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Grady CB, Bhattacharjee B, Silva J, Jaycox J, Lee LW, Monteiro VS, Sawano M, Massey D, Caraballo C, Gehlhausen JR, Tabachnikova A, Mao T, Lucas C, Peña-Hernandez MA, Xu L, Tzeng TJ, Takahashi T, Herrin J, Güthe DB, Akrami A, Assaf G, Davis H, Harris K, McCorkell L, Schulz WL, Grffin D, Wei H, Ring AM, Guan L, Cruz CD, Iwasaki A, Krumholz HM. Impact of COVID-19 vaccination on symptoms and immune phenotypes in vaccine-naïve individuals with Long COVID. medRxiv 2024:2024.01.11.24300929. [PMID: 38260484 PMCID: PMC10802754 DOI: 10.1101/2024.01.11.24300929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Long COVID contributes to the global burden of disease. Proposed root cause hypotheses include the persistence of SARS-CoV-2 viral reservoir, autoimmunity, and reactivation of latent herpesviruses. Patients have reported various changes in Long COVID symptoms after COVID-19 vaccinations, leaving uncertainty about whether vaccine-induced immune responses may alleviate or worsen disease pathology. Methods In this prospective study, we evaluated changes in symptoms and immune responses after COVID-19 vaccination in 16 vaccine-naïve individuals with Long COVID. Surveys were administered before vaccination and then at 2, 6, and 12 weeks after receiving the first vaccine dose of the primary series. Simultaneously, SARS-CoV-2-reactive TCR enrichment, SARS-CoV-2-specific antibody responses, antibody responses to other viral and self-antigens, and circulating cytokines were quantified before vaccination and at 6 and 12 weeks after vaccination. Results Self-report at 12 weeks post-vaccination indicated 10 out of 16 participants had improved health, 3 had no change, 1 had worse health, and 2 reported marginal changes. Significant elevation in SARS-CoV-2-specific TCRs and Spike protein-specific IgG were observed 6 and 12 weeks after vaccination. No changes in reactivities were observed against herpes viruses and self-antigens. Within this dataset, higher baseline sIL-6R was associated with symptom improvement, and the two top features associated with non-improvement were high IFN-β and CNTF, among soluble analytes. Conclusions Our study showed that in this small sample, vaccination improved the health or resulted in no change to the health of most participants, though few experienced worsening. Vaccination was associated with increased SARS-CoV-2 Spike protein-specific IgG and T cell expansion in most individuals with Long COVID. Symptom improvement was observed in those with baseline elevated sIL-6R, while elevated interferon and neuropeptide levels were associated with a lack of improvement.
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Affiliation(s)
- Connor B Grady
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bornali Bhattacharjee
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Julio Silva
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jillian Jaycox
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Valter Silva Monteiro
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeff R Gehlhausen
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Tianyang Mao
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Carolina Lucas
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Mario A Peña-Hernandez
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lan Xu
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Tiffany J Tzeng
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Takehiro Takahashi
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeph Herrin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Athena Akrami
- Sainsbury Wellcome Centre, University College London, London, UK
- Patient-Led Research Collaborative
| | | | | | | | | | - Wade L Schulz
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Daniel Grffin
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York
| | | | - Aaron M Ring
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Leying Guan
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Charles Dela Cruz
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, Connecticut, USA
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Harlan M Krumholz
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Massey D, Saydah S, Adamson B, Lincoln A, Aukerman DF, Berke EM, Sikka R, Krumholz HM. Prevalence of covid-19 and long covid in collegiate student athletes from spring 2020 to fall 2021: a retrospective survey. BMC Infect Dis 2023; 23:876. [PMID: 38093182 PMCID: PMC10717379 DOI: 10.1186/s12879-023-08801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Symptomatic COVID-19 and Long COVID, also referred to as post-acute sequelae of SARS-CoV-2 (PASC) or post-COVID conditions, have been widely reported in young, healthy people, but their prevalence has not yet been determined in student athletes. We sought to estimate the prevalence of reported COVID-19, symptomatic COVID-19, and Long COVID in college athletes in the United States attending 18 schools from spring 2020 to fall 2021. METHODS We developed an online survey to measure the prevalence of student athletes who tested positive for COVID-19, developed Long COVID, and did not return to their sport during the relevant time period. We surveyed a convenience sample of 18 collegiate school administrators, representing about 7,000 student athletes. Of those schools surveyed, 16 responded regarding the spring 2020 semester, and 18 responded regarding the full academic year of fall 2020 to spring 2021 (both semesters). RESULTS According to the survey responses, there were 9.8% of student athletes who tested positive for COVID-19 in spring 2020 and 25.4% who tested positive in the academic year of fall 2020 to spring 2021. About 4% of student athletes who tested positive from spring 2020 to spring 2021 developed Long COVID, defined as new, recurring, or ongoing physical or mental health consequences occurring 4 or more weeks after SARS-CoV-2 infection. CONCLUSIONS This study highlights that Long COVID occurs among young, healthy athletes and is a real consequence of COVID-19. Understanding the prevalence of Long COVID in this population requires longer follow-up and further study.
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Affiliation(s)
- Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, 195 Church Street, Fifth Floor, New Haven, CT, 06510, USA
| | - Sharon Saydah
- Coronaviruses and Other Respiratory Viruses Division, Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Blythe Adamson
- COVID-19 Sports and Society Working Group, Minneapolis, MN, USA
- Infectious Economics, LLC, New York, NY, USA
- The Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Andrew Lincoln
- COVID-19 Sports and Society Working Group, Minneapolis, MN, USA
- Special Olympics, Washington D.C., USA
| | - Douglas F Aukerman
- COVID-19 Sports and Society Working Group, Minneapolis, MN, USA
- Samaritan Athletic Medicine at Oregon State University, Samaritan Health Services, Corvallis, OR, USA
| | - Ethan M Berke
- COVID-19 Sports and Society Working Group, Minneapolis, MN, USA
- UnitedHealth Group, Minnetonka, MN, USA
| | - Robby Sikka
- COVID-19 Sports and Society Working Group, Minneapolis, MN, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, 195 Church Street, Fifth Floor, New Haven, CT, 06510, USA.
- COVID-19 Sports and Society Working Group, Minneapolis, MN, USA.
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
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Lu Y, Liu Y, Dhingra LS, Caraballo C, Mahajan S, Massey D, Spatz ES, Sharma R, Rodriguez F, Watson KE, Masoudi FA, Krumholz HM. National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020. JAMA Netw Open 2023; 6:e2345964. [PMID: 38039001 PMCID: PMC10692850 DOI: 10.1001/jamanetworkopen.2023.45964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
Importance Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention. Objective To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD. Design, Setting, and Participants This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023. Exposure Self-reported race and ethnicity. Main Outcome and Measures Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications. Results The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively. Conclusions and Relevance In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Richa Sharma
- Department of Neurology, Yale School of Public Health, New Haven, Connecticut
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, School of Medicine, Stanford University, Stanford, California
| | - Karol E Watson
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Caraballo C, Herrin J, Mahajan S, Massey D, Lu Y, Ndumele CD, Drye EE, Krumholz HM. Temporal Trends in Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999-2018. Am J Med 2022; 135:1083-1092.e14. [PMID: 35472394 DOI: 10.1016/j.amjmed.2022.04.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Disparities in multimorbidity prevalence indicate health inequalities, as the risk of morbidity does not intrinsically differ by race/ethnicity. This study aimed to determine if multimorbidity differences by race/ethnicity are decreasing over time. METHODS Serial cross-sectional analysis of the National Health Interview Survey, 1999-2018. Included individuals were ≥18 years old and categorized by self-reported race, ethnicity, age, and income. The main outcomes were temporal trends in multimorbidity prevalence based on the self-reported presence of ≥2 of 9 common chronic conditions. FINDINGS The study sample included 596,355 individuals (4.7% Asian, 11.8% Black, 13.8% Latino/Hispanic, and 69.7% White). In 1999, the estimated prevalence of multimorbidity was 5.9% among Asian, 17.4% among Black, 10.7% among Latino/Hispanic, and 13.5% among White individuals. Prevalence increased for all racial/ethnic groups during the study period (P ≤ .001 for each), with no significant change in the differences between them. In 2018, compared with White individuals, multimorbidity was more prevalent among Black individuals (+2.5 percentage points) and less prevalent among Asian and Latino/Hispanic individuals (-6.6 and -2.1 percentage points, respectively). Among those aged ≥30 years, Black individuals had multimorbidity prevalence equivalent to that of Latino/Hispanic and White individuals aged 5 years older, and Asian individuals aged 10 years older. CONCLUSIONS From 1999 to 2018, a period of increasing multimorbidity prevalence for all the groups studied, there was no significant progress in eliminating disparities between Black individuals and White individuals. Public health interventions that prevent the onset of chronic conditions in early life may be needed to eliminate these disparities.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn; Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine
| | - Chima D Ndumele
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn
| | - Elizabeth E Drye
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn; Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn.
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Wilson D, Aggar C, Massey D, Walker F. The use of mobile technology to support work integrated learning in undergraduate nursing programs: An integrative review. Nurse Educ Today 2022; 116:105451. [PMID: 35777295 DOI: 10.1016/j.nedt.2022.105451] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/18/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Investigate the use of mobile technology to support Work Integrated Learning in undergraduate nursing programs. DESIGN Integrative review with narrative synthesis. DATA SOURCES Electronic databases searched in February 2021 included CINAHL, ERIC, MEDLINE and APA PsychInfo. REVIEW METHODS The methodological framework described by Whittemore and Knafl (2005) guided this integrative review. A total of five (5) studies published between 2017 and 2020 were analysed and synthesised. RESULTS Data was categorised into two themes: 1) Accessibility of Learning Resources, and 2) Effective and Timely Communication. Convenient and easy access to Learning Resources at the point of care improved students' confidence and competence to perform clinical skills, thereby reducing student's anxiety and increasing satisfaction rates. The accessibility to educational and skills-based resources also promoted patient safety at the point of care. Effective and Timely Communication improved engagement and collaboration between students, clinical facilitators and academics, enabling a more supportive environment that improved student autonomy and motivation for self-directed learning. The Effective and Timely Communication of student progression and assessment strategies was found to improve student engagement and motivation to be independent learners. CONCLUSION This review contributes important knowledge because internationally there is a need to increase knowledge and understanding of how to best support Work Integrated Learning experiences of student nurses. Mobile technology has been recognised as an innovative tool in education, further research investigating its use to support Work Integrated Learning in undergraduate nursing programs is required.
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Affiliation(s)
- D Wilson
- Southern Cross University, School of Health and Human Sciences, Gold Coast Campus, Southern Cross Drive, Australia.
| | - C Aggar
- Southern Cross University, School of Health and Human Sciences, Gold Coast Campus, Southern Cross Drive, Australia.
| | - D Massey
- Southern Cross University, School of Health and Human Sciences, Gold Coast Campus, Southern Cross Drive, Australia.
| | - F Walker
- Southern Cross University, School of Health and Human Sciences, Gold Coast Campus, Southern Cross Drive, Australia.
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Caraballo C, Mahajan S, Valero-Elizondo J, Massey D, Lu Y, Roy B, Riley C, Annapureddy AR, Murugiah K, Elumn J, Nasir K, Nunez-Smith M, Forman HP, Jackson CL, Herrin J, Krumholz HM. Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018. JAMA Netw Open 2022; 5:e226385. [PMID: 35389500 PMCID: PMC8990329 DOI: 10.1001/jamanetworkopen.2022.6385] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years. OBJECTIVE To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022. EXPOSURES Self-reported race, ethnicity, household income, and sex. MAIN OUTCOMES AND MEASURES Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age. RESULTS The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Amarnath R. Annapureddy
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Johanna Elumn
- SEICHE Center for Health and Justice, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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8
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Lu Y, Liu Y, Dhingra LS, Massey D, Caraballo C, Mahajan S, Spatz ES, Onuma O, Herrin J, Krumholz HM. National Trends in Racial and Ethnic Disparities in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension, 2011-2018. Hypertension 2021; 79:207-217. [PMID: 34775785 DOI: 10.1161/hypertensionaha.121.18381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor hypertension awareness and underuse of guideline-recommended medications are critical factors contributing to poor hypertension control. Using data from 8095 hypertensive people aged ≥18 years from the National Health and Nutrition Examination Survey (2011-2018), we examined recent trends in racial and ethnic differences in awareness and antihypertensive medication use, and their association with racial and ethnic differences in hypertension control. Between 2011 and 2018, age-adjusted hypertension awareness declined for Black, Hispanic, and White individuals, but the 3 outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals had a similar awareness (odds ratio, 1.20 [0.96-1.45]) and overall treatment rates (1.04 [0.84-1.25]), and received more intensive antihypertensive medication if treated (1.41 [1.27-1.56]), but had a lower control rate (0.72 [0.61-0.83]). Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52-0.85] and 0.74 [0.59-0.89]), overall treatment rates (0.72 [0.57-0.88] and 0.69 [0.55-0.82]), received less intensive medication if treated (0.60 [0.50-0.72] and 0.86 [0.75-0.96]), and had lower control rates (0.66 [0.54-0.79] and 0.69 [0.57-0.81]). The racial and ethnic differences in awareness, treatment, and control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were significantly associated with lower control in Asian and Hispanic individuals (P<0.01 for all) but not in Black individuals. These findings highlight the need for interventions to improve awareness and treatment among Asian and Hispanic individuals, and more investigation into the downstream factors that may contribute to the poor hypertension control among Black individuals.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.).,Department of Epidemiology (Chronic Disease), Yale School of Public Health, New Haven CT (E.S.S)
| | - Oyere Onuma
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Jeph Herrin
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.)
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (Y. Lu, Y. Liu, L.S.D., D.M., C.C., S.M., E.S.S., O.O., J.H., H.M.K.).,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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9
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Ding Q, Massey D, Huang C, Grady CB, Lu Y, Cohen A, Matzner P, Mahajan S, Caraballo C, Kumar N, Xue Y, Dreyer R, Roy B, Krumholz HM. Tracking Self-reported Symptoms and Medical Conditions on Social Media During the COVID-19 Pandemic: Infodemiological Study. JMIR Public Health Surveill 2021; 7:e29413. [PMID: 34517338 PMCID: PMC8480398 DOI: 10.2196/29413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/06/2021] [Accepted: 08/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Harnessing health-related data posted on social media in real time can offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. OBJECTIVE This study aimed to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the COVID-19 pandemic, to determine how discussion of these symptoms and medical conditions changed over time, and to identify correlations between frequency of the top 5 commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new deaths, new active cases, and new recovered cases) in the United States. METHODS We used natural language processing (NLP) algorithms to identify symptom- and medical condition-related topics being discussed on social media between June 14 and December 13, 2020. The sample posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of posts. We also assessed the frequency of health-related discussions on social media over time during the study period, and used Pearson correlation coefficients to identify statistically significant correlations between the frequency of the 5 most commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics. RESULTS Within a total of 9,807,813 posts (nearly 70% were sourced from the United States), we identified a discussion of 120 symptom-related topics and 1542 medical condition-related topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts in the frequency of anxiety, generalized pain, and weight loss were significant but negatively correlated with daily new COVID-19 cases in the United States (r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue positively and significantly correlated with daily changes in both new deaths and new active cases in the United States (r ranged=0.39-0.48; P<.05). CONCLUSIONS COVID-19 and symptoms of anxiety were the 2 most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population's mental health status and enhance public health surveillance for infectious disease.
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Affiliation(s)
- Qinglan Ding
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
| | - Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
| | - Connor B Grady
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | | | | | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Navin Kumar
- Department of Sociology, Yale University, New Haven, CT, United States
- Institute for Network Science, Yale University, New Haven, CT, United States
| | - Yuchen Xue
- Foundation for a Smoke-Free World, New York, NY, United States
| | - Rachel Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Brita Roy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
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10
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Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021; 326:637-648. [PMID: 34402830 PMCID: PMC8371573 DOI: 10.1001/jama.2021.9907] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [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] [Received: 10/29/2020] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. EXPOSURES Self-reported race, ethnicity, and income level. MAIN OUTCOMES AND MEASURES Rates and racial and ethnic differences in self-reported health status and health care access and affordability. RESULTS The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. CONCLUSIONS AND RELEVANCE In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oyere Onuma
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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11
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Massey D, Huang C, Lu Y, Cohen A, Oren Y, Moed T, Matzner P, Mahajan S, Caraballo C, Kumar N, Xue Y, Ding Q, Dreyer R, Roy B, Krumholz H. Engagement With COVID-19 Public Health Measures in the United States: A Cross-sectional Social Media Analysis from June to November 2020. J Med Internet Res 2021; 23:e26655. [PMID: 34086593 PMCID: PMC8218897 DOI: 10.2196/26655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/05/2021] [Accepted: 04/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background COVID-19 has continued to spread in the United States and globally. Closely monitoring public engagement and perceptions of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. Objective The aim of this study is to measure the public’s behaviors and perceptions regarding COVID-19 and its effects on daily life during 5 months of the pandemic. Methods Natural language processing (NLP) algorithms were used to identify COVID-19–related and unrelated topics in over 300 million online data sources from June 15 to November 15, 2020. Posts in the sample were geotagged by NetBase, a third-party data provider, and sensitivity and positive predictive value were both calculated to validate the classification of posts. Each post may have included discussion of multiple topics. The prevalence of discussion regarding these topics was measured over this time period and compared to daily case rates in the United States. Results The final sample size included 9,065,733 posts, 70% of which were sourced from the United States. In October and November, discussion including mentions of COVID-19 and related health behaviors did not increase as it had from June to September, despite an increase in COVID-19 daily cases in the United States beginning in October. Additionally, discussion was more focused on daily life topics (n=6,210,255, 69%), compared with COVID-19 in general (n=3,390,139, 37%) and COVID-19 public health measures (n=1,836,200, 20%). Conclusions There was a decline in COVID-19–related social media discussion sourced mainly from the United States, even as COVID-19 cases in the United States increased to the highest rate since the beginning of the pandemic. Targeted public health messaging may be needed to ensure engagement in public health prevention measures as global vaccination efforts continue.
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Affiliation(s)
- Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
| | - Chenxi Huang
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Alina Cohen
- Signals Analytics, New York, NY, United States
| | - Yahel Oren
- Signals Analytics, New York, NY, United States
| | - Tali Moed
- Signals Analytics, New York, NY, United States
| | | | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Navin Kumar
- Department of Sociology, Yale University, New Haven, CT, United States
| | - Yuchen Xue
- Foundation for a Smoke-Free World, New York, NY, United States
| | - Qinglan Ding
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Rachel Dreyer
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Brita Roy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States.,Department of Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Harlan Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, United States.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
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12
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Geia L, Baird K, Bail K, Barclay L, Bennett J, Best O, Birks M, Blackley L, Blackman R, Bonner A, Bryant AO R, Buzzacott C, Campbell S, Catling C, Chamberlain C, Cox L, Cross W, Cruickshank M, Cummins A, Dahlen H, Daly J, Darbyshire P, Davidson P, Denney-Wilson E, De Souza R, Doyle K, Drummond A, Duff J, Duffield C, Dunning T, East L, Elliott D, Elmir R, Fergie OAM D, Ferguson C, Fernandez R, Flower AM D, Foureur M, Fowler C, Fry M, Gorman E, Grant J, Gray J, Halcomb E, Hart B, Hartz D, Hazelton M, Heaton L, Hickman L, Homer AO CSE, Hungerford C, Hutton A, Jackson AO D, Johnson A, Kelly MA, Kitson A, Knight S, Levett-Jones T, Lindsay D, Lovett R, Luck L, Molloy L, Manias E, Mannix J, Marriott AMR, Martin M, Massey D, McCloughen A, McGough S, McGrath L, Mills J, Mitchell BG, Mohamed J, Montayre J, Moroney T, Moyle W, Moxham L, Northam OAM H, Nowlan S, O'Brien AP, Ogunsiji O, Paterson C, Pennington K, Peters K, Phillips J, Power T, Procter N, Ramjan L, Ramsay N, Rasmussen B, Rihari-Thomas J, Rind B, Robinson M, Roche M, Sainsbury K, Salamonson Y, Sherwood J, Shields L, Sim J, Skinner I, Smallwood G, Smallwood R, Stewart L, Taylor S, Usher AM K, Virdun C, Wannell J, Ward R, West C, West R, Wilkes L, Williams R, Wilson R, Wynaden D, Wynne R. A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter. Contemp Nurse 2020; 56:297-308. [DOI: 10.1080/10376178.2020.1809107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- L. Geia
- James Cook University, Townsville, QLD, Australia
| | - K. Baird
- University of Technology Sydney, Sydney, NSW, Australia
| | - K. Bail
- University of Canberra, Canberra, ACT, Australia
| | - L. Barclay
- University of Sydney, Sydney, NSW, Australia
| | - J. Bennett
- University of Newcastle, Callaghan, NSW, Australia
| | - O. Best
- University of Southern Queensland, Darling Heights, QLD, Australia
| | - M. Birks
- James Cook University, Townsville, QLD, Australia
| | - L. Blackley
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | - R. Blackman
- Gidgee Healing Mt Isa, Mount Isa, QLD, Australia
| | - A. Bonner
- Griffith University, Brisbane, QLD, Australia
| | - R. Bryant AO
- Rosemary Bryant Foundation, South Australia, Australia
| | - C. Buzzacott
- Rhodanthe Lipsett Indigenous Midwifery Charitable Fund, Caringbah, NSW, Australia
| | - S. Campbell
- Charles Darwin University, Darwin, NT, Australia
| | - C. Catling
- University of Technology Sydney, Sydney, NSW, Australia
| | | | - L. Cox
- Queensland University of Technology, Brisbane, QLD, Australia
| | - W. Cross
- Federation University, Ballarat, VIC, Australia
| | - M. Cruickshank
- University of Technology Sydney, Sydney, NSW, Australia
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - A. Cummins
- University of Technology Sydney, Sydney, NSW, Australia
| | - H. Dahlen
- Western Sydney University, Sydney, NSW, Australia
| | - J. Daly
- University of Sydney, Sydney, NSW, Australia
| | - P. Darbyshire
- Philip Darbyshire Consulting, Highbury, South Australia, Australia
| | - P. Davidson
- University of Technology Sydney, Sydney, NSW, Australia
- Western Sydney University, Sydney, NSW, Australia
- John Hopkins University, Baltimore, USA
| | | | | | - K. Doyle
- Western Sydney University, Sydney, NSW, Australia
| | - A. Drummond
- Queensland University of Technology, Brisbane, QLD, Australia
| | - J. Duff
- Queensland University of Technology, Brisbane, QLD, Australia
| | - C. Duffield
- University of Technology Sydney, Sydney, NSW, Australia
- Edith Cowan University, Perth, Western Australia, Australia
| | - T. Dunning
- Deakin University, Melbourne, VIC, Australia
| | - L. East
- University of New England, Armidale, NSW, Australia
| | - D. Elliott
- University of Technology Sydney, Sydney, NSW, Australia
| | - R. Elmir
- Western Sydney University, Sydney, NSW, Australia
| | - D. Fergie OAM
- Australian Catholic University, Fitzroy, VIC, Australia
| | - C. Ferguson
- Western Sydney University, Sydney, NSW, Australia
| | - R. Fernandez
- University of Wollongong, Keiraville, NSW, Australia
| | | | - M. Foureur
- University of Newcastle, Callaghan, NSW, Australia
| | - C. Fowler
- University of Technology Sydney, Sydney, NSW, Australia
| | - M. Fry
- University of Technology Sydney, Sydney, NSW, Australia
| | - E. Gorman
- New South Wales Health, Sydney, NSW, Australia
| | - J. Grant
- Charles Sturt University, Dubbo, NSW, Australia
| | - J. Gray
- University of Technology Sydney, Sydney, NSW, Australia
| | - E. Halcomb
- University of Wollongong, Keiraville, NSW, Australia
| | - B. Hart
- University of Notre Dame, Darlinghurst, NSW, Australia
| | - D. Hartz
- Charles Darwin University, Darwin, NT, Australia
| | - M. Hazelton
- University of Newcastle, Callaghan, NSW, Australia
| | - L. Heaton
- Western Sydney University, Sydney, NSW, Australia
| | - L. Hickman
- University of Technology Sydney, Sydney, NSW, Australia
- Contemporary Nurse Journal
| | | | | | - A. Hutton
- University of Newcastle, Callaghan, NSW, Australia
| | - D. Jackson AO
- University of Technology Sydney, Sydney, NSW, Australia
| | - A. Johnson
- University of Newcastle, Callaghan, NSW, Australia
| | - M. A. Kelly
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - A. Kitson
- Western Sydney University, Sydney, NSW, Australia
| | - S. Knight
- James Cook University, Townsville, QLD, Australia
| | | | - D. Lindsay
- James Cook University, Townsville, QLD, Australia
| | - R. Lovett
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - L. Luck
- Western Sydney University, Sydney, NSW, Australia
| | - L. Molloy
- University of Wollongong, Keiraville, NSW, Australia
| | - E. Manias
- Deakin University, Melbourne, VIC, Australia
| | - J. Mannix
- Western Sydney University, Sydney, NSW, Australia
| | | | - M. Martin
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - D. Massey
- Southern Cross University, Gold Coast Campus, QLD, Australia
| | | | - S. McGough
- Curtin University, Perth, Western Australia, Australia
| | - L. McGrath
- Aboriginal Medical Service Redfern, Sydney, NSW, Australia
| | - J. Mills
- La Trobe University, Melbourne, VIC, Australia
| | | | - J. Mohamed
- Lowitja Institute, Melbourne, VIC, Australia
| | - J. Montayre
- Western Sydney University, Sydney, NSW, Australia
| | - T. Moroney
- University of Wollongong, Keiraville, NSW, Australia
| | - W. Moyle
- Griffith University, Brisbane, QLD, Australia
| | - L. Moxham
- University of Wollongong, Keiraville, NSW, Australia
| | | | - S. Nowlan
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | | | - O. Ogunsiji
- Western Sydney University, Sydney, NSW, Australia
| | - C. Paterson
- University of Canberra, Canberra, ACT, Australia
| | - K. Pennington
- Flinders University, Adelaide, South Australia, Australia
| | - K. Peters
- Western Sydney University, Sydney, NSW, Australia
| | - J. Phillips
- University of Technology Sydney, Sydney, NSW, Australia
| | - T. Power
- University of Technology Sydney, Sydney, NSW, Australia
| | - N. Procter
- University of South Australia, Adelaide, South Australia, Australia
| | - L. Ramjan
- Western Sydney University, Sydney, NSW, Australia
| | - N. Ramsay
- Queensland Health, Joyce Palmer Health Service, Palm Island, QLD, Australia
| | | | | | - B. Rind
- Aboriginal Health Unit Mt Druitt Hospital, Sydney, NSW, Australia
| | - M. Robinson
- Murdoch University, Perth, Western Australia, Australia
| | - M. Roche
- University of Technology Sydney, Sydney, NSW, Australia
| | - K. Sainsbury
- University of Canberra, Canberra, ACT, Australia
| | | | - J. Sherwood
- Charles Sturt University, Dubbo, NSW, Australia
| | - L. Shields
- University of Queensland, Brisbane, QLD, Australia
| | - J. Sim
- University of Wollongong, Keiraville, NSW, Australia
| | - I. Skinner
- James Cook University, Townsville, QLD, Australia
| | - G. Smallwood
- James Cook University, Townsville, QLD, Australia
| | - R. Smallwood
- University of Newcastle, Callaghan, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - L. Stewart
- James Cook University, Townsville, QLD, Australia
| | - S. Taylor
- Top End Health, Northern Territory, Darwin, NT, Australia
| | - K. Usher AM
- University of Technology Sydney, Sydney, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - C. Virdun
- University of Technology Sydney, Sydney, NSW, Australia
| | - J. Wannell
- Melbourne Poche Centre for Indigenous Health, Melbourne, VIC, Australia
| | - R. Ward
- University of Southern Queensland, Darling Heights, QLD, Australia
| | - C. West
- James Cook University, Townsville, QLD, Australia
| | - R. West
- Griffith University, Brisbane, QLD, Australia
| | - L. Wilkes
- Western Sydney University, Sydney, NSW, Australia
| | - R. Williams
- Charles Darwin University, Darwin, NT, Australia
| | - R. Wilson
- University of Newcastle, Callaghan, NSW, Australia
- University of New England, Armidale, NSW, Australia
| | - D. Wynaden
- Curtin University, Perth, Western Australia, Australia
| | - R. Wynne
- Western Sydney University, Sydney, NSW, Australia
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Schmid P, Rugo H, Cortés J, Blum P, Crossley K, Massey D, Burris H. 181TiP Xentuzumab (Xe) in combination with everolimus (Ev) and exemestane (Ex) in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC) and non-visceral involvement (XENERA™-1). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Massey D, Ion R, Jackson D. I want it all and I want it now. Challenging the traditional nursing academic paradigm. Nurse Educ Today 2019; 80:12-14. [PMID: 31202055 DOI: 10.1016/j.nedt.2019.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
- D Massey
- Southern Cross University, School of Health and Human Sciences, Gold Coast Campus Office B.7.21, Southern Cross Drive, Australia; School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, 4558, QLD, Australia.
| | - R Ion
- Division of Mental Health Nursing and Counselling, Abertay University, United Kingdom of Great Britain and Northern Ireland
| | - D Jackson
- Faculty of Health, University of Technology, Sydney (UTS), Australia
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Harley A, Johnston ANB, Denny KJ, Keijzers G, Crilly J, Massey D. Emergency nurses' knowledge and understanding of their role in recognising and responding to patients with sepsis: A qualitative study. Int Emerg Nurs 2019; 43:106-112. [PMID: 30733005 DOI: 10.1016/j.ienj.2019.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/23/2018] [Accepted: 01/09/2019] [Indexed: 01/22/2023]
Abstract
AIM Sepsis is a significant and time-sensitive clinical concern for patients who present to Emergency Departments (EDs). Existing guidelines do not define nurses' roles in managing sepsis. This study explored ED nurses' experiences and perceptions around recognising and responding to patients with sepsis, and their awareness of sepsis screening and prognostic tools. The knowledge and insights gained from this study may be used to inform local and international ED policies, and enrich nursing educational packages that may be used to improve quality of patient care and patient outcomes. METHODS Qualitative design incorporating semi-structured interviews with 14 ED nurses was undertaken. Thematic and consensus-based content analyses were used to explore transcripts. FINDINGS Six key themes were identified; (1) contribution of the organisation, (2) appreciation of knowledge, (3) appreciation of clinical urgency, (4) appreciation of importance of staff supervision, (5) awareness of the importance of staff experience, and (6) awareness of the need to seek advice. CONCLUSION ED nurses' identified deficits in their capacity to recognise and respond to patients with sepsis, despite their vital role within the multidisciplinary team that cares for patients with sepsis. The knowledge and insights gained from this study can be used to inform ED policies, to enrich context-specific educational packages that aim to improve quality of patient care and outcomes and identify areas for further research. Development and implementation of a nurse-inclusive sepsis pathway may address many deficits identified in this study.
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Affiliation(s)
- A Harley
- Department of Emergency Medicine, Gold Coast Health, Southport 4215, QLD, Australia; Statewide Paediatric Sepsis Clinical Nurse Consultant: Critical Care Management Team, Queensland Children's Hospital, Brisbane 4101, QLD, Australia.
| | - A N B Johnston
- Department of Emergency Medicine, Gold Coast Health, Southport 4215, QLD, Australia; Department of Emergency Medicine, Princess Alexandra Hospital Metro South Health, Brisbane 4102, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Woolloongabba 4102, QLD, Australia
| | - K J Denny
- Department of Emergency Medicine, Gold Coast Health, Southport 4215, QLD, Australia; Burns, Trauma and Critical Care Research Centre, University of Queensland, Herston 4029, QLD, Australia
| | - G Keijzers
- Department of Emergency Medicine, Gold Coast Health, Southport 4215, QLD, Australia; School of Medicine, Bond University, Robina 4226, QLD, Australia; School of Medicine, Griffith University, Southport 4222, QLD, Australia
| | - J Crilly
- Department of Emergency Medicine, Gold Coast Health, Southport 4215, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Southport 4222, QLD, Australia
| | - D Massey
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs 4558, QLD, Australia
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Proctor JE, Massey D. Electric discharge machine for preparation of diamond anvil cell sample chambers. Rev Sci Instrum 2018; 89:105109. [PMID: 30399960 DOI: 10.1063/1.5050500] [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] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
We have designed and constructed a novel electric discharge machine designed primarily for the preparation of sample chambers in rhenium and stainless steel gaskets for diamond anvil cell experiments. Our design combines automatic stage movement with relatively low voltage (100 V) operation and routinely achieves a drilling/erosion speed of approximately 0.4 μm s-1. The machine is used for preparing 100 μm diameter sample chambers for diamond anvil cell experiments with 250 μm culets and has also been used to prepare 50 μm diameter sample chambers for diamond anvil cell experiments with 100 μm culets to access a pressure of 165 GPa.
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Affiliation(s)
- J E Proctor
- Materials and Physics Research Group, School of Computing, Science and Engineering, University of Salford, Manchester M5 4WT, United Kingdom
| | - D Massey
- Materials and Physics Research Group, School of Computing, Science and Engineering, University of Salford, Manchester M5 4WT, United Kingdom
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Leggett G, Butler A, Massey D, Middleton S, Russell N, Woodward J, Green J, Bond D, Duncan S, Woolner L, Sharkey L. A summary of 10 years of transplant activity and outcomes from a UK centre for intestinal and multivisceral transplantation. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Hirsh V, Tan E, Wu Y, Sequist L, Zhou C, Schuler M, Geater S, Mok T, Hu C, Yamamoto N, Feng J, O’Byrne K, Lu S, Huang Y, Sebastian M, Okamoto I, Dickgreber N, Shah R, Palmer M, Märten A, Massey D, Samuelsen C, Yang J. P3.01-075 Afatinib Dose Adjustment: Effect on Safety, Efficacy and Patient-Reported Outcomes in the LUX-Lung 3/6 Trials in EGFRm+ NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Massey D, Byrne J, Higgins N, Weeks B, Shuker MA, Coyne E, Mitchell M, Johnston ANB. Enhancing OSCE preparedness with video exemplars in undergraduate nursing students. A mixed method study. Nurse Educ Today 2017; 54:56-61. [PMID: 28477564 DOI: 10.1016/j.nedt.2017.02.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/02/2016] [Revised: 02/10/2017] [Accepted: 02/15/2017] [Indexed: 05/29/2023]
Abstract
BACKGROUND Objective structured clinical examinations (OSCEs) are designed to assess clinical skill performance and competency of students in preparation for 'real world' clinical responsibilities. OSCEs are commonly used in health professional education and are typically associated with high levels of student anxiety, which may present a significant barrier to performance. Students, including nursing students, have identified that flexible access to exemplar OSCEs might reduce their anxiety and enable them to better prepare for such examinations. AIM To implement and evaluate an innovative approach to preparing students for OSCEs in an undergraduate (registration) acute care nursing course. METHOD A set of digitized OSCE exemplars were prepared and embedded in the University-based course website as part of usual course learning activities. Use of the exemplars was monitored, pre and post OSCE surveys were conducted, and qualitative data were collected to evaluate the approach. OSCE grades were also examined. FINDINGS The online OSCE exemplars increased self-rated student confidence, knowledge, and capacity to prepare and provided clarity around assessment expectations. OSCE exemplars were accessed frequently and positively received; but did not impact on performance. CONCLUSION Video exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear example of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.
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Affiliation(s)
- D Massey
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; University Sunshine Coast, 90, Sippy Downs Drive, Sippy Downs, QLD 4556, Australia.
| | - J Byrne
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; School of Nursing and Midwifery, Griffith University, Brisbane 4111, Australia.
| | - N Higgins
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; Queensland University of Technology, Kelvin Grove, QLD 4059, Australia.
| | - B Weeks
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia.
| | - M-A Shuker
- Health Executive, Griffith University, QLD 4222, Australia.
| | - E Coyne
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; School of Nursing and Midwifery, Griffith University, Brisbane 4111, Australia.
| | - M Mitchell
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; Princess Alexandra Hospital, Ipswich Rd, Brisbane, Australia; School of Nursing and Midwifery, Griffith University, Brisbane 4111, Australia.
| | - A N B Johnston
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia; Department of Emergency Medicine, Gold Coast University Hospital, D Block, LG096 1 Hospital Blvd, Southport, QLD 4215, Australia; School of Nursing and Midwifery, Griffith University, Brisbane 4111, Australia.
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Ambrose T, Sharkey LM, Louis-Auguste J, Rutter CS, Duncan S, English S, Gkrania-Klotsas E, Carmichael A, Woodward JM, Russell N, Massey D, Butler A, Middleton S. Cytomegalovirus Infection and Rates of Antiviral Resistance Following Intestinal and Multivisceral Transplantation. Transplant Proc 2017; 48:492-6. [PMID: 27109985 DOI: 10.1016/j.transproceed.2015.09.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease is a common and clinically significant complication following intestinal or multivisceral transplantation. CMV disease is more common in cases of serologic mismatch between donor and recipient. Though in some cases it may be asymptomatic, in the immunosuppressed population it often manifests with evidence of systemic infection or end-organ disease. METHODS We conducted a retrospective review of all patients undergoing intestinal or multivisceral transplantation over 8 years at our institution. RESULTS Forty-eight transplantations were performed, with 40% of the patients (19/48) having ≥1 episode of CMV viremia, which rose to 90% in the "donor-positive, recipient-negative" (DPRN) serologic mismatch group. The median time to 1st episode following transplantation was 22.3 weeks (range, 1-78) and median duration of each episode was 4.9 weeks (range, 1.6-37.4). Six of the 19 viremic patients (31.6%) developed virologic resistance with 4 of these occurring in the DPRN group. Four of the 6 patients with drug-resistant CMV died with CMV viremia. All patients with drug resistance acquired ganciclovir resistance; these patients were more challenging to manage with second-line toxicity-limited treatments, including foscarnet, cidofovir, and leflunomide. CMV immunoglobulin has been used and we briefly discuss the use of CMV-specific adoptive T-lymphocyte transfer in the management of 1 case. CONCLUSIONS Post-transplantation CMV disease continues to be challenging to manage, and there is little consensus on optimal management strategies in this patient group, with a significant requirement for novel therapies; these may be pharmacologic or cell based. Extensive multidisciplinary discussion is important for most cases, but particularly for those patients who acquire virologic resistance.
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Affiliation(s)
- T Ambrose
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L M Sharkey
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J Louis-Auguste
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - C S Rutter
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Duncan
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S English
- Department of Clinical Virology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - E Gkrania-Klotsas
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Carmichael
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - J M Woodward
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - N Russell
- Department of Transplant Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - D Massey
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - A Butler
- Department of Transplant Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Middleton
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, United Kingdom.
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Yang JH, Sequist L, Zhou C, Schuler M, Geater S, Mok T, Hu CP, Yamamoto N, Feng J, O'Byrne K, Lu S, Hirsh V, Huang Y, Sebastian M, Okamoto I, Dickgreber N, Shah R, Märten A, Massey D, Wind S, Wu YL. Effect of dose adjustment on the safety and efficacy of afatinib for EGFR mutation-positive lung adenocarcinoma: post hoc analyses of the randomized LUX-Lung 3 and 6 trials. Ann Oncol 2016; 27:2103-2110. [DOI: 10.1093/annonc/mdw322] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/29/2016] [Indexed: 11/13/2022] Open
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Schuler M, Tan EH, O'Byrne K, Zhang L, Boyer M, Mok T, Hirsh V, Yang JH, Lee K, Lu S, Shi Y, Kim SW, Laskin J, Kim DW, Arvis CD, Kölbeck K, Massey D, Fan J, Paz-Ares L, Park K. Time-to-treatment failure (TTF) with first-line afatinib (A) vs gefitinib (G) in patients (pts) with EGFR mutation-positive (EGFRm+) advanced non-small-cell lung cancer (NSCLC): Randomized phase IIb LUX-lung 7 (LL7) trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dickgreber N, Yang JCH, Ahn MJ, Halmos B, Hirsh V, Hochmair M, Levy B, de Marinis F, Mok T, O'Byrne K, Okamoto I, Schuler M, Sebastian M, Shah R, Tan EH, Yamamoto N, Märten A, Massey D, Wind S, Carbone D. Influence of dose adjustment on afatinib safety and efficacy in patients (pts) with advanced EGFR mutation-positive (EGFRm+) non-small cell lung cancer (NSCLC). Pneumologie 2016. [DOI: 10.1055/s-0036-1572233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wu YL, Sequist L, Geater S, Orlov S, Lee K, Tsai CM, Kato T, Kiura K, Barrios C, Schuler M, Hirsh V, Yamamoto N, O'Byrne K, Mok T, Massey D, Märten A, Yang JH. 446P Afatinib (A) versus chemotherapy (CT) for EGFR mutation-positive NSCLC patients (pts) aged ≥65 years: Subgroup analyses of LUX-Lung 3 (LL3) and LUX-Lung 6 (LL6). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv532.30] [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
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25
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Park K, Tan EH, Zhang L, Hirsh V, O'Byrne K, Boyer M, Yang JH, Mok T, Kim M, Massey D, Zazulina V, Paz-Ares L. LBA2_PR Afatinib (A) vs gefitinib (G) as first-line treatment for patients (pts) with advanced non-small cell lung cancer (NSCLC) harboring activating EGFR mutations: results of the global, randomized, open-label, Phase IIb trial LUX-Lung 7 (LL7). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv586.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Wu Y, Geater S, Mok T, O'Byrne K, Schuler M, Sequist L, Yang J, Massey D, O’Brien D, Zazulina V. Epidermal Growth Factor Receptor (EGFR)-Mediated Adverse Events (AEs) in Patients (pts) With EGFR-Mutation Positive (EGFR M+) Non-Small Cell Lung Cancer (NSCLC) Treated With Afatinib (A). Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.223] [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: 11/28/2022]
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27
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Wu Y, Sequist L, Hu C, Feng J, Lu S, Huang Y, Schuler M, Mok T, Yamamoto N, O'Byrne K, Hirsh V, Geater S, Zhou C, Massey D, Lungershausen J, Yang J. Updated Analysis of Response and Patient-Reported Outcomes (Pro) in Two Large Open-Label, Phase III Studies (Lux-Lung 3 [Ll3] and Lux-Lung 6 [Ll6]) of Afatinib (A) Versus Chemotherapy (Ct) in Patients (Pts) with Advanced Nsclc Harboring Egfr Mutations (Mut). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.30] [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: 11/12/2022] Open
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28
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Yamamoto N, Schuler M, O'Byrne K, Hirsh V, Mok T, Kato T, Yoshioka H, Okamoto I, Yokoyama A, Massey D, Jones H, Zazulina V, Shahidi M, Sequist L, Yang JH. Lux-Lung 3: Afatinib Versus Cisplatin and Pemetrexed in Japanese Patients with Adenocarcinoma of the Lung Harboring an EGFR Mutation. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31932-3] [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: 11/25/2022] Open
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29
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Yang J, Schuler M, Yamamoto N, O'Byrne K, Hirsh V, Mok T, Massey D, Zazulina V, Shahidi M, Sequist L. Activity of Afatinib in Uncommon Epidermal Growth Factor Receptor (EGFR) Mutations in Lux-Lung 3, A Phase III Trial of Afatinib or Cisplatin/Pemetrexed in EGFR Mutation-Positive Lung Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33845-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Finocchiaro G, Santoro A, Grossi F, Bidoli P, Favaretto A, Clementi L, Massey D, Lorence R, Cappuzzo F. 9007 ORAL Phase II Study of Afatinib (BIBW 2992), an Irreversible ErbB Family Blocker, in Patients With EGFR FISH-positive Advanced NSCLC. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bateman E, Tashkin D, Siafakas N, Dahl R, Towse L, Massey D, Pavia D, Zhong N. A one-year trial of tiotropium Respimat® plus usual therapy in COPD patients. Respir Med 2010; 104:1460-72. [DOI: 10.1016/j.rmed.2010.06.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 05/28/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
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Schapira A, Albrecht S, Barone P, Comella C, Hsu H, Massey D, McDermott M, Poewe W, Rascol O, Scrine K, Marek K. P1.203 Immediate vs. delayed-start pramipexole in early Parkinson's disease: the PROUD study. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70325-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Maluf DG, Mas VR, Yanek K, Stone JJ, Weis R, Massey D, Spiess B, Posner MP, Fisher RA. Molecular markers in stored kidneys using perfluorocarbon-based preservation solution: preliminary results. Transplant Proc 2006; 38:1243-6. [PMID: 16797273 DOI: 10.1016/j.transproceed.2006.02.109] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delayed graft function (DGF) is a problem in kidney transplantation and cold ischemia has been identified as a risk factor. Perfluorocarbons (PFC) have an enhanced ability to dissolve and release oxygen. We evaluated histologically and a number of molecular changes induced by ischemia in stored kidneys with University of Wisconsin (UW) and PFC-based preservation solutions (PFC-UW). MATERIALS AND METHODS ACI rats were used as kidney donors. UW (control group) or PFC-UW (study group) preservation solutions were used for kidney perfusion. All kidneys were stored at 4 degrees C for 12, 24, and 36 hours. After this time, intragraft histologic evaluation as well as mRNA HO-1 and iNOS levels were also analyzed. RESULTS In the kidneys stored at 24 hours, mRNA HO-1 levels were elevated in the study group when compared with the control and mRNA iNOS was decreased. CONCLUSION We observed overexpression of HO-1 and underexpression of iNOS in the kidney tissue stored with PFC-UW solution at 24 hours. These preliminary data suggest that increasing oxygen delivery by PFC added to the perfusion solution triggers cytoprotective mechanism in kidney transplantation.
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Affiliation(s)
- D G Maluf
- Division of Transplant, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia 23298-0248, USA.
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Massey D, Du Pasquier E, Lennard C. Solvent Desorption of Charcoal Strips (DFLEX®) in the Analysis of Fire Debris Samples: Replacement of Carbon Disulfide. Canadian Society of Forensic Science Journal 2002. [DOI: 10.1080/00085030.2002.10757547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Andreoni C, Massey D. Continuous arteriovenous rewarming: rapid restoration of normothermia in the emergency department. J Emerg Nurs 2001; 27:533-7. [PMID: 11712006 DOI: 10.1067/men.2001.119960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C Andreoni
- Loyola University Medical Center, Maywood, IL, USA.
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Affiliation(s)
- A J Heller
- Department of Otolaryngology-Head and Neck Surgery, The Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23298, USA
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Massey D. Housing discrimination 101. Popul Today 2000; 28:1, 4. [PMID: 12349762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Smith C, Burley C, Ireson M, Johnson T, Jordan D, Knight S, Mason T, Massey D, Moss J, Williams K. Clinical trials of antibacterial agents: a practical guide to design and analysis. Statisticians in the Pharmaceutical Industry Working Party. J Antimicrob Chemother 1998; 41:467-80. [PMID: 9598778 DOI: 10.1093/jac/41.4.467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/07/2023] Open
Abstract
Guidelines on the conduct of clinical trials of antibacterial agents produced by the US Food and Drug Administration, the British Society for Antimicrobial Chemotherapy, the Infectious Diseases Society of America and a European Working Party have been reviewed. Although very informative, these guidelines provide limited practical guidance on the design and statistical aspects of phase III studies of antimicrobial agents. This paper describes the differences between antibacterial trials and clinical studies in other therapeutic areas with regard to subjective endpoints, dual clinical and bacteriological endpoints, frequent protocol violations and difficulty of using placebo controls. The importance of a detailed protocol and planned analysis strategy is emphasized. The choice of comparator agents, practical issues with the blinding of trial materials and the documentation of patients excluded from study entry are discussed. The use of different patient groups and different endpoints in analyses are described. The principles of equivalence and their application to trials of antibacterial agents are discussed, together with an approach to calculating sample size. A variety of statistical analyses of results are compared for different situations indicating some of the problems that can arise. Different methods of presentation of study data are included with emphasis on regulatory submissions rather than scientific publications. Some graphical presentations are recommended and issues regarding data across different studies are discussed.
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Affiliation(s)
- C Smith
- Zeneca Pharmaceuticals, Macclesfield, Cheshire, UK
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Abstract
Symptomatic patients (n = 101) with Helicobacter pylori infection were enrolled into a double-blind, double-dummy study to assess the efficacy of lansoprazole plus amoxycillin in the treatment of H. pylori infection. Patients were randomized to either lansoprazole 30 mg once daily (days 0-28) together with placebo (matched to amoxycillin) three times a day (days 0-14) followed by either placebo or amoxycillin 500 mg three times daily (days 15-28). Biopsy specimens for culture and histology were collected on days 0 and 56 or upon symptomatic relapse. Blood for serology was collected at days 0, 56 and 168. A [14C]-urea breath test was performed on day 168. Eighty-one (80.2%) patients completed the 56 day assessment. Of patients treated with lansoprazole plus amoxycillin, 35.1% (13/37) were cured of infection as assessed at day 56 (26.5% on an intention-to-treat basis), compared with 4.8% (2/42) of the placebo group (4% on an intention-to-treat basis). Recrudescence/re-infection occurred in one patient upon re-evaluation at day 168. Analysis of prognostic factors indicated that smoking and alcohol intake had little impact on the treatment outcome. Inflammation (both acute and chronic) improved in patients treated with lansoprazole plus amoxycillin. The relatively low efficacy of the treatment may relate to a single daily dose of lansoprazole (30 mg) being prescribed, treatment with amoxycillin being commenced 2 weeks after the initiation of lansoprazole or accurate assessment of treatment efficacy (both antral and body biopsy specimens taken).
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Affiliation(s)
- S L Hazell
- School of Microbiology and Immunology, University of New South Wales, Sydney, Australia
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Abstract
In the current climate of scarce financial resources health care managers have had to question the financial viability of a 36-hour stay in an ICU for patients undergoing cardiac surgery. The management of this group of patients has had to be reexamined. The solution to this problem appears to lie in the utilisation of a designated recovery area for the management of this group of patients. This paper is an audit of the first 100 cardiac patients who recovered in such a designated recovery unit. The audit examines types of operations performed, average length of time patients required artificial ventilation, blood loss in the first 4h, average length of stay in hospital, and postoperative complications. Possible methods of improving the utilisation of a recovery area in the management of postoperative cardiac patients are discussed. The conclusion is that utilisation of a designated recovery area for the immediate postoperative management of cardiac surgical patients is a financially viable alternative to an intensive care environment. More importantly, high quality service and care is maintained without increasing the utilisation of resources.
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Massey D, Traverso V, Maroux S. Lipocortin IV is a basolateral cytoskeleton constituent of rabbit enterocytes. J Biol Chem 1991; 266:3125-30. [PMID: 1825208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A monoclonal antibody, BL7B1, which specifically recognized rabbit lipocortin IV, was produced. The BL7B1 epitope is localized between the methionine residues that occupy positions 148 and 259 in human lipocortin IV. Immunofluorescence and subcellular fractionation studies showed that in the rabbit enterocytes, lipocortin IV is specifically associated with the basolateral membranes. When these membranes are solubilized by Triton X-100 in the presence of 1 mM of Ca2+ the lipocortin IV, like the cytoskeleton, remained insoluble suggesting that it might be associated with this structure in vivo. No lipocortin IV was detected in the brush border using immunofluorescence techniques and less than 10% of the amount present in the purified basolateral membranes was detected in the brush border membrane fraction.
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Affiliation(s)
- D Massey
- Centre de Biochimie et de Biologie Moléculaire, Centre National de la Recherche Scientifique, Marseille, France
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Abstract
The results of immunoblot analysis performed with a specific monoclonal antibody showed that the intestinal mucosa, pancreas and liver are privileged tissues for the expression of annexin IV. Immunofluorescence labelling of thin frozen sections of these tissues showed a strong concentration of annexin IV along the basolateral domain of the plasma membrane of intestinal absorbing cells, hepatocytes and pancreatic acinar cells, whereas in intestinal mucous secreting cells and centro acinar pancreatic cells, annexin IV was found to be present throughout the cytoplasm.
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Affiliation(s)
- D Massey
- Centre de Biochimie et de Biologie Moléculaire du Centre National de la Recherche Scientifique, Marseille, France
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Massey D, Feracci H, Gorvel JP, Rigal A, Soulié JM, Maroux S. Evidence for the transit of aminopeptidase N through the basolateral membrane before it reaches the brush border of enterocytes. J Membr Biol 1987; 96:19-25. [PMID: 2884323 DOI: 10.1007/bf01869331] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In vivo pulse-chase labeling of rabbit jejunum loops was used in conjunction with subcellular fractionation and quantitative immunoprecipitation to determine whether or not the newly synthesized aminopeptidase N transits through the basolateral membrane before it reaches the apical brush border, its final localization. The kinetics of the arrival of the newly synthesized enzyme in the Golgi complex, basolateral and brush border membrane fractions strongly suggest that on leaving the Golgi aminopeptidase N is transiently integrated into the basolateral domain before reaching the brush border.
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Gorvel JP, Massey D, Rigal A, Maroux S. Evidence for selective transport of two brush-border glycoproteins from endoplasmic reticulum to Golgi complex in rabbit enterocytes. Biol Cell 1986; 56:251-4. [PMID: 2874853 DOI: 10.1111/j.1768-322x.1986.tb00456.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In vivo pulse-chase labeling of rabbit jejunum loops was used in conjunction with subcellular fractionation and quantitative immunoprecipitation to compare the intracellular transport kinetics of aminopeptidase with that of a 140 kDa brush-border antigen not belonging to the hydrolase class. As judged by the maturation kinetics of Asn-linked glycans, these glycoproteins were found to be transported from the endoplasmic reticulum into the Golgi apparatus at different rates (t1/2 = 25-50 min). The transport from the Golgi complex to the brush-border was rapid and seemed to occur at the same rate for both glycoproteins. In keeping with these kinetic data, the steady-state levels of aminopeptidase and the 140 kDa antigen in the Golgi complex were low, although that of aminopeptidase was significantly higher.
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Abstract
Endoglycosidase F was used to eliminate the N-linked complex glycans from intestinal aminopeptidase N. The glycans which were probably O-linked remaining after the endoglycosidase F treatment exhibited the human blood group A and H determinants expressed in enzymes from A+ or A- rabbits, respectively. The molecular mass estimation of the two types of glycans by SDS-polyacrylamide gel electrophoresis and the sugar composition of aminopeptidase from A+ and A- rabbits strongly suggested the presence of eight N-linked complex glycans and two O-linked oligosaccharides bearing the human group antigenicity.
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Gorvel JP, Liabeuf A, Massey D, Liot D, Goridis C, Maroux S. Recognition of sodium- and potassium-dependent adenosine triphosphatase in organs of the mouse by means of a monoclonal antibody. Cell Tissue Res 1983; 234:619-32. [PMID: 6319000 DOI: 10.1007/bf00218655] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The antigen detected by the rat anti-mouse monoclonal antibody (m Ab), anti-BSP-3, has been initially described as a brain cell-surface protein. Evidence is presented that this m Ab recognizes mouse (Na+ + K+)-ATPase (ATP phosphohydrolase, E.C.3.6.1.3). The antigen, purified from mouse brain by means of affinity chromatography, migrated in SDS-polyacrylamide gels in the form of two polypeptide chains of 100 000 and 48 000 molecular weight, which could be shown to react with subunit-specific polyclonal antisera against ATPase in immunoblotting experiments. Purified BSP-3 antigen was bound to the specific (Na+ + K+)-ATPase inhibitor ouabain. Finally, the anti-BSP-3 m Ab was capable of immunoprecipitating the ATPase activity of a microsomal fraction from mouse kidney. The m Ab was used to study the localization of (Na+ + K+)-ATPase in different organs of the mouse. It stained the basolateral plasma membranes of polarized cells in immunofluorescence experiments, while the entire cell surface of unpolarized cells was labeled. Interestingly, several cell types did not react with the m Ab, indicating a possible heterogeneity of ATPases. Such a m Ab could prove to be a useful tool for studying localization, structure and function of (Na+ + K+)-ATPase.
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Fournier-Massey G, Massey D. [Ethnic differences in respiratory function tests: a survey of French Canadians]. Union Med Can 1972; 101:1155-8. [PMID: 5036373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Massey D, Lemonde J, Fournier-Massey G. [Immunologic factors in asbestosis]. Union Med Can 1971; 100:1588-91. [PMID: 4934790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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50
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Frank H, Ostiguy G, Massey D. [Discussion on respiratory physiology]. Union Med Can 1968; 97:449-50. [PMID: 5676306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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