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Moore M, Zhu Y, Hirsch I, White T, Reiner RC, Barber RM, Pigott D, Collins JK, Santoni S, Sobieszczyk ME, Janes H. Estimating vaccine efficacy during open-label follow-up of COVID-19 vaccine trials based on population-level surveillance data. Epidemics 2024; 47:100768. [PMID: 38643547 DOI: 10.1016/j.epidem.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/20/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
While rapid development and roll out of COVID-19 vaccines is necessary in a pandemic, the process limits the ability of clinical trials to assess longer-term vaccine efficacy. We leveraged COVID-19 surveillance data in the U.S. to evaluate vaccine efficacy in U.S. Government-funded COVID-19 vaccine efficacy trials with a three-step estimation process. First, we used a compartmental epidemiological model informed by county-level surveillance data, a "population model", to estimate SARS-CoV-2 incidence among the unvaccinated. Second, a "cohort model" was used to adjust the population SARS-CoV-2 incidence to the vaccine trial cohort, taking into account individual participant characteristics and the difference between SARS-CoV-2 infection and COVID-19 disease. Third, we fit a regression model estimating the offset between the cohort-model-based COVID-19 incidence in the unvaccinated with the placebo-group COVID-19 incidence in the trial during blinded follow-up. Counterfactual placebo COVID-19 incidence was estimated during open-label follow-up by adjusting the cohort-model-based incidence rate by the estimated offset. Vaccine efficacy during open-label follow-up was estimated by contrasting the vaccine group COVID-19 incidence with the counterfactual placebo COVID-19 incidence. We documented good performance of the methodology in a simulation study. We also applied the methodology to estimate vaccine efficacy for the two-dose AZD1222 COVID-19 vaccine using data from the phase 3 U.S. trial (ClinicalTrials.gov # NCT04516746). We estimated AZD1222 vaccine efficacy of 59.1% (95% uncertainty interval (UI): 40.4%-74.3%) in April, 2021 (mean 106 days post-second dose), which reduced to 35.7% (95% UI: 15.0%-51.7%) in July, 2021 (mean 198 days post-second-dose). We developed and evaluated a methodology for estimating longer-term vaccine efficacy. This methodology could be applied to estimating counterfactual placebo incidence for future placebo-controlled vaccine efficacy trials of emerging pathogens with early termination of blinded follow-up, to active-controlled or uncontrolled COVID-19 vaccine efficacy trials, and to other clinical endpoints influenced by vaccination.
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Affiliation(s)
- Mia Moore
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.
| | | | - Ian Hirsch
- Biometrics, Vaccines, & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Tom White
- Biometrics, Vaccines, & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation within the Schools of Medicine at the University of Washington, Seattle, WA, USA
| | - Ryan M Barber
- Institute for Health Metrics and Evaluation within the Schools of Medicine at the University of Washington, Seattle, WA, USA
| | - David Pigott
- Institute for Health Metrics and Evaluation within the Schools of Medicine at the University of Washington, Seattle, WA, USA
| | - James K Collins
- Institute for Health Metrics and Evaluation within the Schools of Medicine at the University of Washington, Seattle, WA, USA
| | - Serena Santoni
- Institute for Health Metrics and Evaluation within the Schools of Medicine at the University of Washington, Seattle, WA, USA
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Holly Janes
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
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Fastl C, De Carvalho Ferreira HC, Babo Martins S, Sucena Afonso J, di Bari C, Venkateswaran N, Pires SM, Mughini-Gras L, Huntington B, Rushton J, Pigott D, Devleesschauwer B. Animal sources of antimicrobial-resistant bacterial infections in humans: a systematic review. Epidemiol Infect 2023; 151:e143. [PMID: 37577944 PMCID: PMC10540179 DOI: 10.1017/s0950268823001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023] Open
Abstract
Bacterial antimicrobial resistance (AMR) is among the leading global health challenges of the century. Animals and their products are known contributors to the human AMR burden, but the extent of this contribution is not clear. This systematic literature review aimed to identify studies investigating the direct impact of animal sources, defined as livestock, aquaculture, pets, and animal-based food, on human AMR. We searched four scientific databases and identified 31 relevant publications, including 12 risk assessments, 16 source attribution studies, and three other studies. Most studies were published between 2012 and 2022, and most came from Europe and North America, but we also identified five articles from South and South-East Asia. The studies differed in their methodologies, conceptual approaches (bottom-up, top-down, and complex), definitions of the AMR hazard and outcome, the number and type of sources they addressed, and the outcome measures they reported. The most frequently addressed animal source was chicken, followed by cattle and pigs. Most studies investigated bacteria-resistance combinations. Overall, studies on the direct contribution of animal sources of AMR are rare but increasing. More recent publications tailor their methodologies increasingly towards the AMR hazard as a whole, providing grounds for future research to build on.
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Affiliation(s)
- Christina Fastl
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Sara Babo Martins
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - João Sucena Afonso
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Carlotta di Bari
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Narmada Venkateswaran
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | | | - Lapo Mughini-Gras
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Institute for Risk Assessment Sciences (IRAS), Utrecht, The Netherlands
| | - Ben Huntington
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
- Pengwern Animal Health Ltd, Wallasey, UK
| | - Jonathan Rushton
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - David Pigott
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Brecht Devleesschauwer
- Global Burden of Animal Diseases Programme, University of Liverpool, Liverpool, UK
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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Allorant A, Fullman N, Leslie HH, Sarr M, Gueye D, Eliakimu E, Wakefield J, Dieleman JL, Pigott D, Puttkammer N, Reiner RC. A small area model to assess temporal trends and sub-national disparities in healthcare quality. Nat Commun 2023; 14:4555. [PMID: 37507373 PMCID: PMC10382513 DOI: 10.1038/s41467-023-40234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Monitoring subnational healthcare quality is important for identifying and addressing geographic inequities. Yet, health facility surveys are rarely powered to support the generation of estimates at more local levels. With this study, we propose an analytical approach for estimating both temporal and subnational patterns of healthcare quality indicators from health facility survey data. This method uses random effects to account for differences between survey instruments; space-time processes to leverage correlations in space and time; and covariates to incorporate auxiliary information. We applied this method for three countries in which at least four health facility surveys had been conducted since 1999 - Kenya, Senegal, and Tanzania - and estimated measures of sick-child care quality per WHO Service Availability and Readiness Assessment (SARA) guidelines at programmatic subnational level, between 1999 and 2020. Model performance metrics indicated good out-of-sample predictive validity, illustrating the potential utility of geospatial statistical models for health facility data. This method offers a way to jointly estimate indicators of healthcare quality over space and time, which could then provide insights to decision-makers and health service program managers.
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Affiliation(s)
- Adrien Allorant
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Global Health, University of Washington, Seattle, WA, USA.
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Nancy Fullman
- Department of Global Health, University of Washington, Seattle, WA, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Hannah H Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Moussa Sarr
- Institut de Recherche en Santé de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | - Daouda Gueye
- Institut de Recherche en Santé de Surveillance Epidémiologique et de Formation, Dakar, Senegal
| | - Eliudi Eliakimu
- Health Quality Assurance Unit, Ministry of Health, Dodoma, Tanzania
| | - Jon Wakefield
- Department of Statistics and Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - David Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nancy Puttkammer
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Meisner J, Kato A, Lemerani MM, Miaka EM, Ismail AT, Wakefield J, Rowhani-Rahbar A, Pigott D, Mayer JD, Lorton C, Rabinowitz PM. Does a One Health approach to human African trypanosomiasis control hasten elimination? A stochastic compartmental modeling approach. Acta Trop 2023; 240:106804. [PMID: 36682395 PMCID: PMC9992224 DOI: 10.1016/j.actatropica.2022.106804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND . In response to large strides in the control of human African trypanosomiasis (HAT), in the early 2000s the WHO set targets for elimination of both the gambiense (gHAT) and rhodesiense (rHAT) forms as a public health (EPHP) problem by 2020, and elimination of gHAT transmisson (EOT) by 2030. While global EPHP targets have been met, and EOT appears within reach, current control strategies may fail to achieve gHAT EOT in the presence of animal reservoirs, the role of which is currently uncertain. Furthermore, rHAT is not targeted for EOT due to the known importance of animal reservoirs for this form. METHODS . To evaluate the utility of a One Health approach to gHAT and rHAT EOT, we built and parameterized a compartmental stochastic model, using the Institute for Disease Modeling's Compartmental Modeling Software, to six HAT epidemics: the national rHAT epidemics in Uganda and Malawi, the national gHAT epidemics in Uganda and South Sudan, and two separate gHAT epidemics in Democratic Republic of Congo distinguished by dominant vector species. In rHAT foci the reservoir animal sub-model was stratified on four species groups, while in gHAT foci domestic swine were assumed to be the only competent reservoir. The modeled time horizon was 2005-2045, with calibration performed using HAT surveillance data and Optuna. Interventions included insecticide and trypanocide treatment of domestic animal reservoirs at varying coverage levels. RESULTS . Validation against HAT surveillance data indicates favorable performance overall, with the possible exception of DRC. EOT was not observed in any modeled scenarios for rHAT, however insecticide treatment consistently performed better than trypanocide treatment in terms of rHAT control. EOT was not observed for gHAT at 0% coverage of domestic reservoirs with trypanocides or insecticides, but was observed by 2030 in all test scenarios; again, insecticides demonstrated superior performance to trypanocides. CONCLUSIONS EOT likely cannot be achieved for rHAT without control of wildlife reservoirs, however insecticide treatment of domestic animals holds promise for improved control. In the presence of domestic animal reservoirs, gHAT EOT may not be achieved under current control strategies.
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Affiliation(s)
- Julianne Meisner
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | | | - Marshall M Lemerani
- Trypanosomiasis Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Erick M Miaka
- Trypanosomiasis Control Programme, Malawi Ministry of Health, Lilongwe, Malawi
| | - Acaga T Ismail
- Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, DRC
| | - Jonathan Wakefield
- Department of Statistics, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - David Pigott
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jonathan D Mayer
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Geography, University of Washington, Seattle, WA, USA
| | | | - Peter M Rabinowitz
- Department of Environmental and Occupational Health Sciences, Seattle, WA, USA
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di Bari C, Venkateswaran N, Pigott D, Flastl C, Devleesschauwer B. The global burden of neglected zoonotic diseases: current state of evidence. Eur J Public Health 2022; 32:ckac129.757. [PMCID: PMC9594830 DOI: 10.1093/eurpub/ckac129.757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
The majority of emerging infectious diseases are zoonoses, most of which are classified as “neglected”. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden using mortality and morbidity. This review aims to describe and analyze the current state of evidence on the burden of neglected zoonotic diseases (NZDs) and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting the CDC One Health Zoonotic Disease Prioritization Exercise, the Joint External Evaluation reports, and the WHO roadmap for NTDs. A systematic review of global and national burden of disease (BoD) studies for these priority NZDs was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 72 eligible studies (58 national or sub-national, 12 global, and 2 regional studies). The highest number of BoD studies was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies were found in the Netherlands (11), China (5) and Iran (4). The number of BoD studies retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 73 countries, but only one national estimate was retrieved. By summing the available global estimates, these diseases would cause at least 10 million DALYs in total. The burden of NZDs at the global level remains scattered, and trends were challenging to identify. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated into larger global BoD initiatives. Key messages • There is a mismatched between the estimated retrieved in the search and the perception of the importance of these disease. This amplify the need for a comprehensive program. • No complete list of zoonoses exist, and the definition used is vague. A stricter definition of zoonoses and what defines them will help provide a clear view of dealing with and controlling them.
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Affiliation(s)
- C di Bari
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - N Venkateswaran
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, USA
| | - D Pigott
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, Seattle, USA
| | - C Flastl
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - B Devleesschauwer
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Ghent, Belgium
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di Bari C, Venkateswaran N, Patterson G, Pigott D, Devleesschauwer B. Methodological choices in brucellosis burden of disease assessments: A systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Foodborne and zoonotic diseases such as brucellosis present many challenges to public health and economic welfare. Increasingly, researchers and public health institutes use disability-adjusted life years (DALYs) to generate a comprehensive comparison of the population health impact of these conditions. DALY calculations entail several methodological choices and assumptions, with data gaps and uncertainties to accommodate. The following review identifies existing brucellosis burden studies and analyses their methodological choices and assumptions.
Methods/Findings
A systematic search for brucellosis burden calculations was conducted in pre-selected international and grey literature databases. Using a standardized reporting framework, we evaluated each estimate on a variety of key methodological assumptions necessary to compute a DALY. One study reported estimates at the global level, the rest (13) at national or subnational. Most studies retrieved brucellosis epidemiological data from administrative registries. Incidence data were often estimated based on laboratory-confirmed tests. Not all studies included mortality estimates (YLLs) in their assessments due to the lack of data or the assumption that brucellosis is not a fatal disease. Only two studies used a model with variable health states and corresponding disability weights. The rest used a simplified singular health state approach. Wide variation was seen in the duration chosen for brucellosis, ranging from 2 weeks to 4.5 years, irrespective of whether a chronic state was included.
Conclusions
Available brucellosis burden assessments vary widely in their methodology and assumptions. Further research is needed to characterize better the total clinical course of brucellosis and estimate case-fatality rate. In addition, reporting of methodological choices should be improved to enhance transparency and comparability of estimates. These steps will increase the value of these estimates for policymakers.
Key messages
• Inconsistencies in reporting methods and assumptions are found, which hinder transparency and understanding of the methodological choices and the reuse of estimates for prioritization purposes.
• Thus, there is a need for a more standardized reporting system for DALY estimates, which could resemble a checklist that reports the methodological choices and assumptions.
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Affiliation(s)
- C di Bari
- Department of Epidemiology and Public Health , Sciensano, Brussels, Belgium
- Global Burden of Animal Diseases Human Health, , Liverpool, UK
| | - N Venkateswaran
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation , Seattle, USA
- Global Burden of Animal Diseases Human Health, , Liverpool, UK
| | - G Patterson
- Department of Population Medicine, University of Guelph , Guelph, Canada
- Global Burden of Animal Diseases Human Health, , Liverpool, UK
| | - D Pigott
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation , Seattle, USA
- Global Burden of Animal Diseases Human Health, , Liverpool, UK
| | - B Devleesschauwer
- Department of Epidemiology and Public Health , Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University , Ghent, Belgium
- Global Burden of Animal Diseases Human Health, , Liverpool, UK
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Bacro-Duverger B, Thorburn A, Denney B, Gullett J, Thomspon M, Pigott D. Takotsubo Cardiomyopathy Following Traumatic Hand Amputation: A Case Report. Clin Pract Cases Emerg Med 2022; 6:225-228. [PMID: 36049187 PMCID: PMC9436489 DOI: 10.5811/cpcem.2022.2.55463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Takotsubo or stress cardiomyopathy is a syndrome of transient left ventricular systolic dysfunction seen in the absence of obstructive coronary artery disease. Case Report We describe a case of stress cardiomyopathy diagnosed in the emergency department (ED) using point-of-care ultrasound associated with traumatic hand amputation. The patient suffered a near-complete amputation of the right hand while using a circular saw, subsequently complicated by brief cardiac arrest with rapid return of spontaneous circulation. Point-of-care ultrasonography in the ED revealed the classic findings of takotsubo cardiomyopathy, including apical ballooning of the left ventricle and hyperkinesis of the basal walls with a severely reduced ejection fraction. After formalization of the amputation and cardiovascular evaluation, the patient was discharged from the hospital in stable condition 10 days later. Conclusion Emergency physicians should be aware of the possibility of stress cardiomyopathy as a cause for acute decompensation, even in isolated extremity trauma.
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Affiliation(s)
- Bastien Bacro-Duverger
- The University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Ashley Thorburn
- The University of Alabama at Birmingham, Division of Plastic Surgery, Department of Surgery, Birmingham, Alabama
| | - Brad Denney
- The University of Alabama at Birmingham, Division of Plastic Surgery, Department of Surgery, Birmingham, Alabama
| | - John Gullett
- The University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Mawell Thomspon
- The University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - David Pigott
- The University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
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Cramer EY, Ray EL, Lopez VK, Bracher J, Brennen A, Castro Rivadeneira AJ, Gerding A, Gneiting T, House KH, Huang Y, Jayawardena D, Kanji AH, Khandelwal A, Le K, Mühlemann A, Niemi J, Shah A, Stark A, Wang Y, Wattanachit N, Zorn MW, Gu Y, Jain S, Bannur N, Deva A, Kulkarni M, Merugu S, Raval A, Shingi S, Tiwari A, White J, Abernethy NF, Woody S, Dahan M, Fox S, Gaither K, Lachmann M, Meyers LA, Scott JG, Tec M, Srivastava A, George GE, Cegan JC, Dettwiller ID, England WP, Farthing MW, Hunter RH, Lafferty B, Linkov I, Mayo ML, Parno MD, Rowland MA, Trump BD, Zhang-James Y, Chen S, Faraone SV, Hess J, Morley CP, Salekin A, Wang D, Corsetti SM, Baer TM, Eisenberg MC, Falb K, Huang Y, Martin ET, McCauley E, Myers RL, Schwarz T, Sheldon D, Gibson GC, Yu R, Gao L, Ma Y, Wu D, Yan X, Jin X, Wang YX, Chen Y, Guo L, Zhao Y, Gu Q, Chen J, Wang L, Xu P, Zhang W, Zou D, Biegel H, Lega J, McConnell S, Nagraj VP, Guertin SL, Hulme-Lowe C, Turner SD, Shi Y, Ban X, Walraven R, Hong QJ, Kong S, van de Walle A, Turtle JA, Ben-Nun M, Riley S, Riley P, Koyluoglu U, DesRoches D, Forli P, Hamory B, Kyriakides C, Leis H, Milliken J, Moloney M, Morgan J, Nirgudkar N, Ozcan G, Piwonka N, Ravi M, Schrader C, Shakhnovich E, Siegel D, Spatz R, Stiefeling C, Wilkinson B, Wong A, Cavany S, España G, Moore S, Oidtman R, Perkins A, Kraus D, Kraus A, Gao Z, Bian J, Cao W, Ferres JL, Li C, Liu TY, Xie X, Zhang S, Zheng S, Vespignani A, Chinazzi M, Davis JT, Mu K, Pastore y Piontti A, Xiong X, Zheng A, Baek J, Farias V, Georgescu A, Levi R, Sinha D, Wilde J, Perakis G, Bennouna MA, Nze-Ndong D, Singhvi D, Spantidakis I, Thayaparan L, Tsiourvas A, Sarker A, Jadbabaie A, Shah D, Della Penna N, Celi LA, Sundar S, Wolfinger R, Osthus D, Castro L, Fairchild G, Michaud I, Karlen D, Kinsey M, Mullany LC, Rainwater-Lovett K, Shin L, Tallaksen K, Wilson S, Lee EC, Dent J, Grantz KH, Hill AL, Kaminsky J, Kaminsky K, Keegan LT, Lauer SA, Lemaitre JC, Lessler J, Meredith HR, Perez-Saez J, Shah S, Smith CP, Truelove SA, Wills J, Marshall M, Gardner L, Nixon K, Burant JC, Wang L, Gao L, Gu Z, Kim M, Li X, Wang G, Wang Y, Yu S, Reiner RC, Barber R, Gakidou E, Hay SI, Lim S, Murray C, Pigott D, Gurung HL, Baccam P, Stage SA, Suchoski BT, Prakash BA, Adhikari B, Cui J, Rodríguez A, Tabassum A, Xie J, Keskinocak P, Asplund J, Baxter A, Oruc BE, Serban N, Arik SO, Dusenberry M, Epshteyn A, Kanal E, Le LT, Li CL, Pfister T, Sava D, Sinha R, Tsai T, Yoder N, Yoon J, Zhang L, Abbott S, Bosse NI, Funk S, Hellewell J, Meakin SR, Sherratt K, Zhou M, Kalantari R, Yamana TK, Pei S, Shaman J, Li ML, Bertsimas D, Lami OS, Soni S, Bouardi HT, Ayer T, Adee M, Chhatwal J, Dalgic OO, Ladd MA, Linas BP, Mueller P, Xiao J, Wang Y, Wang Q, Xie S, Zeng D, Green A, Bien J, Brooks L, Hu AJ, Jahja M, McDonald D, Narasimhan B, Politsch C, Rajanala S, Rumack A, Simon N, Tibshirani RJ, Tibshirani R, Ventura V, Wasserman L, O’Dea EB, Drake JM, Pagano R, Tran QT, Ho LST, Huynh H, Walker JW, Slayton RB, Johansson MA, Biggerstaff M, Reich NG. Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States. Proc Natl Acad Sci U S A 2022; 119:e2113561119. [PMID: 35394862 PMCID: PMC9169655 DOI: 10.1073/pnas.2113561119] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/24/2022] [Indexed: 01/15/2023] Open
Abstract
Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.org/) collected, disseminated, and synthesized tens of millions of specific predictions from more than 90 different academic, industry, and independent research groups. A multimodel ensemble forecast that combined predictions from dozens of groups every week provided the most consistently accurate probabilistic forecasts of incident deaths due to COVID-19 at the state and national level from April 2020 through October 2021. The performance of 27 individual models that submitted complete forecasts of COVID-19 deaths consistently throughout this year showed high variability in forecast skill across time, geospatial units, and forecast horizons. Two-thirds of the models evaluated showed better accuracy than a naïve baseline model. Forecast accuracy degraded as models made predictions further into the future, with probabilistic error at a 20-wk horizon three to five times larger than when predicting at a 1-wk horizon. This project underscores the role that collaboration and active coordination between governmental public-health agencies, academic modeling teams, and industry partners can play in developing modern modeling capabilities to support local, state, and federal response to outbreaks.
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Affiliation(s)
- Estee Y. Cramer
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Evan L. Ray
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Velma K. Lopez
- COVID-19 Response, Centers for Disease Control and Prevention; Atlanta, GA 30333
| | - Johannes Bracher
- Chair of Econometrics and Statistics, Karlsruhe Institute of Technology, 76185 Karlsruhe, Germany
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies, 69118 Heidelberg, Germany
| | | | | | - Aaron Gerding
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Tilmann Gneiting
- Computational Statistics Group, Heidelberg Institute for Theoretical Studies, 69118 Heidelberg, Germany
- Institute of Stochastics, Karlsruhe Institute of Technology, 69118 Karlsruhe, Germany
| | - Katie H. House
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Yuxin Huang
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Dasuni Jayawardena
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Abdul H. Kanji
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Ayush Khandelwal
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Khoa Le
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Anja Mühlemann
- Institute of Mathematical Statistics and Actuarial Science, University of Bern, CH-3012 Bern, Switzerland
| | - Jarad Niemi
- Department of Statistics, Iowa State University, Ames, IA 50011
| | - Apurv Shah
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Ariane Stark
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Yijin Wang
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Nutcha Wattanachit
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | - Martha W. Zorn
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
| | | | - Sansiddh Jain
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Nayana Bannur
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Ayush Deva
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Mihir Kulkarni
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Srujana Merugu
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Alpan Raval
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Siddhant Shingi
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Avtansh Tiwari
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | - Jerome White
- Wadhwani Institute of Artificial Intelligence, Andheri East, Mumbai, 400093, India
| | | | - Spencer Woody
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712
| | - Maytal Dahan
- Texas Advanced Computing Center, Austin, TX 78758
| | - Spencer Fox
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712
| | | | | | - Lauren Ancel Meyers
- Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712
| | - James G. Scott
- Department of Information, Risk, and Operations Management, University of Texas at Austin, Austin, TX 78712
| | - Mauricio Tec
- Department of Statistics and Data Sciences, University of Texas at Austin, Austin, TX 78712
| | - Ajitesh Srivastava
- Ming Hsieh Department of Computer and Electrical Engineering, University of Southern California, Los Angeles, CA 90089
| | - Glover E. George
- US Army Engineer Research and Development Center, Vicksburg, MS 39180
| | - Jeffrey C. Cegan
- US Army Engineer Research and Development Center, Concord, MA 01742
| | - Ian D. Dettwiller
- US Army Engineer Research and Development Center, Vicksburg, MS 39180
| | | | | | - Robert H. Hunter
- US Army Engineer Research and Development Center, Vicksburg, MS 39180
| | - Brandon Lafferty
- US Army Engineer Research and Development Center, Vicksburg, MS 39180
| | - Igor Linkov
- US Army Engineer Research and Development Center, Concord, MA 01742
| | - Michael L. Mayo
- US Army Engineer Research and Development Center, Vicksburg, MS 39180
| | - Matthew D. Parno
- US Army Engineer Research and Development Center, Hanover, NH 03755
| | | | | | - Yanli Zhang-James
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - Samuel Chen
- School of Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - Stephen V. Faraone
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - Jonathan Hess
- Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - Christopher P. Morley
- Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210
| | - Asif Salekin
- Department of Electrical Engineering and Computer Science, Syracuse University, Syracuse, NY 13207
| | - Dongliang Wang
- Department of Public Health & Preventive Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210
| | | | - Thomas M. Baer
- Department of Physics, Trinity University, San Antonio, TX 78212
| | - Marisa C. Eisenberg
- Department of Complex Systems, University of Michigan, Ann Arbor, MI 48109
- Department of Mathematics, University of Michigan, Ann Arbor, MI 48109
- School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109
| | - Karl Falb
- Department of Physics, University of Michigan, Ann Arbor, MI, 48109
| | - Yitao Huang
- Department of Physics, University of Michigan, Ann Arbor, MI, 48109
| | - Emily T. Martin
- School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109
| | - Ella McCauley
- Department of Physics, University of Michigan, Ann Arbor, MI, 48109
| | - Robert L. Myers
- Department of Physics, University of Michigan, Ann Arbor, MI, 48109
| | - Tom Schwarz
- Department of Physics, University of Michigan, Ann Arbor, MI, 48109
| | - Daniel Sheldon
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA 01003
| | - Graham Casey Gibson
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003
| | - Rose Yu
- Department of Computer Science and Engineering, University of California, San Diego, CA 92093
- Khoury College of Computer Sciences, Northeastern University, Boston, MA 02115
| | - Liyao Gao
- Department of Statistics, University of Washington, Seattle, WA 98185
| | - Yian Ma
- Halıcıoğlu Data Science Institute, University of California, San Diego, CA 92093
| | - Dongxia Wu
- Department of Computer Science and Engineering, University of California, San Diego, CA 92093
| | - Xifeng Yan
- Department of Computer Science, University of California, Santa Barbara, CA 93106
| | - Xiaoyong Jin
- Department of Computer Science, University of California, Santa Barbara, CA 93106
| | - Yu-Xiang Wang
- Department of Computer Science, University of California, Santa Barbara, CA 93106
| | - YangQuan Chen
- Mechatronics, Embedded Systems and Automation Lab, Department of Mechanical Engineering, University of California, Merced, CA 95301
| | - Lihong Guo
- Jilin University, Changchun City, Jilin Province, 130012, People's Republic of China
| | - Yanting Zhao
- University of Science and Technology of China, Heifei, Anhui, 230027, People's Republic of China
| | - Quanquan Gu
- Department of Computer Science, University of California, Los Angeles, CA 90095
| | - Jinghui Chen
- Department of Computer Science, University of California, Los Angeles, CA 90095
| | - Lingxiao Wang
- Department of Computer Science, University of California, Los Angeles, CA 90095
| | - Pan Xu
- Department of Computer Science, University of California, Los Angeles, CA 90095
| | - Weitong Zhang
- Department of Computer Science, University of California, Los Angeles, CA 90095
| | - Difan Zou
- Department of Computer Science, University of California, Los Angeles, CA 90095
| | - Hannah Biegel
- Department of Mathematics, University of Arizona, Tucson, AZ 85721
| | - Joceline Lega
- Department of Mathematics, University of Arizona, Tucson, AZ 85721
| | | | - V. P. Nagraj
- Quality Assurance and Data Science, Signature Science, LLC, Charlottesville, VA 22911
| | - Stephanie L. Guertin
- Quality Assurance and Data Science, Signature Science, LLC, Charlottesville, VA 22911
| | | | - Stephen D. Turner
- Quality Assurance and Data Science, Signature Science, LLC, Charlottesville, VA 22911
| | - Yunfeng Shi
- Department of Materials Science and Engineering, Rensselaer Polytechnic Institute, Troy, NY 12309
| | - Xuegang Ban
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA 98195
| | | | - Qi-Jun Hong
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ 85287
- School of Engineering, Brown University, Providence, RI 02912
| | | | | | - James A. Turtle
- Infectious Disease Group, Predictive Science, Inc, San Diego, CA 92121
| | - Michal Ben-Nun
- Infectious Disease Group, Predictive Science, Inc, San Diego, CA 92121
| | - Steven Riley
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College, W2 1PG London, United Kingdom
| | - Pete Riley
- Infectious Disease Group, Predictive Science, Inc, San Diego, CA 92121
| | | | | | - Pedro Forli
- Oliver Wyman Digital, Oliver Wyman, Sao Paolo, Brazil 04711-904
| | - Bruce Hamory
- Health & Life Sciences, Oliver Wyman, Boston, MA 02110
| | | | - Helen Leis
- Health & Life Sciences, Oliver Wyman, New York, NY 10036
| | - John Milliken
- Financial Services, Oliver Wyman, New York, NY 10036
| | | | - James Morgan
- Financial Services, Oliver Wyman, New York, NY 10036
| | | | - Gokce Ozcan
- Financial Services, Oliver Wyman, New York, NY 10036
| | - Noah Piwonka
- Health & Life Sciences, Oliver Wyman, New York, NY 10036
| | - Matt Ravi
- Core Consultant Group, Oliver Wyman, New York, NY 10036
| | - Chris Schrader
- Health & Life Sciences, Oliver Wyman, New York, NY 10036
| | | | - Daniel Siegel
- Financial Services, Oliver Wyman, New York, NY 10036
| | - Ryan Spatz
- Core Consultant Group, Oliver Wyman, New York, NY 10036
| | - Chris Stiefeling
- Financial Services, Oliver Wyman Digital, Toronto, ON, Canada M5J 0A1
| | | | | | - Sean Cavany
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556
| | - Guido España
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556
| | - Sean Moore
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556
| | - Rachel Oidtman
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556
- Department of Ecology and Evolution, University of Chicago, Chicago, IL 60637
| | - Alex Perkins
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556
| | - David Kraus
- Department of Mathematics and Statistics, Masaryk University, 61137 Brno, Czech Republic
| | - Andrea Kraus
- Department of Mathematics and Statistics, Masaryk University, 61137 Brno, Czech Republic
| | | | | | - Wei Cao
- Microsoft, Redmond, WA 98029
| | | | | | | | | | | | | | - Alessandro Vespignani
- Institute for Scientific Interchange Foundation, Turin, 10133, Italy
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Matteo Chinazzi
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Jessica T. Davis
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Kunpeng Mu
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Ana Pastore y Piontti
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Xinyue Xiong
- Laboratory for the Modeling of Biological and Socio-technical Systems, Northeastern University, Boston, MA 02115
| | - Andrew Zheng
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Jackie Baek
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Vivek Farias
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02142
| | - Andreea Georgescu
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Retsef Levi
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02142
| | - Deeksha Sinha
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Joshua Wilde
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | | | | | | | - Divya Singhvi
- Technology, Operations and Statistics (TOPS) group, Stern School of Business, New York University, New York, NY 10012
| | | | | | | | - Arnab Sarker
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Ali Jadbabaie
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Devavrat Shah
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Nicolas Della Penna
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Leo A. Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | | | | | - Dave Osthus
- Statistical Sciences Group, Los Alamos National Laboratory, Los Alamos, NM 87545
| | - Lauren Castro
- Information Systems and Modeling Group, Los Alamos National Laboratory, Los Alamos, NM 87545
| | - Geoffrey Fairchild
- Information Systems and Modeling Group, Los Alamos National Laboratory, Los Alamos, NM 87545
| | - Isaac Michaud
- Statistical Sciences Group, Los Alamos National Laboratory, Los Alamos, NM 87545
| | - Dean Karlen
- Department of Physics and Astronomy, University of Victoria, Victoria, BC, V8W 2Y2, Canada
- Physical Sciences Division, TRIUMF, Vancouver, BC, V8W 2Y2, Canada
| | - Matt Kinsey
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723
| | - Luke C. Mullany
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723
| | | | - Lauren Shin
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723
| | | | - Shelby Wilson
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723
| | - Elizabeth C. Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Juan Dent
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Kyra H. Grantz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Alison L. Hill
- Institute for Computational Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218
| | - Joshua Kaminsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | | | - Lindsay T. Keegan
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84108
| | - Stephen A. Lauer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Joseph C. Lemaitre
- Laboratory of Ecohydrology, School of Architecture, Civil and Environmental Engineering, École Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Hannah R. Meredith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Javier Perez-Saez
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Sam Shah
- Unaffiliated, San Francisco, CA 94122
| | - Claire P. Smith
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
| | - Shaun A. Truelove
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21215
- International Vaccine Access Center, Johns Hopkins University, Baltimore, MD 21231
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231
| | | | - Maximilian Marshall
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Lauren Gardner
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD 21218
| | - Kristen Nixon
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD 21218
| | | | - Lily Wang
- Department of Statistics, Iowa State University, Ames, IA 50011
| | - Lei Gao
- Department of Finance, Iowa State University, Ames, IA 50011
| | - Zhiling Gu
- Department of Statistics, Iowa State University, Ames, IA 50011
| | - Myungjin Kim
- Department of Statistics, Iowa State University, Ames, IA 50011
| | - Xinyi Li
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634
| | - Guannan Wang
- Department of Mathematics, College of William & Mary, Williamsburg, VA 23187
| | - Yueying Wang
- Department of Statistics, Iowa State University, Ames, IA 50011
| | - Shan Yu
- Department of Statistics, University of Virginia, Charlottesville, VA 22904
| | - Robert C. Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | - Ryan Barber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | - Steve Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | - Chris Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | - David Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195
| | | | | | | | | | - B. Aditya Prakash
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30308
| | - Bijaya Adhikari
- Department of Computer Science, University of Iowa, Iowa City, IA 52242
| | - Jiaming Cui
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30308
| | | | - Anika Tabassum
- Department of Computer Science, Virginia Tech, Falls Church, VA 22043
| | - Jiajia Xie
- College of Computing, Georgia Institute of Technology, Atlanta, GA 30308
| | - Pinar Keskinocak
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
| | - John Asplund
- Advanced Data Analytics, Metron, Inc., Reston, VA 20190
| | - Arden Baxter
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
| | - Buse Eylul Oruc
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
| | - Nicoleta Serban
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
| | | | | | | | | | | | | | | | | | | | - Thomas Tsai
- Department of Health Policy and Management, Harvard University, Cambridge, MA 02138
| | | | | | | | - Sam Abbott
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom
| | - Nikos I. Bosse
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom
| | - Joel Hellewell
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom
| | - Sophie R. Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom
| | - Katharine Sherratt
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT London, United Kingdom
| | - Mingyuan Zhou
- McCombs School of Business, The University of Texas at Austin, Austin, TX 78712
| | - Rahi Kalantari
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Teresa K. Yamana
- Department of Environmental Health Sciences, Columbia University, New York, NY 10032
| | - Sen Pei
- Department of Environmental Health Sciences, Columbia University, New York, NY 10032
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY 10032
| | - Michael L. Li
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Dimitris Bertsimas
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02142
| | - Omar Skali Lami
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Saksham Soni
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Hamza Tazi Bouardi
- Operations Research Center, Massachusetts Institute of Technology; Cambridge, MA 02139
| | - Turgay Ayer
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
- Winship Cancer Institute, Emory University Medical School, Atlanta, GA 30322
| | - Madeline Adee
- Radiology-Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA 02114
| | - Jagpreet Chhatwal
- Radiology-Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA 02114
| | - Ozden O. Dalgic
- Health Economic Modeling, Value Analytics Labs, 34776 İstanbul, Turkey
| | - Mary A. Ladd
- Radiology-Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA 02114
| | - Benjamin P. Linas
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA 02118
| | - Peter Mueller
- Radiology-Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA 02114
| | - Jade Xiao
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
| | - Yuanjia Wang
- Department of Biostatistics, Columbia University, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Qinxia Wang
- Department of Biostatistics, Columbia University, New York, NY 10032
| | - Shanghong Xie
- Department of Biostatistics, Columbia University, New York, NY 10032
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Alden Green
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Jacob Bien
- Marshall School of Business, Department of Data Sciences and Operations (DSO), University of Southern California, Los Angeles, CA 90089
| | - Logan Brooks
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Addison J. Hu
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Maria Jahja
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Daniel McDonald
- Department of Statistics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Balasubramanian Narasimhan
- Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305
- Department of Statistics, Stanford University, Stanford, CA 94305
| | - Collin Politsch
- Machine Learning Department, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Samyak Rajanala
- Department of Statistics, Stanford University, Stanford, CA 94305
| | - Aaron Rumack
- Machine Learning Department, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Noah Simon
- Department of Biostatistics, University of Washington, Seattle, WA 98195
| | - Ryan J. Tibshirani
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Rob Tibshirani
- Department of Statistics, Stanford University, Stanford, CA 94305
| | - Valerie Ventura
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Larry Wasserman
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Eamon B. O’Dea
- Odum School of Ecology, University of Georgia, Athens, GA 30602
| | - John M. Drake
- Odum School of Ecology, University of Georgia, Athens, GA 30602
| | | | - Quoc T. Tran
- Catalog Data Science, Walmart Inc., Sunnyvale, CA 94085
| | - Lam Si Tung Ho
- Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Huong Huynh
- Virtual Power System Inc, Milpitas, CA 95035
| | - Jo W. Walker
- COVID-19 Response, Centers for Disease Control and Prevention; Atlanta, GA 30333
| | - Rachel B. Slayton
- COVID-19 Response, Centers for Disease Control and Prevention; Atlanta, GA 30333
| | - Michael A. Johansson
- COVID-19 Response, Centers for Disease Control and Prevention; Atlanta, GA 30333
| | - Matthew Biggerstaff
- COVID-19 Response, Centers for Disease Control and Prevention; Atlanta, GA 30333
| | - Nicholas G. Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA 01003
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9
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Rajasekaran RB, Palmer AJR, Whitwell D, Cosker TDA, Pigott D, Zsolt O, Booth R, Gibbons MRJP, Carr A. The role of intraoperative cell salvage for musculoskeletal sarcoma surgery. J Bone Oncol 2021; 30:100390. [PMID: 34589408 PMCID: PMC8458974 DOI: 10.1016/j.jbo.2021.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Musculoskeletal sarcoma surgery involving the lower limb is associated with significant intraoperative blood loss, with more than 500 ml in 96% of patients. Salvaged blood was processed and re-infused in 94% of patients. An estimated one-fourth of intraoperative blood loss was returned to the patient through (Intraoperative cell salvage) ICS. Cytological analysis of imprints from leucodepletion filters(LDF) and reinfused blood did not reveal evidence of tumour cells.
Background The efficacy and safety of cell salvage for musculoskeletal sarcoma surgery have not been reported, and concerns over re-infusion of tumour cells remain. This study aims to i) describe the intra-operative blood loss and cell salvage reinfusion volumes for lower limb sarcoma and pelvic sarcoma procedures ii) and explore whether there is evidence of tumour cells in reinfused blood. Methods Retrospective analysis of 109 consecutive surgical procedures for biopsy-proven sarcoma or bone metastasis performed between 1 July 2015 and 30 October 2019. Salvaged blood was processed and reinfused when intraoperative blood loss exceeded 500 ml. Primary bone tumour (n = 86(79%)) and metastasis (n = 23(21%) constituted the study group and surgeries were classified under hemipelvectomy (n = 43(39%)), lower limb endoprosthesis replacement (LLE) (n = 50(46%)) and wide excision surgery (WE) (n = 16(15%)). Microscopic examination of imprint cytology of leuco-depletion(LD) filters, and peripheral smear examination was performed for reinfused blood. Results Median (IQR) intra-operative blood loss was 1750 (600–3000) ml for hemipelvectomy, 850 (600–1200) ml for LLE, and 1000 (550–2000) ml for WE. Salvaged blood was re-infused in 102 of 109 (94%) patients. The mean (SD) volume of re-infusion was 445(4 2 5) ml for hemipelvectomy, 206(1 3 1) ml for LLE, and 184(1 0 6) ml for WE. In total, 64 of 109 (59%) patients received an allogeneic red blood transfusion within 72 h of surgery. Cytology analysis of imprints taken from the filtered blood available in 95(87%) patients and peripheral smear examination of reinfused blood available in 32(29%) patients did not reveal evidence of tumour cells on microscopic examination of any samples. Conclusion Our study demonstrates that musculoskeletal sarcoma surgery is associated with significant blood loss, and cell salvage permits reinfusion of autologous blood in most patients. The cytological analysis did not reveal evidence of tumour cells in reinfused blood, consistent with other studies where cell salvage is used for cancer surgery.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Duncan Whitwell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Thomas D A Cosker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - David Pigott
- Consultant Anaesthetist, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Orosz Zsolt
- Consultant Pathologist, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert Booth
- Transfusion Practitioner, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M R J P Gibbons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Andrew Carr
- Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK
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10
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Huntington B, Bernardo TM, Bondad-Reantaso M, Bruce M, Devleesschauwer B, Gilbert W, Grace D, Havelaar A, Herrero M, Marsh TL, Mesenhowski S, Pendell D, Pigott D, Shaw AP, Stacey D, Stone M, Torgerson P, Watkins K, Wieland B, Rushton J. Global Burden of Animal Diseases: a novel approach to understanding and managing disease in livestock and aquaculture. REV SCI TECH OIE 2021; 40:567-584. [PMID: 34542092 DOI: 10.20506/rst.40.2.3246] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Investments in animal health and Veterinary Services can have a measurable impact on the health of people and the environment. These investments require a baseline metric that describes the burden of animal health and welfare in order to justify and prioritise resource allocation and from which to measure the impact of interventions. This paper is part of a process of scientific enquiry in which problems are identified and solutions sought in an inclusive way. It poses the broad question: what should a system to measure the animal disease burden on society look like and what value would it add? Moreover, it aims to do this in such a way as to be accessible by a wide audience, who are encouraged to engage in this debate. Given that farmed animals, including those raised by poor smallholders, are an economic entity, this system should be based on economic principles. These poor farmers are negatively impacted by disparities in animal health technology, which can be addressed through a mixture of supply-led and demand-driven interventions, reinforcing the relevance of targeted financial support from government and non-governmental organisations. The Global Burden of Animal Diseases (GBADs) Programme will glean existing data to measure animal health losses within carefully characterised production systems. Consistent and transparent attribution of animal health losses will enable meaningful comparisons of the animal disease burden to be made between diseases, production systems and countries, and will show how it is apportioned by people's socio-economic status and gender. The GBADs Programme will produce a cloud-based knowledge engine and data portal, through which users will access burden metrics and associated visualisations, support for decisionmaking in the form of future animal health scenarios, and the outputs of wider economic modelling. The vision of GBADs, strengthening the food system for the benefit of society and the environment, is an example of One Health thinking in action.
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11
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Schrading WA, Pigott D, Thompson L. Virtual Remote Attending Supervision in an Academic Emergency Department During the COVID-19 Pandemic. AEM Educ Train 2020; 4:266-269. [PMID: 32704597 PMCID: PMC7369503 DOI: 10.1002/aet2.10460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Walter A. Schrading
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAL
| | - David Pigott
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAL
| | - Linda Thompson
- Department of Emergency MedicineUniversity of Alabama at BirminghamBirminghamAL
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12
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Shufflebarger E, DeLaney M, Pigott D. Young Man With Suspected Foreign Body Ingestion. Clin Pract Cases Emerg Med 2019; 3:449-450. [PMID: 31763616 PMCID: PMC6861032 DOI: 10.5811/cpcem.2019.8.44080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/26/2019] [Accepted: 08/15/2019] [Indexed: 11/17/2022] Open
Abstract
As United States emergency departments (ED) and hospitals continue to contend with increasing numbers of patients presenting with complications of substance abuse, emergency physicians should also be aware of patients who may be smuggling illicit drugs. We report the case of a 26-year-old man who was transported to the ED for suspected drug smuggling. Abdominal computed tomography was notable for the presence of multiple tubular foreign bodies throughout the colon that were later identified as packets containing heroin. Body-packing patients present a high-risk clinical scenario that may result in massive, inadvertent drug exposure.
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Affiliation(s)
- Erin Shufflebarger
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Matthew DeLaney
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - David Pigott
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
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13
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Dwyer-Lindgren L, Cork MA, Sligar A, Steuben KM, Wilson KF, Provost NR, Mayala BK, VanderHeide JD, Collison ML, Hall JB, Biehl MH, Carter A, Frank T, Douwes-Schultz D, Burstein R, Casey DC, Deshpande A, Earl L, El Bcheraoui C, Farag TH, Henry NJ, Kinyoki D, Marczak LB, Nixon MR, Osgood-Zimmerman A, Pigott D, Reiner RC, Ross JM, Schaeffer LE, Smith DL, Davis Weaver N, Wiens KE, Eaton JW, Justman JE, Opio A, Sartorius B, Tanser F, Wabiri N, Piot P, Murray CJL, Hay SI. Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature 2019; 570:189-193. [PMID: 31092927 PMCID: PMC6601349 DOI: 10.1038/s41586-019-1200-9] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/10/2019] [Indexed: 12/16/2022]
Abstract
HIV/AIDS is a leading cause of disease burden in sub-Saharan Africa. Existing evidence has demonstrated that there is substantial local variation in the prevalence of HIV; however, subnational variation has not been investigated at a high spatial resolution across the continent. Here we explore within-country variation at a 5 × 5-km resolution in sub-Saharan Africa by estimating the prevalence of HIV among adults (aged 15–49 years) and the corresponding number of people living with HIV from 2000 to 2017. Our analysis reveals substantial within-country variation in the prevalence of HIV throughout sub-Saharan Africa and local differences in both the direction and rate of change in HIV prevalence between 2000 and 2017, highlighting the degree to which important local differences are masked when examining trends at the country level. These fine-scale estimates of HIV prevalence across space and time provide an important tool for precisely targeting the interventions that are necessary to bringing HIV infections under control in sub-Saharan Africa. Fine-scale estimates of the prevalence of HIV in adults across sub-Saharan Africa reveal substantial within-country variation and local differences in both the direction and rate of change in the prevalence of HIV between 2000 and 2017.
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Affiliation(s)
- Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael A Cork
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amber Sligar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Krista M Steuben
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kate F Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Naomi R Provost
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - John D VanderHeide
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael L Collison
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jason B Hall
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly H Biehl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Austin Carter
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tahvi Frank
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dirk Douwes-Schultz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Daniel C Casey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tamer H Farag
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damaris Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - David Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jennifer M Ross
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeffrey W Eaton
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jessica E Justman
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alex Opio
- Medireal Investment Uganda, Entebbe, Uganda
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Research Department of Infection & Population Health, University College London, London, UK
| | - Njeri Wabiri
- HIV/AIDS, STIs & TB Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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14
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Haakenstad A, Harle AC, Tsakalos G, Micah AE, Tao T, Anjomshoa M, Cohen J, Fullman N, Hay SI, Mestrovic T, Mohammed S, Mousavi SM, Nixon MR, Pigott D, Tran K, Murray CJL, Dieleman JL. Tracking spending on malaria by source in 106 countries, 2000-16: an economic modelling study. Lancet Infect Dis 2019; 19:703-716. [PMID: 31036511 PMCID: PMC6595179 DOI: 10.1016/s1473-3099(19)30165-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/02/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sustaining achievements in malaria control and making progress toward malaria elimination requires coordinated funding. We estimated domestic malaria spending by source in 106 countries that were malaria-endemic in 2000-16 or became malaria-free after 2000. METHODS We collected 36 038 datapoints reporting government, out-of-pocket (OOP), and prepaid private malaria spending, as well as malaria treatment-seeking, costs of patient care, and drug prices. We estimated government spending on patient care for malaria, which was added to government spending by national malaria control programmes. For OOP malaria spending, we used data reported in National Health Accounts and estimated OOP spending on treatment. Spatiotemporal Gaussian process regression was used to ensure estimates were complete and comparable across time and to generate uncertainty. FINDINGS In 2016, US$4·3 billion (95% uncertainty interval [UI] 4·2-4·4) was spent on malaria worldwide, an 8·5% (95% UI 8·1-8·9) per year increase over spending in 2000. Since 2000, OOP spending increased 3·8% (3·3-4·2) per year, amounting to $556 million (487-634) or 13·0% (11·6-14·5) of all malaria spending in 2016. Governments spent $1·2 billion (1·1-1·3) or 28·2% (27·1-29·3) of all malaria spending in 2016, increasing 4·0% annually since 2000. The source of malaria spending varied depending on whether countries were in the malaria control or elimination stage. INTERPRETATION Tracking global malaria spending provides insight into how far the world is from reaching the malaria funding target of $6·6 billion annually by 2020. Because most countries with a high burden of malaria are low income or lower-middle income, mobilising additional government resources for malaria might be challenging. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | - Golsum Tsakalos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Angela E Micah
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tianchan Tao
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Mina Anjomshoa
- Rafsanjan University of Medical Sciences Social Determinants of Health Research Center, Rafsanjan, Iran; Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran; Tehran University of Medical Sciences Department of Health Management and Economics, Tehran, Iran
| | - Jessica Cohen
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tomislav Mestrovic
- Dr Zora Profozic Polyclinic Clinical Microbiology and Parasitology Unit, Zagreb, Croatia; University Centre Varazdin, Varazdin, Croatia
| | - Shafiu Mohammed
- Ahmadu Bello University, Zaria, Nigeria; Heidelberg University Institute of Public Health, Heidelberg, Germany
| | - Seyyed Meysam Mousavi
- Tehran University of Medical Sciences Department of Health Management and Economics, Tehran, Iran
| | - Molly R Nixon
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - David Pigott
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Khanh Tran
- University of Auckland Department of Molecular Medicine and Pathology, Auckland, New Zealand; Military Medical University Department of Clinical Hematology and Toxicology, Hanoi, Vietnam
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15
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Burleson S, Cirillo F, Gibson C, Gullett J, Pigott D. Superficial Temporal Artery Pseudoaneurysm Diagnosed by Point-of-Care Ultrasound. Clin Pract Cases Emerg Med 2019; 3:77-78. [PMID: 30775675 PMCID: PMC6366385 DOI: 10.5811/cpcem.2018.11.40958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/20/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Samuel Burleson
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - Francesca Cirillo
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - Courtney Gibson
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - John Gullett
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
| | - David Pigott
- University of Alabama, Department of Emergency Medicine, Birmingham, Alabama
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16
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Rushton J, Bruce M, Bellet C, Torgerson P, Shaw A, Marsh T, Pigott D, Stone M, Pinto J, Mesenhowski S, Wood P. Initiation of Global Burden of Animal Diseases Programme. Lancet 2018; 392:538-540. [PMID: 30152376 DOI: 10.1016/s0140-6736(18)31472-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Jonathan Rushton
- Institute of Infection and Global Health, University of Liverpool, Liverpool L3 5RF, UK.
| | | | - Camille Bellet
- Institute of Infection and Global Health, University of Liverpool, Liverpool L3 5RF, UK
| | - Paul Torgerson
- Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Tom Marsh
- Washington State University, Pullman, WA, USA
| | - David Pigott
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Matthew Stone
- The World Organisation for Animal Health, Paris, France
| | - Julio Pinto
- The Food and Agriculture Organization of the United Nations, Rome, Italy
| | | | - Paul Wood
- Independent Consultant, Melbourne, VIC, Australia
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17
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Affiliation(s)
- Ellen M Goldberg
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA
| | - David Pigott
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA
| | - Shreya Shirude
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA
| | - Jeffrey Stanaway
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA.
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18
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Vogel T, Brockmann JG, Pigott D, Neil DAH, Muthusamy ASR, Coussios CC, Friend PJ. Successful transplantation of porcine liver grafts following 48-hour normothermic preservation. PLoS One 2017; 12:e0188494. [PMID: 29176869 PMCID: PMC5703476 DOI: 10.1371/journal.pone.0188494] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/30/2017] [Indexed: 12/22/2022] Open
Abstract
Current cold storage organ preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation of liver allografts. Long-term organ preservation using normothermic perfusion might not only allow organ viability assessment before transplantation, but also provide the means for further organ modifications under physiologic conditions. Previous research has shown that porcine livers can be transplanted successfully after normothermic preservation of 20 hours. In the present study we investigate whether similar methodology is capable of further extending the safe limit to 48 hours. In this study, livers from White Landrace pigs were preserved by normothermic, oxygenated sanguineous perfusion. After a 48-hour period of preservation, livers were transplanted into recipient pigs and followed for 5 days. Outcome parameters measured included markers of synthetic and metabolic liver function as well as hepatocellular injury and blood gas analysis during perfusion and follow-up. Histological assessment of morphological liver integrity was performed. All livers showed sustained bile production and metabolic activity throughout the preservation period. Low levels of hepatocellular damage were found. Following transplantation all liver grafts revealed excellent graft function and death-censored graft survival was 100%. Porcine livers were transplanted successfully following 48 hours normothermic machine preservation.
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Affiliation(s)
- Thomas Vogel
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Jens G. Brockmann
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - David Pigott
- Nuffield Department of Anaesthesia, University of Oxford, Oxford, United Kingdom
| | - Desley A. H. Neil
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | - Peter J. Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Purse BV, Masante D, Golding N, Pigott D, Day JC, Ibañez-Bernal S, Kolb M, Jones L. How will climate change pathways and mitigation options alter incidence of vector-borne diseases? A framework for leishmaniasis in South and Meso-America. PLoS One 2017; 12:e0183583. [PMID: 29020041 PMCID: PMC5636069 DOI: 10.1371/journal.pone.0183583] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 08/18/2017] [Indexed: 12/26/2022] Open
Abstract
The enormous global burden of vector-borne diseases disproportionately affects poor people in tropical, developing countries. Changes in vector-borne disease impacts are often linked to human modification of ecosystems as well as climate change. For tropical ecosystems, the health impacts of future environmental and developmental policy depend on how vector-borne disease risks trade off against other ecosystem services across heterogeneous landscapes. By linking future socio-economic and climate change pathways to dynamic land use models, this study is amongst the first to analyse and project impacts of both land use and climate change on continental-scale patterns in vector-borne diseases. Models were developed for cutaneous and visceral leishmaniasis in the Americas-ecologically complex sand fly borne infections linked to tropical forests and diverse wild and domestic mammal hosts. Both diseases were hypothesised to increase with available interface habitat between forest and agricultural or domestic habitats and with mammal biodiversity. However, landscape edge metrics were not important as predictors of leishmaniasis. Models including mammal richness were similar in accuracy and predicted disease extent to models containing only climate and land use predictors. Overall, climatic factors explained 80% and land use factors only 20% of the variance in past disease patterns. Both diseases, but especially cutaneous leishmaniasis, were associated with low seasonality in temperature and precipitation. Since such seasonality increases under future climate change, particularly under strong climate forcing, both diseases were predicted to contract in geographical extent to 2050, with cutaneous leishmaniasis contracting by between 35% and 50%. Whilst visceral leishmaniasis contracted slightly more under strong than weak management for carbon, biodiversity and ecosystem services, future cutaneous leishmaniasis extent was relatively insensitive to future alternative socio-economic pathways. Models parameterised at narrower geographical scales may be more sensitive to land use pattern and project more substantial changes in disease extent under future alternative socio-economic pathways.
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Affiliation(s)
- Bethan V. Purse
- NERC Centre for Ecology and Hydrology,Crowmarsh Gifford, Oxfordshire, United Kingdom
| | - Dario Masante
- NERC Centre for Ecology and Hydrology, Environment Centre Wales, Bangor, United Kingdom
| | - Nicholas Golding
- School of BioSciences, University of Melbourne, Victoria, Australia
| | - David Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - John C. Day
- NERC Centre for Ecology and Hydrology,Crowmarsh Gifford, Oxfordshire, United Kingdom
| | - Sergio Ibañez-Bernal
- Instituto de Ecología, A.C. (INECOL), Red Ambiente y Sustentabilidad, Xalapa, Veracruz, Mexico
| | - Melanie Kolb
- Institute of Geography, National Autonomous University of Mexico, Mexico City, Mexico
| | - Laurence Jones
- NERC Centre for Ecology and Hydrology, Environment Centre Wales, Bangor, United Kingdom
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Sarvananthan S, Rahman N, Ainsworth Q, Evans R, Grebenik K, Gibson F, Hill E, Keiralla A, Palin C, Pigott D, Black E, Belcher E. P-118IMPACT OF INTER-OBSERVER VARIABILITY ON THORACOSCORE RISK STRATIFICATION. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.118] [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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21
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Anastasiadis K, Westaby S, Antonitsis P, Argiriadou H, Karapanagiotidis G, Pigott D, Papakonstantinou C. Minimal Extracorporeal Circulation Circuit Standby for “Off-Pump” Left Ventricular Assist Device Implantation. Artif Organs 2010; 34:1156-8. [DOI: 10.1111/j.1525-1594.2009.00983.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mahesh B, Yim B, Robson D, Pillai R, Ratnatunga C, Pigott D. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial☆☆☆. Eur J Cardiothorac Surg 2008; 33:370-6. [DOI: 10.1016/j.ejcts.2007.12.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 11/25/2022] Open
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23
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Balacumaraswami L, Abu-Omar Y, Selvanayagam J, Pigott D, Taggart DP. The effects of on-pump and off-pump coronary artery bypass grafting on intraoperative graft flow in arterial and venous conduits defined by a flow/pressure ratio. J Thorac Cardiovasc Surg 2008; 135:533-9. [DOI: 10.1016/j.jtcvs.2007.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 08/03/2007] [Accepted: 10/05/2007] [Indexed: 10/22/2022]
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24
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Guerrieri Wolf L, Abu-Omar Y, Choudhary BP, Pigott D, Taggart DP. Gaseous and solid cerebral microembolization during proximal aortic anastomoses in off-pump coronary surgery: the effect of an aortic side-biting clamp and two clampless devices. J Thorac Cardiovasc Surg 2007; 133:485-93. [PMID: 17258587 DOI: 10.1016/j.jtcvs.2006.10.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Intraoperative cerebral microembolism is a cause of cerebral dysfunction after cardiac surgery, and particulate microemboli are the most damaging. Using a new-generation transcranial Doppler ultrasound, we compared the number and nature of microemboli in patients undergoing off-pump coronary artery bypass grafting during performance of proximal anastomoses with three techniques: an aortic side-biting clamp and two clampless devices (the Enclose II device [Novare Surgical Systems, Inc, Cupertino, Calif] and the Heartstring II device [Guidant Corporation, Santa Clara, Calif]) developed to obviate the need for an aortic side-biting clamp, thereby reducing the number of cerebral microemboli. METHODS Bilateral continuous monitoring of the middle cerebral arteries was performed with a multirange, multifrequency transcranial Doppler device that both automatically rejects artifacts online and discriminates between solid and gaseous microemboli. Recordings were continuously undertaken during performance of 66 proximal aortic anastomoses in 42 patients. Thirty-five anastomoses were performed with an aortic side-biting clamp, 20 with the Enclose device, and 11 the Hearstring device. RESULTS Most microemboli occurred during application/insertion and removal of each device from the ascending aorta. The median number (interquartile range) of total microemboli was 11 (6-32) during side clamping, 11 (6-15) with the Enclose device, 40 (31-48) with the Heartstring device (P < .01). The proportion of solid microemboli was significantly higher in the side-clamp group (23%) compared with 6% and 1% in the Enclose and Heartstring groups, respectively (P < .01). CONCLUSIONS Avoidance of aortic side clamping results in a significant reduction in the proportion of solid microemboli detected with transcranial Doppler. As solid microemboli are probably the most damaging, use of the Enclose and Heartstring devices may represent an important strategy for minimizing cerebral injury during proximal aortic anastomoses.
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MESH Headings
- Aged
- Anastomosis, Surgical/adverse effects
- Anastomosis, Surgical/instrumentation
- Coronary Angiography
- Coronary Artery Bypass, Off-Pump/adverse effects
- Coronary Artery Bypass, Off-Pump/methods
- Coronary Stenosis/diagnostic imaging
- Coronary Stenosis/mortality
- Coronary Stenosis/surgery
- Embolism, Air/diagnostic imaging
- Embolism, Air/etiology
- Embolism, Air/prevention & control
- Equipment Design
- Equipment Safety
- Female
- Humans
- Intracranial Embolism/diagnostic imaging
- Intracranial Embolism/etiology
- Intracranial Embolism/prevention & control
- Intraoperative Complications/diagnostic imaging
- Intraoperative Complications/prevention & control
- Male
- Middle Aged
- Monitoring, Intraoperative/methods
- Probability
- Prognosis
- Prospective Studies
- Reference Values
- Risk Assessment
- Surgical Instruments
- Survival Rate
- Treatment Outcome
- Ultrasonography, Doppler, Transcranial
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25
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Abu-Omar Y, Cader S, Guerrieri Wolf L, Pigott D, Matthews PM, Taggart DP. Short-term changes in cerebral activity in on-pump and off-pump cardiac surgery defined by functional magnetic resonance imaging and their relationship to microembolization. J Thorac Cardiovasc Surg 2006; 132:1119-25. [PMID: 17059932 DOI: 10.1016/j.jtcvs.2006.04.057] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Revised: 04/14/2006] [Accepted: 04/24/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive dysfunction is common early after cardiac surgery. We previously reported that functional magnetic resonance imaging of the brain can detect subclinical changes in prefrontal cortical activation after coronary artery bypass grafting. In this study, we used functional magnetic resonance imaging to contrast perioperative prefrontal activation in patients undergoing on-pump and off-pump coronary artery bypass grafting and to relate differences to cerebral microembolic load. METHODS Functional images of the brain were acquired in 25 patients undergoing cardiac surgery (13 off-pump and 12 on-pump) before surgery and 4 weeks after surgery during performance of a verbal memory task of increasing complexity (n-back task). Continuous intraoperative transcranial Doppler scanning was performed to quantify the number of cerebral microemboli. Perioperative changes in task-associated prefrontal activation were compared between the 2 groups and were then correlated with the number of microemboli recorded during surgery. RESULTS The median (interquartile range) number of detected microemboli was 35 (21-63) in the off-pump group and 254 (116-397) in the on-pump group (P < .005). Functional imaging performed before surgery demonstrated increased activity in the prefrontal regions with increasing task complexity. After surgery, there was a significant reduction in task-associated prefrontal activation in the on-pump, but not in the off-pump, group (P < .05). There was a negative correlation between the perioperative signal changes in the prefrontal region and the total number of microemboli (r = -0.63; P < .01). CONCLUSIONS Patients undergoing on-pump, but not off-pump, surgery have a significant relative reduction in prefrontal activation, which correlates with intraoperative cerebral microembolic load. We hypothesize that this reduction in activation is related to subclinical functional impairments and that microembolic load is an important mechanism of perioperative cerebral insult.
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Affiliation(s)
- Yasir Abu-Omar
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK
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26
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Balacumaraswami L, Abu-Omar Y, Choudhary B, Pigott D, Taggart DP. A comparison of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency. J Thorac Cardiovasc Surg 2005; 130:315-20. [PMID: 16077393 DOI: 10.1016/j.jtcvs.2004.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intraoperative graft patency assessment during coronary artery bypass grafting enables detection and immediate correction of graft failure. Currently transit-time flowmetry is used to assess graft patency on the basis of mean graft flow and derived values, such as the pulsatility index. Intraoperative fluorescence imaging, based on the fluorescence of indocyanine green dye, provides direct visual images to confirm graft patency. METHODS We performed a prospective observational study to assess intraoperative graft patency in patients undergoing coronary artery bypass grafting, by using an intraoperative fluorescence imaging system (SPY) and transit-time flowmetry (BF 2004). Poor flow with the intraoperative fluorescence imaging system was defined if there was an absence of fluorescence or if it did not appear within 15 seconds in the graft. A persistent mean graft flow value less than 5 mL/min and a pulsatility index greater than 5 with transit-time flowmetry were considered unacceptable and prompted graft revision. RESULTS We assessed the intraoperative patency of 266 grafts in 100 coronary artery bypass grafting patients. Intraoperative fluorescence imaging and transit-time flowmetry confirmed adequate flow in 241 (91%) grafts in 75 patients (75%). Transient poor flow was detected with both intraoperative fluorescence imaging and transit-time flowmetry in 7 (2.6%) grafts in 7 (7%) patients. This subsequently proved to be adequate on repeat testing and hence did not necessitate graft revision. Both intraoperative fluorescence imaging and transit-time flowmetry confirmed persistent poor flow in 8 (3%) grafts in 8 (8%) patients that necessitated graft revision. However, in a further 10 (3.8%) grafts in 10 (10%) patients, transit-time flowmetry indicated persistently poor flows on the basis of mean graft flow and pulsatility index values, whereas the intraoperative fluorescence imaging system demonstrated satisfactory flow. These grafts were not revised. CONCLUSIONS In most patients, both intraoperative fluorescence imaging and transit-time flowmetry are useful to confirm intraoperative graft patency. However, in a small proportion of patients (10%), graft patency assessment with transit-time flowmetry alone might prompt unnecessary graft revision.
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27
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Selvanayagam JB, Pigott D, Balacumaraswami L, Petersen SE, Neubauer S, Taggart DP. Relationship of irreversible myocardial injury to troponin I and creatine kinase-MB elevation after coronary artery bypass surgery: Insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol 2005; 45:629-31. [PMID: 15708715 DOI: 10.1016/j.jacc.2004.11.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Reddy S, Greenwood J, Maniakin N, Bhattacharjya S, Zilvetti M, Brockmann J, James T, Pigott D, Friend P. Non-heart-beating donor porcine livers: the adverse effect of cooling. Liver Transpl 2005; 11:35-8. [PMID: 15690534 DOI: 10.1002/lt.20287] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Normothermic preservation has been shown to be advantageous in an experimental model of preservation of non-heart-beating donor (NHBD) livers, which have undergone significant warm ischemic injury. The logistics of clinical organ retrieval might dictate a period of cold preservation prior to warm perfusion. We have investigated the effects of a brief period of cold preservation on NHBD livers prior to normothermic preservation. Porcine livers were subjected to 60 minutes of warm ischaemia and then assigned to following groups: Group W (n = 5), normothermic preservation for 24 hours; and Group C (n = 6), cold preservation in University of Wisconsin solution for 1 hour followed by normothermic preservation for 23 hours (total preservation time, 24 hours). Synthetic function (bile production and factor V production) and cellular damage were compared on the ex vivo circuit during preservation. There was no significant difference in the synthetic function of the livers (bile production and factor V production). Markers of hepatocellular damage (alanine aminotransferase and aspartate aminotransferase release), sinusoidal endothelial cell dysfunction (hyaluronic acid), and Kupffer cell injury (beta-galactosidase) were significantly higher in Group C. The histology of the livers at the end of perfusion was similar. In conclusion, a brief-period cold preservation prior to normothermic perfusion maintains the synthetic function and metabolic activity but results in significant hepatocellular damage, sinusoidal endothelial cell dysfunction, and Kupffer cell injury. Transplant studies are required to establish whether livers treated in this way are viable for transplantation.
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Affiliation(s)
- Srikanth Reddy
- Nuffield Department of Surgery, University of Oxford, Oxford, OX3 9DU, UK
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29
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Balacumaraswami L, Abu-Omar Y, Anastasiadis K, Choudhary B, Pigott D, Yeong SK, Taggart DP. Does off-pump total arterial grafting increase the incidence of intraoperative graft failure? J Thorac Cardiovasc Surg 2004; 128:238-44. [PMID: 15282460 DOI: 10.1016/j.jtcvs.2003.11.072] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early graft failure is a common cause of cardiac mortality and morbidity after coronary artery bypass grafting, but there is little information on its natural incidence. Furthermore, there is particular concern about graft patency in off-pump coronary artery bypass grafting and total arterial grafting. METHODS We performed a prospective observational study to assess intraoperative graft patency in patients undergoing off-pump and on-pump coronary artery bypass grafting, who also underwent total arterial grafting. We used an intraoperative imaging system, SPY (Novadaq Technologies Inc), based on the fluorescent properties of indocyanine green dye. RESULTS We assessed the intraoperative graft patency of 533 conduits in 200 patients. The mean number of grafts was 2.7 per patient. Of these patients, 155 (78%) had off-pump coronary artery bypass grafting, and 45 (22%) had on-pump coronary artery bypass grafting. Overall, 161 (80%) had total arterial grafting, with composite arterial grafting performed in 120 (60%) patients. Fluorescence, confirming graft patency, was observed in all but 8 (1.5%) conduits in 8 (4%) patients, necessitating graft revision. Six (3.9%) and 2 (4.4%) of these patients, respectively, had off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting. CONCLUSION Intraoperative fluorescence imaging demonstrated a low (1.5%) but well-defined incidence of intraoperative graft failure, which affects around 4% of patients. This emphasizes the need for routine assessment of graft patency. Intraoperative fluorescence imaging permits detection and revision of failed grafts in the operating room. We found no difference in the incidence of failed grafts when comparing on-pump and off-pump total arterial grafting.
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Affiliation(s)
- Lognathen Balacumaraswami
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
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30
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Bachmann LH, Pigott D, Desmond R, Jones M, Lumpkins J, Gala P, Terndrup T, Hook EW. Prevalence and factors associated with gonorrhea and chlamydial infection in at-risk females presenting to an urban emergency department. Sex Transm Dis 2003; 30:335-9. [PMID: 12671555 DOI: 10.1097/00007435-200304000-00012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients without a regular healthcare source are less likely to be tested, diagnosed, and treated effectively for sexually transmitted diseases (STDs). Emergency departments (EDs) are a major healthcare source for patients without health insurance or primary care providers. GOAL This study evaluated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women aged 15 to 35 years presenting to a metropolitan ED with genitourinary or pregnancy-related complaints and the frequency with which patients were effectively treated for these infections during routine ED care. STUDY DESIGN Women completed an interviewer-administered questionnaire and submitted urine for ligase chain reaction (LCR) testing for C trachomatis and N gonorrhoeae. RESULTS The combined prevalence of gonorrhea and chlamydia was 16.4% (n = 62), and factors associated with infection included younger age and greater numbers of sex partners over 30 days. Problem-oriented care failed to detect infection in most cases, and 58% of infected women left the ED without effective therapy. Through a close working relationship with the local health department, we documented that 92% had received effective follow-up therapy. CONCLUSION Continued efforts to refine and develop tools for the diagnosis and management of cervical infections for at-risk women seen in EDs are warranted.
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Affiliation(s)
- Laura H Bachmann
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, USA.
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31
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Coles C, Taggart D, Choudhary B, Abu-Omar Y, Balacumaraswami L, Pigott D. The use of a novel imaging technique to evaluate patency of coronary grafts. Anaesthesia 2003. [DOI: 10.1046/j.1365-2044.2003.03093_1.x] [Citation(s) in RCA: 2] [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: 11/20/2022]
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32
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Westaby S, Jarvik R, Freeland A, Pigott D, Robson D, Saito S, Catarino P, Frazier OH. Postauricular percutaneous power delivery for permanent mechanical circulatory support. J Thorac Cardiovasc Surg 2002; 123:977-83. [PMID: 12019385 DOI: 10.1067/mtc.2002.121045] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Percutaneous driveline infection continues to detract from both quality and length of life in patients with a left ventricular assist device. We have pursued an alternative route by using a skull-mounted percutaneous pedestal similar to cochlear implant technology. We have now used this method in patients implanted with the Jarvik 2000 heart (Jarvik Heart, Inc, New York, NY) as destination therapy for end-stage (New York Heart Association class IV) heart failure. METHODS Four men with cardiomyopathy aged 61 to 72 years received the Jarvik 2000 heart with postauricular power delivery for permanent mechanical circulatory support. The power cable was brought through the second posterior intercostal space and routed through the neck to a percutaneous titanium implant screwed to the skull. This joins with the cable to the external controller and battery. RESULTS In 3 patients the pedestal healed well and remained free from infection up to 1 year. The system was user friendly, and the whole external apparatus is exchangeable. The second patient had a subdural hematoma. This caused us to improve the preparation and modify the implant procedure. CONCLUSION For widespread use, permanent implantable circulatory support requires a reliable, user-friendly device with freedom from powerline infection. Our early experience with the Jarvik 2000 heart suggests that rigid fixation and the vascularity of scalp skin promote healing and reduce the risk of driveline infection.
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33
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St Peter SD, Imber CJ, Lopez I, McGuire J, James T, Taylor R, Pigott D, Friend PJ. beta-Galactosidase as a novel marker of ischaemic injury and a mechanism for viability assessment in liver transplantation. Transplant Proc 2001; 33:3753-5. [PMID: 11750599 DOI: 10.1016/s0041-1345(01)02589-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S D St Peter
- Department of Surgery, John Radcliffe Hospital, Oxford, UK
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34
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Abstract
Forty patients having surgery requiring muscle paralysis and tracheal intubation were randomly allocated to receive either halothane (n = 20) or sevoflurane (n = 20). Following intravenous anaesthesia and tracheal intubation, inhalation induction of anaesthesia was simulated. After attaining an end-tidal anaesthetic concentration of 2 MAC for the respective agent, the airway was obstructed for 3 min. The end-tidal anaesthetic concentration was measured for the first three breaths following the period of airway obstruction. The decrease in alveolar concentration of sevoflurane following 3 min of airway obstruction was found to be significantly greater than that of halothane. We conclude that even if the airway obstructs completely during inhalational induction of general anaesthesia, awakening would be faster with sevoflurane than with halothane.
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Affiliation(s)
- Y Girgis
- Department of Anaesthesia, The Royal Orthopaedic Hospital, Birmingham, UK
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35
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Abstract
A patient with acute fulminant lymphocytic myocarditis and cardiogenic shock was successfully treated by mechanical off loading of the left ventricle. A nonpulsatile left-heart bypass was undertaken with an implantable centrifugal blood pump. Careful weaning resulted in device removal on the seventh day. Left and right ventricular function is sustained at 7 months. Widespread application of this method depends on the availability of an inexpensive user friendly blood pump, appropriate weaning protocols and emerging strategies to promote sustainable myocardial recovery.
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Affiliation(s)
- S Westaby
- Department of Cardiac Surgery, John Radcliffe Hospital Oxford, England.
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36
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Abstract
BACKGROUND Mechanical bridge to left ventricular recovery is an emerging strategy for the treatment of heart failure. We sought to validate the use of a new intracardiac axial flow impeller pump for this purpose. METHODS AND RESULTS The Jarvik 2000 Heart was implanted into 30 sheep to ascertain mechanical reliability, biocompatibility, and hemodynamic function. We attempted but failed to anticoagulate with warfarin. Elective explants with survival were performed in 3 animals to simulate bridge to recovery. Extensive autopsy studies were performed in all other animals. At speeds between 8000 and 12 000 rpm the device pumped up to 8 L/min, captured all mitral flow, and augmented cardiac output with elevation of mean arterial pressure. The pump was silent and hemolysis negligible. Nonpulsatile flow did not adversely affect neurological or renal function. Device removal proved straightforward and safe. A fractured inflow bearing occurred in 1 early model. There were no other pump failures, but power interruption occurred when the sheep chewed the cables or head-butted the percutaneous pedestal. At autopsy, there was no thromboembolism or primary thrombus formation in any device. Pump occlusion occurred in 2 sheep with bacterial endocarditis. One electively explanted pump, previously switched off for 5 months, had no thrombus in the device or vascular graft. CONCLUSIONS The Jarvik 2000 Heart is a major advance in blood-pump technology and increases the scope of mechanical circulatory support. Reliability and ease of removal favor its use for bridge to myocyte recovery, as well as for bridge to transplantation or long-term support.
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37
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Piriou V, Ross S, Bastien O, Pigott D, Trivin F, Foëx P. Cardiovascular effects of concomitant administration of isoflurane and nicorandil in dogs. Br J Anaesth 1998; 80:481-7. [PMID: 9640155 DOI: 10.1093/bja/80.4.481] [Citation(s) in RCA: 5] [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: 11/14/2022] Open
Abstract
Nicorandil, a new KATP channel opener, is used in clinical practice for anti-anginal therapy. It exhibits vasodilator properties as does the halogenated anaesthetic isoflurane. We have examined the cardiovascular effects of increasing concentrations of isoflurane after administration of nicorandil in 10 adult beagle dogs anaesthetized with thiopental and whose lungs were ventilated mechanically. During surgery, anaesthesia was maintained with 1.0-1.5% isoflurane. A left thoracotomy was performed and the heart suspended in a pericardial cradle. Monitoring included: ECG; aortic, left ventricular, arterial, central venous and pulmonary artery pressures; cardiac output; coronary flow; and segmental length in the apical region. After surgery, isoflurane anaesthesia was set at an end-tidal concentration of 1.05% (1 MAC) and measurements obtained; these were repeated with 1.4%, 1.75%, 2.1% and 1.05% isoflurane concentrations after appropriate stabilization periods. Nicorandil (100 micrograms kg-1 bolus, 25 micrograms kg-1 min-1 infusion) was begun and a second dose-response study of isoflurane was obtained as before. Blood samples were obtained for measurement of concentrations of nicorandil. Systolic ventricular function was assessed by systolic shortening (%SS) and preload recruitable stroke work (PRSW). Increasing isoflurane concentration produced decreases in heart rate, systolic pressure, cardiac output, %SS and PRSW. Nicorandil produced a slight decrease in systolic arterial pressure (10 and 15 mm Hg after 1.05% and 2.05% isoflurane) and a slight increase in heart rate (10 and 5 beat min-1 after 1.05% and 2.05% isoflurane). Preload, assessed by end-diastolic length, decreased. Coronary blood flow increased with infusion of nicorandil. Left ventricular function was not affected by infusion of nicorandil. We conclude that nicorandil has only minor vaso/venodilatory effects in the presence of isoflurane. Ventricular function was not altered by infusion of nicorandil.
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Affiliation(s)
- V Piriou
- Nuffield Department of Anaesthetics, Radcliffe Infirmary, University of Oxford
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38
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Abstract
BACKGROUND Driveline infection limits the event-free survival of patients with a left ventricular assist device. With the evolving prospect of improved left ventricular assist devices in the bridge-to-transplantation or recovery setting, we sought to reduce the risk of driveline complications. METHODS As part of the Oxford Jarvik 2000 research program, we developed a carbon and then titanium pedestal to transmit the electric wires through the skin. In a sheep model, the pedestal was brought out through the skin of the shoulder (n = 10) or the scalp (n = 9) with underlying fixation to the skull. Exit wounds were carefully inspected for healing and infection. Power cable durability tests were performed in 6 additional animals without an implanted pump. RESULTS The cumulative observation period was 1,491 days (mean time, 78 days; range, 14 days to 198 days). There was no difference in observation period between the two groups. Infection (n = 2) and impaired healing (n = 5) occurred in the mobile tissues at the shoulder. Skull-mounted pedestals were free from infection or healing problems. The electric cables were not interrupted by repeated neck flexion (cumulative observation period, 588 days). The carbon pedestal was replaced by a titanium pedestal when the head butting of the sheep fractured the carbon. CONCLUSIONS The combination of rigid fixation and highly vascular scalp skin reduces the risk of percutaneous driveline infection and may solve an important outstanding problem in use of left ventricular assist devices.
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Affiliation(s)
- R Jarvik
- Oxford Heart Centre, John Radcliffe Hospital, United Kingdom
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39
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Abstract
METHODS We developed a system for mechanical circulatory support based on the Jarvik 2000 intraventricular axial flow impeller pump (Jarvik Research, Inc., New York, N.Y.) and percutaneous electric power. The adult pump provides flow at a rate up to 10 L/min with an energy requirement of 7 to 10 watts. The device was implanted into the apex of the left ventricle through a left thoracotomy without cardiopulmonary bypass. A Dacron graft conveyed blood to the descending thoracic aorta. In patients, we will use a skull-mounted carbon pedestal to transmit fine electric wires through the scalp skin. Being highly vascular, the scalp skin is resistant to infection. RESULTS We tested 16 adult systems and one pediatric system in 17 adult ewes weighing between 60 and 90 kg. Five died of perioperative complications. Twelve survived between 3 and 198 days (mean 44 days) with a functioning device. None of the sheep could receive adequate anticoagulation with warfarin (INR 1.0 to 1.5). Acute thrombotic occlusion occurred after a 3-hour power loss in one device (46 days) but was cleared with streptokinase. In a second animal with endocarditis, the pump inflow became occluded with vegetations. No other device-related problems or important hemolysis developed despite pump speeds between 10,000 and 18,000 rpm. Renal function remained normal in all animals. Autopsy studies showed no pannus ingrowth at the device inflow despite the restrictive left ventricular cavity size. No sign of thromboembolism could be detected in the brains or kidneys. CONCLUSION Our findings indicate the Jarvik 2000 Oxford System to be a safe and effective circulatory assist device. Potential uses include permanent circulatory support, bridge to transplantation, or bridge to myocardial recovery in acute or chronic left ventricular failure.
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Affiliation(s)
- S Westaby
- Oxford Heart Centre, Oxford, United Kingdom
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40
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Abstract
In common with halogenated anaesthetics, nicorandil, a new KATP channel opener, has been shown to have cardioprotective and vasodilator effects. Recent studies have also suggested that the vasodilator and protective effects of halogenated anaesthetics are mediated partly via KATP channel opening. This study examined the effects of concurrent administration of nicorandil and isoflurane on haemodynamic state and ventricular function before, during and after 15 min of ischaemia. We studied left ventricular function in 40 anaesthetized rabbits using ultrasonomicrometry. Measurements were obtained before, during and after 15 min of regional ischaemia. Regional ventricular function was assessed in terms of systolic shortening (SS%) and preload recruitable work area (PRWA, the area beneath the regional stroke work vs end-diastolic length relationship) during reperfusion. Four groups were studied: group F (n = 10) received a bolus dose of fentanyl 100 micrograms kg-1 and then 400 micrograms kg-1 h-1 throughout; group 1 (n = 10) received 2.05% end-tidal concentration of isoflurane (1 MAC); group FN (n = 10) received fentanyl, a bolus does of nicorandil 100 micrograms kg-1 and then 25 micrograms kg-1 min-1, 15 min before occlusion; and group IN (n = 10) received isoflurane and nicorandil. Isoflurane decreased left ventricular systolic pressure and ventricular contractility (+dP/dtmax, slope of preload recruitable stroke work, and SS%). Nicorandil increased -dP/dtmax in group FN. Post-ischaemic regional left ventricular contractility in group I did not differ from that in group F, however, groups receiving nicorandil recovered to a greater extent. Group IN showed better recovery compared with all other groups when ventricular contractility was assessed by PRWA normalized to pre-occlusion values (mean 99.3 (SEM 10.5)% vs 73.4 (7.5)%, 50.2 (5.8)% and 52.4 (3.7)% at 120 min reperfusion in groups FN, I and F, respectively). Tissue ATP and lactate contents did not differ between groups. We conclude that concurrent administration of nicorandil and isoflurane enhanced post-ischaemic recovery compared with isoflurane anaesthesia or nicorandil and fentanyl administration.
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Affiliation(s)
- V Piriou
- Hôpital Cardio-Vasculaire Louis Pradel, Département d'Anesthésie Réanimation, Lyon Bron, France
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41
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Cahen P, Grunwald D, Pigott D, Brocard M, Khochbin S, Lawrence J. Characterization of a mutated p53 exhibiting a cell cycle-related nuclear translocation. Int J Oncol 1994; 5:811-7. [PMID: 21559646 DOI: 10.3892/ijo.5.4.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We studied the p53 expression in the F4NW0 cell line. We found that this mutated p53 has a deletion of eight amino acids, between the conserved domains IV and V. Only one of the two alleles is expressed. It contains a single base mutation, which seems to promote the use of a cryptic splicing acceptor site, resulting in the observed deletion. The protein shows a cell cycle-dependent nuclear translocation: in G(1), it is exclusively cytoplasmic, and during the G(1)/S transition, it translocates into the nucleus. Nevertheless, different antibodies assayed revealed different patterns of localization.
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Affiliation(s)
- P Cahen
- CEA,DEPT BIOL MOLEC & STRUCT,INSERM,U309,BIOL MOLEC CYCLE CELLULAIRE LAB,F-38054 GRENOBLE 9,FRANCE
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42
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Abstract
Infection of quiescent rat kidney cells with human adenovirus is shown to transcriptionally stimulate (transactivate) the p53 oncogene. The increased transcription results in an accumulation of p53-specific mRNA in parallel with an increase in p53 protein levels, although there is a considerable delay between transcriptional activation and the detection of stable p53 mRNA and protein. The induction of p53 is detectable with two monoclonal antibodies recognizing different epitopes. The induction of p53 by adenovirus is delayed compared to induction by serum, and it occurs after the onset of adenovirus-induced cellular DNA replication. Thus, adenovirus-induced DNA replication bypasses a G0/G1 control point. Experiments with hydroxyurea show that p53 activation does not require continued cell cycling and thus is likely to be a direct consequence of viral gene expression. Finally, the induction of p53 is shown to be dependent on expression of the 289-residue product encoded by the viral E1a gene.
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Affiliation(s)
- A Braithwaite
- Division of Cell Biology, John Curtin School of Medical Research, Australian National University, Canberra
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43
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Coombs LM, Pigott D, Proctor A, Eydmann M, Denner J, Knowles MA. Simultaneous isolation of DNA, RNA, and antigenic protein exhibiting kinase activity from small tumor samples using guanidine isothiocyanate. Anal Biochem 1990; 188:338-43. [PMID: 2221384 DOI: 10.1016/0003-2697(90)90617-i] [Citation(s) in RCA: 35] [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] [Indexed: 12/30/2022]
Abstract
Correlative studies of genes and their expression in human tumors are often hampered by the small sample size and the need to use differing and incompatible techniques to obtain DNA, RNA, and protein. We describe an extension of the established guanidine isothiocyanate method for isolation of DNA and RNA which allows the simultaneous isolation of total cellular protein. The protein obtained by this method (from solid tumors and cell lines) was comparable to protein extracted by a standard detergent solubilization method. Antigenicity was retained as demonstrated by Western blotting for epidermal growth factor receptor and actin and by immunoprecipitation of p53. Kinase activity was similar in proteins extracted by the two methods. It seems probable that most monomeric proteins can be obtained in a form suitable for Western analysis and immunoprecipitation and that these may also retain some functional activity.
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Affiliation(s)
- L M Coombs
- Marie Curie Research Institute, Oxted, Surrey, United Kingdom
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44
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Abstract
Rapid proliferation of mammary epithelial cells derived from biopsy specimens of human fibroadenomas was observed when medium was supplemented with ten percent fetal bovine serum and hydrocortisone (5 microgram per ml-1). Hydrocortisone in combination with FBS also led to a 2.5-fold increase in cell cluster attachment and subsequent colony formation. A similar effect was not observed with human serum. In contrast to fibroblast cell systems, insulin did not significantly alter cell growth. The results show that a mitogenic response to glucocorticoids by mammary epithelium may depend on the presence of factors in sera.
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45
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Abstract
Clusters of cells derived from biopsy specimens of human mammary ductal carcinomas form two morphologically distinct epithelial colonies in culture, designated as E and E'. The proportion of E' cell clusters that attached and formed colonies ranged from 0.3 to 13.0% with different tumors. Attachment was independent of tumor grade. Microscopic observations revealed that the survival of E' cell colonies was limited to approximately 10 days with rapid cell degeneration commencing about 7 days. A comparison of sera showed that colony formation by cells from malignant tumors during the 1st week of culture was maximum in the presence of fetal bovine serum. Human serum alone was 70 to 100% less effective in promoting E' colonies. The most significant finding was that human serum from normal donors inhibited E' colony development in the presence of FBS. Although human serum was less effective than FBS in promoting colony formation by clusters of E cells, an inhibition was not observed. Inhibitory activity could not be attributed to either antagonistic hormones or the source of human serum. These results demonstrate that normal human serum contains a factor(s) that exhibits an inhibitory activity specific for human epithelial cells (E') derived from malignant tumors.
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46
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Hallowes RC, Millis R, Pigott D, Shearer M, Stoker MG, Taylor-Papadimitriou J. Results on a pilot study of cultures of human lacteal secretions and benign and malignant breast tumors. Clin Oncol (R Coll Radiol) 1977; 3:81-90. [PMID: 862279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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47
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Stoker MG, Pigott D, Taylor-Papadimitriou J. Response to epidermal growth factors of cultured human mammary epithelial cells from benign tumours. Nature 1976; 264:764-7. [PMID: 1012318 DOI: 10.1038/264764a0] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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