OBJECTIVE To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks' or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. INTERVENTIONS Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). MAIN OUTCOMES AND MEASURES The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. RESULTS Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks' gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, -1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. CONCLUSIONS AND RELEVANCE Among term infants with hypoxic-ischemic encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00614744.
Collapse
Affiliation(s)
- Abbot R Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Jon E Tyson
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Breda Munoz
- Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City
| | | | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | | | - Richard A Ehrenkranz
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Angelita M Hensman
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
| | - Krisa P Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
- Lucile Packard Children's Hospital, Palo Alto, California
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Amir M Khan
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston
| | - Shannon E G Hamrick
- Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Gregory M Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Michele C Walsh
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Brenda B Poindexter
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Roger G Faix
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City
| | | | - Ivan D Frantz
- Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts
| | - Ronnie Guillet
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Uday Devaskar
- Department of Pediatrics, University of California, Los Angeles
| | - William E Truog
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
- University of Missouri Kansas City School of Medicine, Kansas City
| | - Valerie Y Chock
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
- Lucile Packard Children's Hospital, Palo Alto, California
| | - Myra H Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Elisabeth C McGowan
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island
| | - David P Carlton
- Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Heidi M Harmon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | | | - C Michael Cotten
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Anna Maria Hibbs
- Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | |
Collapse
|
21
|
Halpern MT, Arena LC, Royce RA, Soler RE, Munoz B, Hennessy CM. Neighborhood and Individual Sociodemographic Characteristics Associated with Disparities in Adult Obesity and Perceptions of the Home Food Environment. Health Equity 2017; 1:139-149. [PMID: 29167837 PMCID: PMC5685320 DOI: 10.1089/heq.2017.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Multiple studies have demonstrated significant disparities in the relationship between individual sociodemographic characteristics and risk of overweight or obesity. However, little information is available for assessing the complex associations among being overweight or obese with neighborhood and individual sociodemographic factors and the measured and perceived community food environment. Methods: Using 2014 national evaluation data from 20 communities (analyzed 2015-2016) that participated in the U.S. Centers for Disease Control and Prevention Community Transformation Grants Program, we used multilevel multivariable models to assess associations among factors at the individual, census tract, and county levels with being overweight or obese and with the perceived home food environment. Results: Individual level factors (age, sex, race/ethnicity, household income, and education) were significantly associated with the likelihood of being overweight or obese in every model tested. Census tract level poverty and education were significantly associated with the likelihood of being overweight or obese in univariate but not multivariable analyses. Perceived community food environment was a significant predictor of the perceived home food environment; the objective measure of county-level grocery store access was not. Neither perceived nor objective community food environment measures were significantly associated with overweight/obesity in multivariable analyses. Conclusion: Individual-level sociodemographic characteristics are more strongly associated with obesity-related outcomes than are area-level measures. Future interventions designed to address health equity issues in obesity among underserved populations may benefit from focusing on nutrition education tailored to individuals, to encourage purchase and consumption of healthy food. Improving healthy food availability in underserved communities may also be critical for nutrition education to have a meaningful impact.
Collapse
Affiliation(s)
- Michael T Halpern
- RTI International, Social, Statistical, and Environmental Sciences, Research Triangle Park, North Carolina and Washington, DC.,Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Laura C Arena
- RTI International, Social, Statistical, and Environmental Sciences, Research Triangle Park, North Carolina and Washington, DC
| | - Rachel A Royce
- RTI International, Social, Statistical, and Environmental Sciences, Research Triangle Park, North Carolina and Washington, DC
| | - Robin E Soler
- Division of Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Breda Munoz
- RTI International, Social, Statistical, and Environmental Sciences, Research Triangle Park, North Carolina and Washington, DC
| | - Caitlin M Hennessy
- RTI International, Social, Statistical, and Environmental Sciences, Research Triangle Park, North Carolina and Washington, DC
| |
Collapse
|
22
|
Swenor B, Munoz B, West S. IS VISUAL IMPAIRMENT JUST ANOTHER COMORBID CONDITION? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Swenor
- Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| | - B. Munoz
- Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| | - S. West
- Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
23
|
Subramanian S, Kibachio J, Hoover S, Edwards P, Amukoye E, Amuyunzu–Nyamongo M, Abbam G, Busakhala N, Chakava A, Dick J, Gakunga R, Gathecha G, Hilscher R, Husain MJ, Kaduka L, Kayima J, Karagu A, Kiptui D, Korir A, Meme N, Munoz B, Mwanda W, Mwai D, Mwangi J, Munyoro E, Muriuki Z, Njoroge J, Ogola E, Olale C, Olwal–Modi D, Rao R, Rosin S, Sangoro O, von Rège D, Wata D, Williams P, Yonga G. Research for Actionable Policies: implementation science priorities to scale up non–communicable disease interventions in Kenya. J Glob Health 2017. [PMCID: PMC5441449 DOI: 10.7189/jogh.07.010204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Gisela Abbam
- GE Healthcare, Chalfont St Giles, UK
- Global Diagnostic Imaging, Healthcare IT & Radiation Therapy Trade Association, Arlington, Virginia, USA
| | - Naftali Busakhala
- Moi University, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Jonathan Dick
- Moi University, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | | | | | | | - Lydia Kaduka
- Kenya Medical Research Institute, Nairobi, Kenya
| | - James Kayima
- Makerere University, Uganda Heart Institute, Kampala, Uganda
| | | | | | - Anne Korir
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Nkatha Meme
- Makerere University, Uganda Heart Institute, Kampala, Uganda
| | - Breda Munoz
- RTI International, Waltham, Massachusetts USA
| | - Walter Mwanda
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | | | | | - Elijah Ogola
- University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | - Rose Rao
- Novo Nordisk A/S, Copenhagen, Denmark
| | | | | | | | - David Wata
- Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | |
Collapse
|
24
|
Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS, Wickremasinghe R. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples. Environ Monit Assess 2016; 188:548. [PMID: 27591985 DOI: 10.1007/s10661-016-5524-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 05/09/2023]
Abstract
The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.
Collapse
Affiliation(s)
- Keith E Levine
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Myles F Elledge
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kristin Smith
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Breda Munoz
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Roshini J Periris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nalini Sathiakumar
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Harrington
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Donna S Womack
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | |
Collapse
|
25
|
Levine KE, Redmon JH, Elledge MF, Wanigasuriya KP, Smith K, Munoz B, Waduge VA, Periris-John RJ, Sathiakumar N, Harrington JM, Womack DS, Wickremasinghe R. Quest to identify geochemical risk factors associated with chronic kidney disease of unknown etiology (CKDu) in an endemic region of Sri Lanka-a multimedia laboratory analysis of biological, food, and environmental samples. Environ Monit Assess 2016; 188:548. [PMID: 27591985 DOI: 10.3768/rtipress.2014.rb.0007.1405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/01/2016] [Indexed: 05/24/2023]
Abstract
The emergence of a new form of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka's North Central Province (NCP) has become a catastrophic health crisis. CKDu is characterized as slowly progressing, irreversible, and asymptomatic until late stages and, importantly, not attributed to diabetes, hypertension, or other known risk factors. It is postulated that the etiology of CKDu is multifactorial, involving genetic predisposition, nutritional and dehydration status, exposure to one or more environmental nephrotoxins, and lifestyle factors. The objective of this limited geochemical laboratory analysis was to determine the concentration of a suite of heavy metals and trace element nutrients in biological samples (human whole blood and hair) and environmental samples (drinking water, rice, soil, and freshwater fish) collected from two towns within the endemic NCP region in 2012 and 2013. This broad panel, metallomics/mineralomics approach was used to shed light on potential geochemical risk factors associated with CKDu. Based on prior literature documentation of potential nephrotoxins that may play a role in the genesis and progression of CKDu, heavy metals and fluoride were selected for analysis. The geochemical concentrations in biological and environmental media areas were quantified. Basic statistical measurements were subsequently used to compare media against applicable benchmark values, such as US soil screening levels. Cadmium, lead, and mercury were detected at concentrations exceeding US reference values in many of the biological samples, suggesting that study participants are subjected to chronic, low-level exposure to these elements. Within the limited number of environmental media samples, arsenic was determined to exceed initial risk screening and background concentration values in soil, while data collected from drinking water samples reflected the unique hydrogeochemistry of the region, including the prevalence of hard or very hard water, and fluoride, iron, manganese, sodium, and lead exceeding applicable drinking water standards in some instances. Current literature suggests that the etiology of CKDu is likely multifactorial, with no single biological or hydrogeochemical parameter directly related to disease genesis and progression. This preliminary screening identified that specific constituents may be present above levels of concern, but does not compare results against specific kidney toxicity values or cumulative risk related to a multifactorial disease process. The data collected from this limited investigation are intended to be used in the subsequent study design of a comprehensive and multifactorial etiological study of CKDu risk factors that includes sample collection, individual surveys, and laboratory analyses to more fully evaluate the potential environmental, behavioral, genetic, and lifestyle risk factors associated with CKDu.
Collapse
Affiliation(s)
- Keith E Levine
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Myles F Elledge
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Kristin Smith
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Breda Munoz
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | | - Roshini J Periris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nalini Sathiakumar
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Harrington
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | - Donna S Womack
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA
| | | |
Collapse
|
26
|
Abstract
OBJECTIVE This study examined mental health service use, by service type, of adolescents ages 12-17. METHODS Data were from approximately 113,000 adolescents who participated in the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION Polynomial contrasts tested for linear and quadratic changes across age in the use of three types of past-year mental health services: school-based services, outpatient therapist or clinic, and overnight hospital stay. RESULTS Although mental health service use increased from age 12 to age 14 across all service types, it decreased or stabilized from age 15 to 17. School-based services were the most commonly used service and showed the steepest decline in use from age 12 to 17. CONCLUSIONS Although adolescence can be marked by an increasing prevalence of mental disorders, mental health service use declined or leveled off for many service types by age 14 or 15.
Collapse
Affiliation(s)
- Heather Ringeisen
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Shari Miller
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Breda Munoz
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Harley Rohloff
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Sarra L Hedden
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Lisa J Colpe
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| |
Collapse
|
27
|
Miller S, Ringeisen H, Munoz B, Hedden SL, Colpe LJ, Rohloff H, Embry V. Correlates of Mental Health Service Use Among Young Adults With Mental Illness: Results From the National Survey on Drug Use and Health. Psychiatr Serv 2016; 67:642-9. [PMID: 27079984 DOI: 10.1176/appi.ps.201400486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined correlates of use of outpatient and inpatient mental health services and psychotropic medication in a large, nationally representative sample of young adults ages 18-26 with mental illness (N=22,600). METHODS Data were from the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION Separate logistic regression models examined past-year use of three mental health service types (outpatient services, inpatient services, and psychotropic medication). Correlates included demographic characteristics, factors developmentally relevant to young adults, and general medical and mental health status. RESULTS Within this sample of young adults with mental illness, 20.4% used outpatient services, 3.6% used inpatient services, and 25.4% used psychotropic medication. Variables associated with use of one or more types of mental health services included being female (outpatient and medication), one to two moves in the past year (medication), having health insurance (all types), past-year criminal justice involvement (all types), poor health (inpatient and medication), substance use disorders (inpatient and medication), and mental illness with severe impairment (all types). Non-Hispanic blacks, Asians, and Hispanics were less likely than non-Hispanic whites to receive outpatient mental health services or psychotropic medications. Surprisingly, young adults employed full-time were less likely than those who were unemployed to receive services, and living with a partner (versus living alone) was not associated with a likelihood of using outpatient services. CONCLUSIONS Results support the unique nature of young adulthood and the need to tailor mental health services to close gaps in service use during this developmental period.
Collapse
Affiliation(s)
- Shari Miller
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Heather Ringeisen
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Breda Munoz
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Sarra L Hedden
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Lisa J Colpe
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Harley Rohloff
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| | - Venita Embry
- Dr. Miller, Dr. Ringeisen, Dr. Munoz, Ms. Rohloff, and Ms. Embry are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
| |
Collapse
|
28
|
Miller J, Drew L, Bastos C, Parks D, Green O, McEwan B, Patel N, Aghamohammadzadeh S, Villella A, Giuliano K, Longo K, Ivarsson M, Munoz B, Mehmet H. WS13.2 Novel F508del-CFTR corrector that complements other CFTR modulators. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
29
|
Miller J, Drew L, Green O, Dukovski D, McEwan B, Villella A, Patel N, Bastos C, Cullen M, Danh H, Wachi S, Giuliano K, Longo K, Bhalla A, Qiu D, Zou C, Ivarsson M, Munoz B, Mehmet H. WS13.5 CFTR amplifiers are mutation-agnostic modulators that increase CFTR protein levels and complement other CF therapeutic modalities. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30137-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Miller J, Drew L, Green O, Villella A, Bastos C, Munoz B, Cullen M, Hauck S, Wachi S, Giuliano K, Longo K, Roskelley E, Dobbs W, Garza D, Haeberlein M, Weiner D, Bridges R, Thakerar A, Hutt D, Balch W, Tait B. WS1.3 Enhanced correction of F508del CFTR using drug-like small molecules in combination with correctors and potentiators. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Hill T, Kulz E, Munoz B, Dorney JR. Compensatory stream and wetland mitigation in North Carolina: an evaluation of regulatory success. Environ Manage 2013; 51:1077-1091. [PMID: 23515905 DOI: 10.1007/s00267-013-0027-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/26/2013] [Indexed: 06/01/2023]
Abstract
Data from a probability sample were used to estimate wetland and stream mitigation success from 2007 to 2009 across North Carolina (NC). "Success" was defined as whether the mitigation site met regulatory requirements in place at the time of construction. Analytical results were weighted by both component counts and mitigation size. Overall mitigation success (including preservation) was estimated at 74 % (SE = 3 %) for wetlands and 75 % (SE = 4 %) for streams in NC. Compared to the results of previous studies, wetland mitigation success rates had increased since the mid-1990s. Differences between mitigation providers (mitigation banks, NC Ecosystem Enhancement Program's design-bid-build and full-delivery programs, NC Department of Transportation and private permittee-responsible mitigation) were generally not significant although permittee-responsible mitigation yielded higher success rates in certain circumstances. Both wetland and stream preservation showed high rates of success and the stream enhancement success rate was significantly higher than that of stream restoration. Additional statistically significant differences when mitigation size was considered included: (1) the Piedmont yielded a lower stream mitigation success rate than other areas of the state, and (2) recently constructed wetland mitigation projects demonstrated a lower success rate than those built prior to 2002. Opportunities for improvement exist in the areas of regulatory record-keeping, understanding the relationship between post-construction establishment and long-term ecological trajectories of stream and wetland restoration projects, incorporation of numeric ecological metrics into mitigation monitoring and success criteria, and adaptation of stream mitigation designs to achieve greater success in the Piedmont.
Collapse
Affiliation(s)
- Tammy Hill
- Division of Water Quality, North Carolina Department of Environment and Natural Resources, Raleigh, NC 27699-1650, USA.
| | | | | | | |
Collapse
|
32
|
Hugues T, Lacroix-Hugues V, Yaici K, Gibelin P, Cabrita I, Pires S, Nunes A, Sousa C, Cortez-Dias N, Pinto F, Hrynkiewicz-Szymanska A, Braksator W, Szymanski F, Chmielewski M, Dluzniewski M, Alonso Fernandez P, Andres Lahuerta A, Miro Palau V, Buendia Fuentes F, Igual Munoz B, Osa Saez A, Quesada Carmona A, Tejada Ponce D, Munoz B, Salvador Sanz A, Imamura S, Hirata KH, Kubo T, Orii M, Tanimono T, Takemoto K, Ino Y, Yamaguchi T, Imanishi T, Akasaka T, Kinoshita T, Asai T, Suzuki T, Krestjyaninov M, Ruzov V, Imamura S, Hirata KH, Kubo T, Orii M, Tanimoto T, Yamano T, Ino Y, Yamaguchi T, Imanishi T, Akasaka T, Junca Puig G, Sistach EF, Delgado Ramis L, Lopez Ayerbe J, Vallejo Camazon N, Gual Capllonch F, Teis Soley A, Camara Rosell M, Ruyra Baliarda X, Bayes-Genis A, Alonso fernandez P, Igual Munoz B, Andres Lahuerta A, Maceira Gonzalez A, Hernandez C, Bel Minguez A, Miro Palau V, Munoz Igual B, Montero Argudo A, Salvador Sanz A, Antit S, fennira S, Zairi I, Kamoun S, Kraiem S, Matsuyama A, Hirata KH, Kubo T, Orii M, Takemoto K, Tanimoto T, Yamano T, Ino Y, Imanishi T, Akasaka T, Van De Heyning C, Magne J, Pierard L, Davin L, Bruyere P, De Maeyer C, Paelinck B, Vrints C, Lancellotti P, Wang J, fang F, Liu M, Liang Y, Yu C, Lam Y, Kenny C, Monaghan M, Ercan S, Kervancioglu S, Davutoglu V, Cakici M, Ozkur A, Oylumlu M, Sari I, Sikora-Puz A, Mizia M, Gieszczyk-Strozik K, Matyjaszczyk-Zbieg K, Haberka M, Mizia-Stec K, Gasior Z, Wos S, Deja M, Jasinski M, Enescu O, florescu M, Mihalcea D, Rimbas R, Cinteza M, Vinereanu D. Club 35 Poster Session Wednesday 5 December * Right ventricular systolic function. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Bruhn MC, Munoz B, Cajka J, Smith G, Curry RJ, Wagener DK, Wheaton WD. Synthesized Population Databases: A Geospatial Database of US Poultry Farms. Methods Rep RTI Press 2012; MR-0023-1201:1-24. [PMID: 25364787 DOI: 10.3768/rtipress.2012.mr.0023.1201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The pervasive and potentially severe economic, social, and public health consequences of infectious disease in farmed animals require that plans be in place for a rapid response. Increasingly, agent-based models are being used to analyze the spread of animal-borne infectious disease outbreaks and derive policy alternatives to control future outbreaks. Although the locations, types, and sizes of animal farms are essential model inputs, no public domain nationwide geospatial database of actual farm locations and characteristics currently exists in the United States. This report describes a novel method to develop a synthetic dataset that replicates the spatial distribution of poultry farms, as well as the type and number of birds raised on them. It combines county-aggregated poultry farm counts, land use/land cover, transportation, business, and topographic data to generate locations in the conterminous United States where poultry farms are likely to be found. Simulation approaches used to evaluate the accuracy of this method when compared to that of a random placement alternative found this method to be superior. The results suggest the viability of adapting this method to simulate other livestock farms of interest to infectious disease researchers.
Collapse
|
34
|
Hersey JC, Khavjou O, Strange LB, Atkinson RL, Blair SN, Campbell S, Hobbs CL, Kelly B, Fitzgerald TM, Kish-Doto J, Koch MA, Munoz B, Peele E, Stockdale J, Augustine C, Mitchell G, Arday D, Kugler J, Dorn P, Ellzy J, Julian R, Grissom J, Britt M. The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration. Prev Med 2012; 54:42-9. [PMID: 22001689 DOI: 10.1016/j.ypmed.2011.09.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 09/23/2011] [Accepted: 09/24/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE The study investigated the efficacy and cost-effectiveness of a cognitive-behavioral weight management program, complemented by an interactive Web site and brief telephone/e-mail coaching. METHODS In 2006-2007, 1755 overweight, non-active-duty TRICARE beneficiaries were randomized to one of three conditions with increasing intervention intensity: written materials and basic Web access (RCT1), plus an interactive Web site (RCT2), plus brief telephone/e-mail coaching support (RCT3). The study assessed changes in weight, blood pressure, and physical activity from baseline to 6, 12, and 15-18 months. (Study retention was 31% at 12 months.) Average and incremental cost-effectiveness and cost-offset analyses were conducted. RESULTS Participants experienced significant weight loss (-4.0%, -4.0%, and -5.3%, respectively, in each RCT group after 12 months and -3.5%, -3.8%, and -5.1%, respectively, after 15 to 18 months), increased physical activity, and decreased blood pressure. Cost-effectiveness ratios were $900 to $1100/quality-adjusted life year (QALY) for RCT1 and RCT2 and $1900/QALY for RCT3. The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT3. CONCLUSION A relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes. Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs.
Collapse
|
35
|
Andrews J, Chang DS, Jiang Y, He M, Foster PJ, Munoz B, Kashiwagi K, Friedman DS. Comparing approaches to screening for angle closure in older Chinese adults. Eye (Lond) 2011; 26:96-100. [PMID: 21997356 DOI: 10.1038/eye.2011.244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AIMS Primary angle-closure glaucoma is expected to account for nearly 50% of bilateral glaucoma blindness by 2020. This study was conducted to assess the performance of the scanning peripheral anterior chamber depth analyzer (SPAC) and limbal anterior chamber depth (LACD) as screening methods for angle closure. METHODS This study assessed two clinical populations to compare SPAC, LACD, and gonioscopy: the Zhongshan Angle-closure Prevention Trial, from which 370 patients were eligible as closed-angle participants and the Liwan Eye Study, from which 72 patients were selected as open-angle controls. Eligible participants were assessed by SPAC, LACD, and gonioscopy. RESULTS Angle status was defined by gonioscopy. Area under the receiver operating characteristic curve (AUROC) for SPAC was 0.92 (0.89-0.95) whereas AUROC for LACD was 0.94 (0.92-0.97). Using conventional cutoff points, sensitivity/specificity was 93.0%/70.8% for SPAC and 94.1%/87.5% for LACD. Sequential testing using both SPAC and LACD increased the specificity to 94.4% and decreased the sensitivity to 87.0%. CONCLUSION SPAC has significantly lower specificity than LACD measurement using conventional cutoffs but interpretation of the findings can be performed by modestly trained personnel.
Collapse
Affiliation(s)
- J Andrews
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, Deisenhofer I, Nakanishi H, Kashiwase K, Hirata A, Wada M, Ueda Y, Skoda J, Neuzil P, Popelova J, Petru J, Sediva L, Lavergne T, Le Heuzey JY, Mousseaux E, Hersi A, Alhabib K, Alfaleh H, Sulaiman K, Almahmeed W, Alsuwidi J, Amin H, Reddy VY, Almotarreb A, Pang HWK, Redfearn DP, Simpson CS, Michael K, Pereira EJ, Munt PW, Fitzpatrick MF, Baranchuk A, Revishvili AS, Uldry L, Simonyan G, Dzhordzhikiya T, Sopov O, Kalinin V, Locati ET, Vecchi AM, Cattafi G, Sachero A, Lunati M, Sayah S, Forclaz A, Alizadeh A, Nazari N, Hekmat M, Moradi M, Zeighami M, Ghanji H, Suzuki K, Takagi M, Maeda K, Tatsumi H, Virag N, Gomes C, Meireles A, Anjo D, Roque C, Vieira P, Lagarto V, Reis H, Torres S, Toth A, Vago H, Hocini M, Takacs P, Edes E, Marki A, Balazs GY, Huttl K, Merkely B, Lainis F, Buckley MM, Johns EJ, Seifer CM, Vesin JM, Daba L, Liebrecht K, Pietrucha AZ, Borowiec A, Mroczek-Czernecka D, Bzukala I, Wnuk M, Piwowarska W, Nessler J, Toquero Ramos J, Jais P, Perez Pereira E, Mitroi C, Castro Urda V, Fernandez Villanueva JM, Corona Figueroa A, Hernandez Reina L, Fernandez Lozano I, Bartoletti A, Bocconcelli P, Giuli S, Kappenberger L, Massa R, Svetlich C, Tarsi G, Tronconi F, Vitale E, Pietrucha AZ, Bzukala I, Wnuk M, Stryjewski P, Konduracka E, Haissaguerre M, Wegrzynowska M, Kruszelnicka O, Nessler J, Lousinha A, Labandeiro J, Antunes E, Silva S, Alves S, Timoteo A, Oliveira M, Sehra R, Cruz Ferreira R, Pietrucha AZ, Wnuk M, Jedrzejczyk-Spaho J, Bzukala I, Kruszelnicka O, Wegrzynowska M, Piwowarska W, Nessler J, Krummen D, Briggs C, Rappel WJ, Narayan S, Sediva L, Neuzil P, Petru J, Skoda J, Janotka M, Chovanec M, Yamashiro K, Takami K, Sakamoto Y, Satoh K, Suzuki T, Nakagawa H, Romanov A, Pokushalov E, Artemenko S, Shabanov V, Stenin I, Elesin D, Turov A, Yakubov A, Hioki M, Matsuo S, Ito K, Narui R, Yamashita S, Sugimoto K, Yoshimura M, Yamane T, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Elesin D, Stenin I, Turov A, Yakubov A, Miyazaki S, Shah AJ, Hocini M, Jais P, Haissaguerre M, Di Biase L, Gallinghouse JD, Rajappan K, Kautzner J, Dello Russo A, Tondo C, Lorgat F, Natale A, Balta O, Buenz K, Paessler M, Anders H, Horlitz M, Deneke T, Lickfett L, Liberman I, Linhart M, Andrie R, Mittmann-Braun E, Stockigt F, Nickenig G, Schrickel J, Tilz R, Rillig A, Feige B, Metzner A, Fuernkranz A, Burchard A, Wissner E, Ouyang F, Betts TR, Jones MA, Wong KCK, Qureshi N, Bashir Y, Rajappan K, Romanov A, Pokushalov E, Corbucci G, Artemenko S, Shabanov V, Turov A, Losik D, Selina V, Crandall MA, Daniels C, Daoud E, Kalbfleisch S, Yamaji H, Murakami T, Kawamura H, Murakami M, Hina K, Kusachi S, Dakos G, Vassilikos V, Paraskevaidis S, Mantziari A, Theophylogiannakos S, Chouvarda I, Chatzizisis I, Styliadis I, Kimura T, Fukumoto K, Nishiyama N, Aizawa Y, Fukuda Y, Sato T, Miyoshi S, Takatsuki S, Navarrete Casas AJ, Ali I, Conte FC, Moran M, Graham BG, Kalejs O, Lacis R, Stradins P, Koris A, Putnins I, Vikmane M, Lejnieks A, Erglis A, Estrada A, Perez Silva A, Castrejon S, Doiny D, Merino JL, Baranchuk A, Greiss I, Simpson CS, Abdollah H, Redfearn DP, Buys-Topart M, Nitzsche R, Thibault B, Deisenhofer I, Reents T, Ammar S, Fichtner S, Kathan S, Kolb C, Hessling G, Reif S, Schade S, Taggeselle J, Frey A, Birkenhagen A, Kohler S, Schmidt M, Cano Perez O, Buendia F, Igual B, Osca JM, Sanchez JM, Sancho-Tello MJ, Olague JM, Salvador A, Calvo N, Tolosana JM, Fernandez-Armenta J, Matas M, Barbarin MC, Berruezo A, Brugada J, Mont L, Habibovic M, Van Den Broek KC, Theuns DAMJ, Jordaens L, Alings M, Van Der Voort PH, Pedersen SS, Pupita G, Molini S, Brambatti M, Capucci A, Molodykh S, Idov EM, Belyaev OV, Segreti L, Soldati E, Zucchelli G, Di Cori A, Viani S, Paperini L, De Lucia R, Bongiorni MG, Binner L, Taborsky M, Bello D, Heuer H, Ramza B, Jenniskens I, Johnson WB, Silvetti MS, Rava' L, Russo MS, Di Mambro C, Ammirati A, Gimigliano G, Prosperi M, Drago F, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Jacinto A, Trinca M, Mazzone P, Ciconte G, Marzi A, Paglino G, Vergara P, Sora N, Gulletta S, Della Bella P, Koppitz P, Fach A, Hobbiesiefken S, Fiehn E, Hambrecht R, Sperzel J, Jung M, Schmitt J, Pajitnev D, Burger H, Burger H, Goebel G, Ehrlich W, Walther T, Ziegelhoeffer T, Vancura V, Wichterle D, Melenovsky V, Kautzner J, Glikson M, Goldenberg G, Segev A, Dvir D, Kuzniec J, Finkelstein A, Hay I, Guetta V, Choo WK, Gupta S, Kirkfeldt R, Johansen J, Nohr E, Moller M, Arnsbo P, Nielsen J, Santos AR, Picarra B, Semedo P, Dionisio P, Matos R, Leitao M, Banha M, Trinca M, Stojanov P, Raspopovic S, Vasic D, Savic D, Nikcevic G, Jovanovic V, Defaye P, Mondesert B, Mbaye A, Cassagneau R, Gagniere V, Jacon J, Sanfins V, Reis HR, Nobre JN, Martins VM, Duarte LD, Morais CM, Conceicao JC, Hero M, Rey JL, Thibault B, Ducharme A, Simpson C, Stuglin C, Blier L, Senaratne M, Khaykin Y, Pinter A, Mlynarska A, Mlynarski R, Sosnowski M, Wilczek J, Iorgulescu C, Bogdan S, Constantinescu D, Caldararu C, Dorobantu M, Radu A, Vatasescu RG, Yusu S, Ikeda T, Mera H, Miwa Y, Abe A, Miyakoshi M, Tsukada T, Yoshino H, Nayar V, Cantelon P, Rawling A, Belham MRD, Pugh PJ, Osca Asensi J, Sanchez JM, Cano O, Tejada D, Munoz B, Rodriguez M, Sancho-Tello MJ, Olague J, Wecke L, Van Hunnik A, Thompson T, Di Carlo L, Zdeblick M, Auricchio A, Prinzen F, Doltra Magarolas A, Bijnens B, Silva E, Penela D, Mont L, Tolosana JM, Brugada J, Sitges M, Ofman P, Navaravong L, Leng J, Peralta A, Hoffmeister P, Levine R, Cook J, Stoenescu M, Tettamanti ME, Revilla Orodea A, Lopez Diaz J, De La Fuente Galan L, Arnold R, Garcia Moran E, San Roman Calvar JA, Gomez Salvador I, Nakamura K, Takami M, Keida T, Mesato A, Higa S, Shimabukuro M, Masuzaki H, Proietti R, Sagone A, Domenichini G, Burri H, Valzania C, Biffi M, Sunthorn H, Gavaruzzi G, Foulkes H, Boriani G, Koh S, Hou W, Rosenberg S, Snell J, Poore J, Dalal N, Bornzin G, Kloppe A, Mijic D, Bogossian H, Ninios I, Zarse M, Lemke B, Guedon-Moreau L, Kouakam C, Klug D, Marquie C, Ziglio F, Kacet S, Mohamed Fereig Hamed H, Hamdy AMAL, Abd El Aziz AHMED, Nabih MRVAT, Hamdy REHAB, Yaminisaharif A, Davoudi GH, Kasemisaeid A, Sadeghian S, Vasheghani Farahani A, Yazdanifard P, Shafiee A, Alonso C, Grimard C, Jauvert G, Lazarus A, Fernandez-Armenta J, Berruezo A, Mont LL, Sitges M, Andreu D, Ortiz-Perez J, Caralt T, Brugada J, Escudero J, Perez F, Griffith KM, Ferreyra R, Urena P, Demas M, Muratore C, Mazzetti H, Guardado J, Sanfins V, Fernandes M, Pereira VH, Canario-Almeida F, Ferreira F, Rodrigues B, Almeida J, Sokal A, Jedrzejczyk E, Lenarczyk R, Pluta S, Kowalski O, Pruszkowska P, Swiatkowski A, Kalarus Z, Heinke M, Ismer B, Kuehnert H, Heinke T, Surber R, Osypka N, Prochnau D, Figulla HR, Iacopino S, Landolina M, Proclemer A, Padeletti L, Calvi V, Pierantozzi A, Di Stefano P, Boriani G, Bauer A, Bode F, Le Gal F, Deharo JC, Delay M, Nitzsche R, Clementy J, Kawamura M, Munetsugu Y, Tanno K, Kobayashi Y, Cannom D, Hosoda J, Ishikawa T, Andoh K, Nobuyoshi M, Fujii S, Shizuta S, Kimura T, Isshiki T, Castel MA, Tolosana JM, Perez-Villa F, Mont L, Sitges M, Vidal B, Brugada J, Pluta S, Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Sokal A, Szulik M, Kukulski T, Kalarus Z, Gianfranchi L, Bettiol K, Pacchioni F, Alboni P, Abu Sham'a R, Buber J, Nof E, Kuperstein R, Feinberg M, Luria D, Eldar M, Glikson M, Parks K, Stone JR, Singh JP, Hatzinikolaou-Kotsakou E, Kotsakou M, Beleveslis TH, Moschos G, Reppas E, Latsios P, Tsakiridis K, Kazemisaeid A, Davoodi G, Yamini Sharif A, Sadeghian S, Sheikhvatan M, Toniolo M, Zanotto G, Rossi A, Tomasi L, Vassanelli C, Versteeg H, Van Den Broek KC, Theuns DAMJ, Mommersteeg PMC, Alings M, Van Der Voort PH, Jordaens L, Pedersen SS, Vergara G, Blauer J, Ranjan R, Vijayakumar S, Kholmovski E, Volland N, Macleod R, Marrouche N, Aguinaga Arrascue LE, Bravo A, Garcia Freire P, Gallardo P, Hasbani E, Dantur J, Quintana R, Adragao PP, Cavaco D, Parreira L, Reis Santos K, Carmo P, Miranda R, Marcelino S, Cabrita D, Sommer P, Gaspar T, Rolf S, Arya A, Piorkowski C, Hindricks G, Valles Gras E, Bazan V, Portillo L, Suarez F, Bruguera J, Marti J, Huo Y, Arya A, Richter S, Schoenbauer R, Sommer P, Hindricks G, Piorkowski C, Rivas N, Casaldaliga J, Roca I, Dos L, Perez-Rodon J, Pijuan A, Garcia-Dorado D, Moya A, Carter HB, Garg A, Hegrenes J, Sih HJ, Teplitsky LR, Kuroki K, Tada H, Seo Y, Ishizu T, Igawa M, Sekiguchi Y, Kuga K, Aonuma K, Rodriguez A C, Mejias J, Hidalgo P, Hidalgo L JA, Orczykowski M, Derejko P, Walczak F, Szufladowicz E, Urbanek P, Bodalski R, Bieganowska K, Szumowski L, Peichl P, Wichterle D, Cihak R, Skalsky I, Kautzner J, Kubus P, Vit P, Zaoral L, Peichl P, Gebauer RA, Fiala M, Janousek J, Hiroshima K, Goya M, Ohe M, Hayashi K, Makihara Y, Nagashima M, An Y, Nobuyoshi M, Schloesser M, Lawrenz T, Meyer Zu Vilsendorf D, Strunk-Mueller C, Stellbrink C, Papagiannis J, Avramidis D, Kokkinakis C, Kirvassilis G, Eidelman G, Arenal A, Datino T, Atienza F, Gonzalez Torrecilla E, Miracle A, Hernandez J, Fernandez Aviles F, Ene E, Caldararu C, Iorgulescu C, Dorobantu M, Vatasescu RG, Insulander P, Bastani H, Braunschweig F, Drca N, Kenneback G, Schwieler J, Tapanainen J, Jensen-Urstad M, Andrea B, Andrea EMA, Maciel WM, Siqueira LS, Cosenza RC, Mittidieri FM, Farah SF, Atie JA, Kanoupakis E, Kallergis E, Mavrakis H, Goudis C, Saloustros I, Malliaraki N, Chlouverakis G, Vardas P, Bonnes JL, Jaspers Focks J, Westra SW, Brouwer MA, Smeets JLRM, Inama G, Pedrinazzi C, Landolina M, Oliva F, Senni M, Proclemer A, Zoni Berisso M, Mostov S, Haim M, Nevzorov R, Hasadi D, Starsberg B, Porter A, Kuschyk J, Schoene A, Streitner F, Veltmann CG, Schimpf R, Borggrefe M, Luesebrink U, Gardiwal A, Oswald H, Koenig T, Duncker D, Klein G, Bastiaenen R, Batchvarov V, Atty O, Cheng JH, Behr ER, Gallagher MM, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, Adhya S, Smith LA, Zhao T, Bannister C, Kamdar RH, Martinelli M, Siqueira S, Greco R, Nishioka SAD, Pedrosa AAA, Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
37
|
Tada H, Yamasaki H, Sekiguchi Y, Igarashi M, Kuroki K, Machino T, Yoshida K, Aonuma K, Heinzel FR, Forstner H, Lercher P, Bisping E, Rotman B, Fruhwald FM, Pieske BM, Dabrowski R, Kowalik I, Borowiec A, Smolis-Bak E, Trybuch A, Sosnowski C, Szwed H, Baturova MA, Lindgren A, Shubik YV, Olsson B, Platonov PG, Van Den Broek KC, Denollet J, Widdershoven J, Kupper N, Allam R, Allam RAGAB, Galal WAGDY, El-Damnhoury HAYAM, Mortada AYMAN, Jimenez-Candil J, Martin A, Hernandez J, Martin F, Gallego M, Martin-Luengo C, Quintanilla JG, Moreno Planas J, Molina-Morua R, Archondo T, Garcia-Torrent MJ, Perez-Castellano N, Macaya C, Perez-Villacastin J, Saiz J, Tobon C, Rodriguez JF, Hornero F, Ferrero JM, Ito K, Date T, Kawai M, Hioki M, Narui R, Matsuo S, Yoshimura M, Yamane T, Tabatabaei N, Lin G, Powell BD, Smairat R, Glockner JF, Brady PA, Fichtner S, Czudnochowsky U, Estner H, Reents T, Jilek C, Ammar S, Hessling G, Deisenhofer I, Shah DC, Kautzner J, Saoudi N, Herrera C, Jais P, Hindricks G, Neuzil P, Kuck KH, Wong KCK, Jones M, Qureshi N, Muthumala A, Betts TR, Bashir Y, Rajappan K, Vogtmann T, Wagner M, Schurig J, Hein P, Hamm B, Baumann G, Lembcke A, Saad B, Piwowarska W, Nessler J, Edvardsson N, Rieger G, Garutti C, Linker N, Jorge C, Silva Marques J, Veiga A, Cruz J, Slater C, Correia MJ, Sousa J, Miltenberger-Miltenyi G, Nunes Diogo A, Matic D, Mrdovic I, Stankovic G, Asanin M, Antonijevic N, Matic M, Oliveira LA, Kocev N, Vasiljevic Z, Ramirez-Marrero MA, Perez-Villardon B, Delgado-Prieto JL, Jimenez-Navarro M, De Teresa-Galvan E, De Mora-Martin M, Pietrucha AZ, Bzukala I, Elias R, Sztefko K, Wnuk M, Malek A, Piwowarska W, Nessler J, Szili-Torok T, Bauernfeind T, De Groot N, Shalganov T, Schalij M, Camiletti A, Jordaens L, Rivas N, Casaldaliga J, Roca I, Pijuan A, Perez-Rodon J, Dos L, Garcia-Dorado D, Moya A, Baruteau AE, Moura D, Behaghel A, Chatel S, Mabo P, Schott JJ, Daubert JC, Le Marec H, Probst V, Zorio Grima E, Navarro-Manchon J, Molina P, Maldonado P, Igual B, Cano O, Bermejo M, Giner J, Salvador A, Bourgonje VJA, Vos MA, Ozdemir S, Doisne N, Van Der Heyden MAG, Camanho LE, Van Veen AAB, Sipido K, Antoons G, Altieri PI, Escobales N, Crespo M, Banchs HL, Sciarra L, Bloise R, Allocca G, Bulava A, Marras E, Lioy E, Delise P, Priori S, Calo' L, Hanis J, Sitek D, Novotny A, Chik WB, Lim TW, Choon HK, See VA, Mccall R, Thomas L, Ross DL, Thomas SP, Chen J, De Bortoli A, Rossvoll O, Hoff PI, Solheim E, Sun LZ, Schuster P, Ohm OJ, Ardashev AV, Zhelyakov E, Rybachenko MS, Konev AV, Belenkov YUN, Gunawardene M, Chun KRJ, Schulte-Hahn B, Windhorst V, Kulikoglu M, Nowak B, Schmidt B, Albina GA, Rivera RS, Scazzuso F, Laino RL, Giniger GA, Arbelo E, Calvo N, Tamborero D, Andreu D, Borras R, Berruezo A, Brugada J, Mont L, Stefan L, Eisenberger M, Celentano E, Peytchev P, Bodea O, Geelen P, De Potter T, Oliveira MM, Silva N, Cunha PS, Feliciano J, Lousinha A, Toste A, Santos S, Ferreira RC, Matsuda H, Harada T, Soejima K, Ishikawa Y, Mizukoshi K, Sasaki T, Mizuno K, Miyake F, Adragao PP, Cavaco D, Miranda R, Santos M, Morgado F, Reis Santos K, Candeias R, Marcelino S, Zoppo F, Grandolino G, Zerbo F, Bertaglia E, Schlueter SM, Grebe O, Vester EG, Miracle Blanco AL, Arenal Maiz A, Atienza Fernandez F, Datino Romaniega T, Gonzalez Torrecilla E, Eidelman G, Hernandez Hernandez J, Fernandez Aviles F, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Richter B, Gwechenberger M, Socas A, Zorn G, Albinni S, Marx M, Wojta J, Goessinger H, Deneke T, Balta O, Paesler M, Buenz K, Anders H, Horlitz M, Muegge A, Shin DI, Natsuyama K, Yamaguchi KM, Nishida YN, De Bortoli A, Ohm OJ, Hoff PI, Solheim E, Schuster P, Sun LZ, Chen J, Kosiuk J, Bode K, Arya A, Piorkowski C, Gaspar T, Sommer P, Hindricks G, Bollmann A, Wichterle D, Peichl P, Simek J, Havranek S, Bulkova V, Cihak R, Kautzner J, Jurado Roman A, Salguero Bodes R, Lopez Gil M, Fontenla Cerezuela A, De Riva Silva M, Arribas Ynsaurriaga F, Fernandez Herranz AI, De Dios Perez S, Revishvili AS, Dishekov M, Tembotova Z, Barsamyan S, Vaccari D, Alvarenga C, Jesus I, Layher J, Takahashi A, Singh N, Siot P, Elkaim JP, Savelieva I, Mcclelland L, Lovegrove A, Jones S, Camm J, Folino AF, Breda R, Calzavara P, Comisso J, Borghetti F, Iliceto S, Buja G, Mlynarski R, Mlynarska A, Sosnowski M, Wilczek J, Mabo P, Carrault G, Bordachar P, Makdissi A, Duchemin L, Alonso C, Neri G, Masaro G, Vittadello S, Vaccari D, Gardin A, Barbetta A, Di Gregorio F, Sciaraffia E, Ginks MR, Gustafsson JS, Hollmark MC, Rinaldi CA, Blomstrom Lundqvist C, Brusich S, Tomasic D, Ferek-Petric B, Mavric Z, Kutarski A, Malecka B, Kolodzinska A, Grabowski M, Dovellini EV, Giurlani L, Cerisano G, Carrabba N, Valenti R, Antoniucci D, Kolodzinska A, Kutarski A, Grabowski M, Malecka B, Opolski G, Tomassoni G, Baker J, Corbisiero R, Martin D, Niazi I, Sheppard R, Sperzel J, Gutleben K, Petru J, Sediva L, Skoda J, Neuzil P, Mazzone P, Ciconte G, Vergara P, Marzi A, Paglino G, Sora N, Gulletta S, Della Bella P, Kutarski A, Pietura R, Czajkowski M, Cabanelas N, Martins VP, Alves M, Valente FX, Marta L, Francisco A, Silva R, Ferreira Da Silva G, Huo Y, Holmqvist F, Carlson J, Arya A, Wetzel U, Hindricks G, Bollmann A, Platonov P, Nof E, Abu Shama R, Kuperstein R, Feinberg MS, Eldar M, Glikson M, Luria D, Kubus P, Materna O, Gebauer RA, Matejka T, Gebauer R, Tlaskal T, Janousek J, Muessigbrodt A, Arya A, Wetzel U, Hindricks G, Richter S, Stockburger M, Boveda S, Defaye P, Stancak Branislav P, Kaliska G, Rolando M, Moreno J, Ohlow MAG, Lauer B, Buchter B, Schreiber M, Geller JC, Val-Mejias JE, Ouali S, Azzez S, Kacem S, Ben Salem H, Hammas S, Neffeti E, Remedi F, Boughzela E, Miyazaki H, Miyanaga S, Shibayama K, Tokuda M, Narui R, Kudo T, Yamane T, Yoshimura M, Coppola B, Shehada REN, Costandi P, Healey J, Hohnloser SH, Gold MR, Capucci A, Van Gelder IC, Carlson M, Lau CP, Connolly SJ, Bogaard MD, Leenders GE, Maskara B, Tuinenburg AE, Loh P, Hauer RN, Doevendans PA, Meine M, Thibault B, Dubuc M, Karst E, Ryu K, Paiement P, Farazi T, Puetz V, Berndt C, Buchholz J, Dorszewski A, Mornos C, Cozma D, Ionac A, Petrescu L, Mornos A, Pescariu S, Puetz V, Berndt C, Buchholz J, Dorszewski A, Benser M, Roscoe G, De Jong S, Roberts G, Boileau P, Rec A, Ryu K, Folman C, Morttada A, Abd El Kader M, Samir R, Roushdy R, Khaled S, Abo El Maaty M, Van Gelder B, Houthuizen P, Bracke FA, Osca Asensi J, Tejada D, Sanchez JM, Munoz B, Cano O, Rodriguez M, Sancho-Tello MJ, Olague J, Hou W, Rosenberg S, Koh S, Poore J, Snell J, Yang M, Nirav D, Bornzin G, Deering T, Dan D, Wickliffe AC, Cazeau S, Karimzadeh K, Mukerji S, Loghin C, Kantharia B, Bogaard MD, Leenders GE, Maskara B, Tuinenburg AE, Loh P, Hauer RN, Doevendans PA, Meine M, Betts TR, Jones MA, Wong KCK, Qureshi N, Rajappan K, Bashir Y, Lamba J, Simpson CS, Redfearn DP, Michael KA, Fitzpatrick M, Baranchuk A, Heinke M, Ismer B, Kuehnert H, Surber R, Haltenberger AM, Prochnau D, Figulla HR, Delarche N, Bizeau O, Couderc P, Chapelet A, Amara W, Lazarus A, Kubus P, Krupickova S, Gebauer RA, Janousek J, Van Deursen CJM, Strik M, Vernooy K, Van Hunnik A, Kuiper M, Crijns HJGM, Prinzen FW, Islam N, Gras D, Abraham W, Calo L, Birgersdotter-Green U, Clyne C, Herre J, Sheppard R, Abraham W, Gras D, Birgersdotter-Green U, Calo L, Clyne C, Klein N, Herre J, Sheppard R, Kowalski O, Lenarczyk R, Pruszkowska P, Sokal A, Kukulski T, Zielinska T, Pluta S, Kalarus Z, Schwab JO, Gasparini M, Anselme F, Clementy J, Santini M, Martinez Ferrer J, Burrone V, Santi E, Nevzorov R, Porter A, Kusniec J, Golovchiner G, Ben-Gal T, Strasberg B, Haim M, Rordorf R, Savastano S, Sanzo A, Vicentini A, Petracci B, De Amici M, Striuli L, Landolina M, Tolosana JM, Martin AM, Hernandez-Madrid A, Macias A, Fernandez-Lozano I, Osca J, Quesada A, Mont L, Igarashi M, Tada H, Yamasaki H, Sekiguchi Y, Kuroki K, Yoshida K, Noguchi Y, Aonuma K, Shahrzad S, Karim Soleiman N, Tavoosi A, Taban S, Emkanjoo Z, Fukunaga M, Goya M, Hiroshima K, Ohe M, Hayashi K, Iwabuchi M, Nosaka H, Nobuyoshi M, Doiny D, Perez-Silva A, Castrejon Castrejon S, Estrada A, Ortega M, Lopez-Sendon JL, Merino JL, Garcia Fernandez FJ, Gallardo R, Pachon M, Almendral J, Gonzalez Torrecilla E, Martin J, Yahya D, Al-Mogheer B, Gouda S, Eweis E, El Ramly M, Abdelwahab A, Kassenberg W, Wittkampf FHM, Hof IE, Heijden JH, Neven KGEJ, Meine M, Hauer RNW, Loh P, Baratto F, Bignami E, Pappalardo F, Maccabelli G, Nicolotti D, Zangrillo A, Della Bella P, Hayashi K, Goya M, Hiroshima K, Nagashima M, An Y, Fukunaga M, Okreglicki A, Russouw C, Tilz R, Yoshiga Y, Mathew S, Fuernkranz A, Rillig A, Wissner E, Kuck KH, Ouyang F, De Sisti A, Tonet J, Gueffaf F, Amara W, Touil F, Aouate P, Hidden-Lucet F, Doiny D, Castrejon Castrejon S, Estrada A, Ortega M, Perez-Silva A, Lopez-Sendon JL, Merino JL, Makimoto H, Satomi K, Yamada Y, Okamura H, Noda T, Shimizu W, Aihara N, Kamakura S, Estrada A, Perez Silva A, Doiny D, Castrejon S, Gonzalez Vasserot M, Merino JL, Tilz R, Senges J, Brachmann J, Andresen D, Hoffmann E, Schumacher B, Willems S, Kuck KH, Reents T, Deisenhofer I, Ammar S, Springer B, Fichtner S, Jilek C, Kolb C, Hessling G, Akca F, Bauernfeind T, De Groot NMS, Schwagten B, Witsenburg M, Jordaens L, Szili-Torok T, Hata Y, Nakagami R, Watanabe T, Sato A, Watanabe H, Kabutoya T, Mituhashi T, Theuns DAMJ, Smith T, Pedersen SS, Dabiri-Abkenari L, Jordaens L, Prull MW, Unverricht S, Bittlinsky A, Wirdemann H, Sasko B, Wirdeier S, Trappe HJ, Zorio Grima E, Rueda J, Medina P, Jaijo T, Sevilla T, Osca J, Arnau MA, Salvador A, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, De Haan S, Commandeur J, De Boer K, Beek AM, Van Rossum AC, Allaart CP, Berne P, Porres JM, Fernandez-Lozano I, Arnaiz JA, Mont L, Berruezo A, Brugada R, Brugada J, Man S, Maan AC, Thijssen J, Van Der Wall EE, Schalij MJ, Burattini L, Burattini R, Swenne CA, Bonny A, Hidden-Lucet F, Ditah I, Larrazet F, Frank R, Fontaine G, Van Den Broek KC, Pedersen SS, Theuns DAMJ, Jordaens L, Van Der Voort PH, Alings M, Denollet J, Shimane A, Okajima K, Kanda G, Yokoi K, Yamada S, Taniguchi Y, Hayashi T, Kajiya T, Santos MC, Wright J, Betts J, Denman R, Dominguez-Perez L, Arias Palomares MA, Toquero J, Jimenez-Candil J, Olague J, Diaz-Infante E, Tercedor L, Valverde I, Miracle Blanco AL, Datino Romaniega T, Arenal Maiz A, Atienza Fernandez F, Gonzalez Torrecilla E, Eidelman G, Hernandez Hernandez J, Fernandez Aviles F, Napp A, Joosten S, Stunder D, Zink M, Marx N, Schauerte P, Silny J, Trucco ME, Arce M, Palazzolo J, Femenia F, Glad JM, Szymkiewicz SJ, Glad JM, Szymkiewicz SJ, Fernandez-Armenta J, Camara O, Mont LL, Andreu D, Diaz E, Silva E, Frangi A, Berruezo A, Brembilla-Perrot B, Laporte F, Jimenez-Candil J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, Hadid C, Almendral J, Ortiz M, Quesada A, Wolpert C, Cobo E, Navarro X, Arribas F, Miki Y, Naitoh S, Kumagai K, Goto K, Kaseno K, Oshima S, Taniguchi K, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Muggenthaler M, Raju H, Papadakis M, Chandra N, Bastiaenen R, Behr ER, Sharma S, Samniah N, Radezishvsky Y, Omari H, Rosenschein U, Perez Riera AR, Ferreira M, Hopman WM, Mcintyre WF, Baranchuk AR, Wongcharoen W, Keanprasit K, Phrommintikul A, Chaiwarith R, Yagishita A, Hachiya H, Nakamura T, Tanaka Y, Higuchi K, Kawabata M, Hirao K, Isobe M, Havranek S, Simek J, Wichterle D, Stoickov V, Ilic S, Deljanin Ilic M, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Sousa A, Lebreiro A, Sousa C, Oliveira S, Correia AS, Rangel I, Freitas J, Maciel MJ, Asensio Lafuente E, Aguilera AAC, Corral MACC, Mendoza KLMC, Nava PEND, Rendon ALRC, Villegas LVC, Castillo LCM, Schaerf R, Develle R, Brembilla-Perrot B, Oliver C, Zinzius PY, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Borbola J, Abraham P, Foldesi CS, Kardos A, Miranda R, Almeida S, Santos MB, Cavaco D, Quaresma R, Morgado FB, Adragao P, Fatemi M, Didier R, Le Gal G, Etienne Y, Jobic Y, Gilard M, Boschat J, Mansourati J, Zubaid M, Rashed W, Alsheikh-Ali A, Almahmeed W, Shehab A, Sulaiman K, Asaad N, Amin H, Boersma LVA, Swaans M, Post M, Rensing B, Jarverud K, Broome M, Noren K, Svensson T, Hjelm S, Hollmark M, Bjorling A, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Maeda K, Takagi M, Suzuki K, Tatsumi H, Yoshiyama M, Simeonidou E, Michalakeas C, Kastellanos S, Varounis C, Nikolopoulou A, Koniari C, Anastasiou-Nana M, Furukawa T, Maggi R, Bertolone C, Fontana D, Brignole M, Pietrucha AZ, Wnuk M, Bzukala I, Mroczek-Czernecka D, Konduracka E, Kruszelnicka O. Poster Session 4. Europace 2011. [DOI: 10.1093/europace/eur231] [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: 11/14/2022] Open
|
38
|
Keay L, Munoz B, Turano K, Munro C, Duncan DD, Baldwin K, Bandeen-Roche KJ, Gower EW, West SK. Driving errors influence an older drivers decision to give up or restrict driving. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Mkocha H, Munoz B, West S. Trachoma and ocular Chlamydia trachomatis rates in children in trachoma-endemic communities enrolled for at least three years in the Tanzania National Trachoma Control Programme. ACTA ACUST UNITED AC 2010; 11:103-10. [PMID: 20734706 DOI: 10.4314/thrb.v11i3.47694] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trachoma, a blinding eye disease caused by repeated and prolonged infection with Chlamydia trachomatis, is a significant public health problem for sub-Saharan Africa. Tanzania has had a National Trachoma Task Force since 1999, working on trachoma control in endemic districts. The objective of this study was twofold: first, to determine the current status of infection and clinical trachoma in these districts in Tanzania, and second, to determine if a combination of clinical signs could be used as a surrogate for infection. We conducted a survey for trachoma and infection with C. trachomatis in 75 villages in eight districts of Kongwa, Kilosa, Mpwapwa, Bahi, Kondoa, Manyoni, Monduli and Iramba in Tanzania, which have previously been shown to be endemic. In each village, a random sample of households, and of children within households, was taken for examination. Trachoma was graded using the World Health Organization system, which we expanded, and a swab taken to determine presence of infection. The rates of trachoma ranged from 0% in Iramba District to 15.17% in Monduli District, with large variation in villages within districts. Infection rates were generally lower than trachoma rates, as expected, and most districts had villages with no infection. A combination of clinical signs of trachoma in children, when absent, showed very high specificity for identifying villages with no infection. We conclude that these signs might be useful for monitoring absence of infection in villages, and that districts with trachoma prevalence between 10% and 15% should have village level rapid surveys to avoid unnecessary mass treatment.
Collapse
Affiliation(s)
- H Mkocha
- Kongwa Trachoma Project, Kongwa, P.O. Box 124, Kongwa, Tanzania.
| | | | | |
Collapse
|
40
|
Munoz B, Lesser VM, Smith RA. Applying Multiple Imputation with Geostatistical Models to Account for Item Nonresponse in Environmental Data. J Mod App Stat Meth 2010. [DOI: 10.22237/jmasm/1272687960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
41
|
|
42
|
Munoz B, Lesser VM, Dorney JR, Savage R. A proposed methodology to determine accuracy of location and extent of geographically isolated wetlands. Environ Monit Assess 2009; 150:53-64. [PMID: 19083113 DOI: 10.1007/s10661-008-0672-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 03/10/2008] [Indexed: 05/27/2023]
Abstract
Wetlands can provide significant environmental benefits such as assimilation of pollutants, flood water storage, groundwater recharge, and fish and wildlife habitat. Geographically isolated wetlands (IWs) can provide the same benefits as other wetlands, but are particularly vulnerable to losses from urbanization and agriculture since they are isolated, often smaller, and not equal to other wetlands in regulatory protection. There is a need for a reliable assessment of the total number and area of IWs. Access to this information can provide the foundation to monitor IW loss, and can assist in understanding the ecological effects of such loss as well as help to address regulatory shortcomings. A probability sampling survey methodology that balances statistical considerations, expert opinion, and operational considerations is discussed for assessing the accuracy of IW maps. A simulation exercise was used to illustrate how the proposed sampling methodology will produce reliable results in map accuracy assessment. A wetland map for the Lockwood Folly River watershed, in Brunswick County, NC, was created using historical and recent data and used as the sampling frame in the simulation exercise. An updated wetland map for the same watershed, showing exact locations of wetlands, was used to provide "ground-truth" observations based on wetland delineations approved by the U.S. Army Corps of Engineers. Survey-based accuracy estimates were calculated by comparing site classification differences obtained by using both the original and updated wetland maps.
Collapse
Affiliation(s)
- Breda Munoz
- RTI International, 3040 Cornwallis Rd, Cox 221, Research Triangle Park, NC 27709, USA.
| | | | | | | |
Collapse
|
43
|
Quiroga T, Willemse J, Matus V, Munoz B, Panes O, Goycoolea M, Pereira J, Hendriks D, Mezzano D. PLASMA PROCPU (TAFI) AND CLOT LYSIS TIME ARE CORRELATED WITH CLOTTING FACTOR LEVELS AND THROMBIN GENERATION: A NOVEL APPROACH TO ASSESS THROMBOSIS RISK? J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb03057.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
44
|
West ES, Munoz B, Imeru A, Alemayehu W, Melese M, West SK. The association between epilation and corneal opacity among eyes with trachomatous trichiasis. Br J Ophthalmol 2006; 90:171-4. [PMID: 16424528 PMCID: PMC1860176 DOI: 10.1136/bjo.2005.075390] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery. METHODS Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status. RESULTS Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated. CONCLUSION Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.
Collapse
Affiliation(s)
- E S West
- Dana Center for Preventive Ophthalmology, Johns Hopkins School of Medicine, 116 Wilmer Building, 600 N Wolfe Street, Baltimore, MD 21287, USA.
| | | | | | | | | | | |
Collapse
|
45
|
West S, Munoz B, Mkocha H, Holland M, Aguirre A, Solomon A, Foster A, Bailey R, Mabey D. Infection with Chlamydia trachomatis after mass treatment of a trachoma hyperendemic community in Tanzania: a longitudinal study. Am J Ophthalmol 2006. [DOI: 10.1016/j.ajo.2005.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Melese M, West ES, Alemayehu W, Munoz B, Worku A, Gaydos CA, West SK. Characteristics of trichiasis patients presenting for surgery in rural Ethiopia. Br J Ophthalmol 2005; 89:1084-8. [PMID: 16113353 PMCID: PMC1772827 DOI: 10.1136/bjo.2005.066076] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To determine the characteristics of trichiasis patients presenting for surgery in Wolayta Zone of Ethiopia. METHODS Patients referred for trichiasis surgery by community health agents were evaluated by trained integrated eye care workers (IECWs) for the presence of trichiasis, locations of inturned lashes, severity of trichiasis, corneal opacity, and visual acuity. RESULTS 1635 individuals with trichiasis presented for surgery. 82% had bilateral trichiasis; 91% of patients reported trichiasis duration of >2 years. Epilation was practised by over three fourths of the study subjects. A high proportion of patients tested positive for ocular Chlamydia trachomatis at presentation. 17% had monocular blindness and 8% were binocularly blind. Corneal opacity was highly associated with the trichiasis duration and severity and visual loss was associated with corneal opacity. CONCLUSION Severe trichiasis reflects the magnitude of the trachoma problem in Ethiopia. Visual impairment due to trichiasis is highly associated with disease severity and duration. Early intervention to correct trichiasis before it become severe is recommended to prevent visual impairment.
Collapse
Affiliation(s)
- M Melese
- Project ORBIS, Addis Ababa, Ethiopia
| | | | | | | | | | | | | |
Collapse
|
47
|
Lewis A, Congdon N, Munoz B, Bowie H, Lai H, Chen P, West SK. Cataract surgery and subtype in a defined, older population: the SEECAT Project. Br J Ophthalmol 2004; 88:1512-7. [PMID: 15548802 PMCID: PMC1772435 DOI: 10.1136/bjo.2004.045484] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2004] [Indexed: 11/04/2022]
Abstract
AIM To describe the distribution of cataract subtypes present before surgery among a defined population of older, bilaterally pseudophakic individuals. METHODS This was a cohort study of bilaterally pseudophakic individuals participating in the Salisbury Eye Evaluation (SEE), and their locally resident siblings. Subjects underwent slit lamp and retroillumination photography and grading using the Wilmer Cataract Grading System. For all individuals determined to be bilaterally pseudophakic, an attempt was made to determine for each eye the type(s) of cataract present before surgery, based on previous SEE photographs (for SEE participants) and/or medical records obtained from the operating ophthalmologist (for both SEE participants and their siblings). RESULTS The mean age of 223 participants providing data in this study was 78.7 (SD 5.2) years, 19.3% of subjects were black and 60.1% female. The most common surgically removed cataract subtype in this population was pure nuclear (43.5%), followed by nuclear combined with posterior subcapsular cataract (PSC) (20.6%), and nuclear combined with cortical (13.9%); less common types were pure cortical (4.9%), pure PSC (4.5%), and PSC combined with cortical (2.7%). Factors such as sex and source of lens data (study photograph versus clinical record) did not significantly affect the distribution of lens opacity types, while PSC was significantly (p = 0.01) more common among younger people and nuclear cataract was significantly (p = 0.001) more common among white compared to black people. CONCLUSION Epidemiological studies have suggested that the different subtypes of cataract are associated with different risk factors. As studies begin to identify new prevention strategies for cataract, it would appear likely that different strategies will be efficacious against different types of cataract. In this setting, it will be helpful to know which cataract types are most frequently associated with surgery. Among this older, majority white population, nuclear cataract showed a clear predominance among individuals having undergone surgery in both eyes. This may be contrasted with both clinic and population based studies of younger people, which have generally found PSC cataract to predominate.
Collapse
Affiliation(s)
- A Lewis
- Dana Center for Preventive Ophthalmology, Johns Hopkins University Schools of Medicine and Public Health, Wilmer 120, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
West S, Nguyen MP, Mkocha H, Holdsworth G, Ngirwamungu E, Kilima P, Munoz B. Gender equity and trichiasis surgery in the Vietnam and Tanzania national trachoma control programmes. Br J Ophthalmol 2004; 88:1368-71. [PMID: 15489474 PMCID: PMC1772400 DOI: 10.1136/bjo.2004.041657] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 11/03/2022]
Abstract
AIMS To calculate the gender distribution of trichiasis cases in trachoma communities in Vietnam and Tanzania, and the gender distribution of surgical cases, to determine if women are using surgical services proportional to their needs. METHODS Population based data from surveys done in Tanzania and Vietnam as part of the national trachoma control programmes were used to determine the rate of trichiasis by gender in the population. Surgical records provided data on the gender ratio of surgical cases. RESULTS The rates of trichiasis in both countries are from 1.4-fold to sixfold higher in females compared to males. In both countries, the female to male rate of surgery was the same or even higher than the female to male rate of trichiasis in the population. CONCLUSIONS These data provide assurance of gender equity in the provision and use of trichiasis surgery services in the national programmes of these two countries. Such simple analyses should be used by other programmes to assure gender equity in provision and use of trichiasis surgery services.
Collapse
Affiliation(s)
- S West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Barten DM, Guss VL, Corsa JA, Loo A, Hansel SB, Zheng M, Munoz B, Srinivasan K, Wang B, Robertson BJ, Polson CT, Wang J, Roberts SB, Hendrick JP, Anderson JJ, Loy JK, Denton R, Verdoorn TA, Smith DW, Felsenstein KM. Dynamics of {beta}-amyloid reductions in brain, cerebrospinal fluid, and plasma of {beta}-amyloid precursor protein transgenic mice treated with a {gamma}-secretase inhibitor. J Pharmacol Exp Ther 2004; 312:635-43. [PMID: 15452193 DOI: 10.1124/jpet.104.075408] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [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: 12/24/2022] Open
Abstract
gamma-Secretase inhibitors are one promising approach to the development of a therapeutic for Alzheimer's disease (AD). gamma-Secretase inhibitors reduce brain beta-amyloid peptide (Abeta), which is believed to be a major contributor in the etiology of AD. Transgenic mice overexpressing the human beta-amyloid precursor protein (APP) are valuable models to examine the dynamics of Abeta changes with gamma-secretase inhibitors in plaque-free and plaque-bearing animals. BMS-299897 2-[(1R)-1-[[(4-chlorophenyl)sulfony](2,5-difluorophenyl)amino]ethyl]-5-fluorobenzenepropanoic acid, a gamma-secretase inhibitor, showed dose- and time dependent reductions of Abeta in brain, cerebrospinal fluid (CSF), and plasma in young transgenic mice, with a significant correlation between brain and CSF Abeta levels. Because CSF and brain interstitial fluid are distinct compartments in composition and location, this correlation could not be assumed. In contrast, aged transgenic mice with large accumulations of Abeta in plaques showed reductions in CSF Abeta in the absence of measurable changes in plaque Abeta in the brain after up to 2 weeks of treatment. Hence, CSF Abeta levels were a valuable measure of gamma-secretase activity in the central nervous system in either the presence or absence of plaques. Transgenic mice were also used to examine potential side effects due to Notch inhibition. BMS-299897 was 15-fold more effective at preventing the cleavage of APP than of Notch in vitro. No changes in the maturation of CD8(+) thymocytes or of intestinal goblet cells were observed in mice treated with BMS-299897, showing that it is possible for gamma-secretase inhibitors to reduce brain Abeta without causing Notch-mediated toxicity.
Collapse
Affiliation(s)
- D M Barten
- Neuroscience Drug Discovery, Bristol-Myers Squibb, P.O. Box 5100, 3CD-405, 5 Research Pkwy., Wallingford, CT 06492, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Quigley HA, West SK, Rodriguez J, Munoz B, Klein R, Snyder R. The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER. Arch Ophthalmol 2001; 119:1819-26. [PMID: 11735794 DOI: 10.1001/archopht.119.12.1819] [Citation(s) in RCA: 377] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the prevalence of glaucoma in a population-based sample of Hispanic adults older than 40 years. METHODS Using 1990 census data for Arizona, groups of persons living in sections of the city in Nogales and Tucson were randomly selected with a probability proportional to the Hispanic population older than 40 years. We tried to recruit all eligible adults in homes with 1 self-described Hispanic adult. Detailed ocular examinations at a local clinic included visual acuity testing, applanation tonometry, gonioscopy, an optic disc evaluation, and a threshold visual field test. Open-angle glaucoma (OAG) was defined using a proposed international system for prevalence surveys, including threshold visual field defect and optic disc damage. Angle-closure glaucoma was defined as bilateral appositional angle closure, combined with optic nerve damage (judged by field and disc as for OAG). RESULTS Examinations were conducted in 72% (4774/6658) of eligible persons, with a 1.97% prevalence (95% confidence interval, 1.58%-2.36%) of OAG (94 persons). The age-specific OAG prevalence increased nonlinearly from 0.50% in those aged 41 to 49 years to 12.63% in those 80 years and older. Angle-closure glaucoma was detected in 5 persons (0.10%). Sex, blood pressure, and cigarette smoking were not significant OAG risk factors. Only 36 (38%) of the 94 persons with OAG were aware of their OAG before the study. Screening results with an intraocular pressure higher than 22 mm Hg (in the eye with a higher pressure) would miss 80% of the OAG cases. CONCLUSIONS The prevalence of OAG in Hispanic persons was intermediate between reported values for white and black persons. The prevalence increased more quickly with increasing age than in other ethnic groups. Glaucoma was the leading cause of bilateral blindness.
Collapse
Affiliation(s)
- H A Quigley
- Dana Center for Preventive Ophthalmology, Wilmer Institute, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA.
| | | | | | | | | | | |
Collapse
|