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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Cruickshank S, Briggs S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Pulse oximetry has limited utility in identifying potential patients for long-term oxygen therapy. Int J Tuberc Lung Dis 2024; 28:253-255. [PMID: 38659138 DOI: 10.5588/ijtld.23.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- C J Crooks
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK
| | - J West
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK, East Midlands Academic Health Science Network, University of Nottingham, Nottingham, UK
| | - J R Morling
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Simmonds
- Nottingham University Hospitals NHS Trust, UK
| | - I Juurlink
- Nottingham University Hospitals NHS Trust, UK
| | | | - S Briggs
- Nottingham University Hospitals NHS Trust, UK
| | - S Hammond-Pears
- Nottingham University Hospitals NHS Trust, UK, East Midlands Academic Health Science Network, University of Nottingham, Nottingham, UK
| | - D Shaw
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham
| | - T R Card
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A W Fogarty
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK, Nottingham University Hospitals NHS Trust, UK, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
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Wang DS, Phu A, McKee K, Strasser SI, Sheils S, Weltman M, Sellar S, Davis JS, Young M, Braund A, Farrell GC, Blunn A, Harding D, Ralton L, Muller K, Davison SA, Shaw D, Wood M, Hajkowicz K, Skolen R, Davies J, Tate-Baker J, Doyle A, Tuma R, Hazeldine S, Lam W, Edmiston N, Zohrab K, Pratt W, Watson B, Zekry A, Stephens C, Clark PJ, Day M, Park G, Kim H, Wilson M, McGarity B, Menzies N, Russell D, Lam T, Boyd P, Kok J, George J, Douglas MW. Hepatitis C Virus Antiviral Drug Resistance and Salvage Therapy Outcomes Across Australia. Open Forum Infect Dis 2024; 11:ofae155. [PMID: 38651137 PMCID: PMC11034952 DOI: 10.1093/ofid/ofae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024] Open
Abstract
Background Hepatitis C virus (HCV) infection can now be cured with well-tolerated direct-acting antiviral (DAA) therapy. However, a potential barrier to HCV elimination is the emergence of resistance-associated substitutions (RASs) that reduce the efficacy of antiviral drugs, but real-world studies assessing the clinical impact of RASs are limited. Here, an analysis of the impact of RASs on retreatment outcomes for different salvage regimens in patients nationally who failed first-line DAA therapy is reported. Methods We collected data from 363 Australian patients who failed first-line DAA therapy, including: age, sex, fibrosis stage, HCV genotype, NS3/NS5A/NS5B RASs, details of failed first-line regimen, subsequent salvage regimens, and treatment outcome. Results Of 240 patients who were initially retreated as per protocol, 210 (87.5%) achieved sustained virologic response (SVR) and 30 (12.5%) relapsed or did not respond. The SVR rate for salvage regimens that included sofosbuvir/velpatasvir/voxilaprevir was 94.3% (n = 140), sofosbuvir/velpatasvir 75.0% (n = 52), elbasvir/grazoprevir 81.6% (n = 38), and glecaprevir/pibrentasvir 84.6% (n = 13). NS5A RASs were present in 71.0% (n = 210) of patients who achieved SVR and in 66.7% (n = 30) of patients who subsequently relapsed. NS3 RASs were detected in 20 patients (20%) in the SVR group and 1 patient in the relapse group. NS5B RASs were observed in only 3 patients. Cirrhosis was a predictor of relapse after retreatment, as was previous treatment with sofosbuvir/velpatasvir. Conclusions In our cohort, the SVR rate for sofosbuvir/velpatasvir/voxilaprevir was higher than with other salvage regimens. The presence of NS5A, NS5B, or NS3 RASs did not appear to negatively influence retreatment outcomes.
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Affiliation(s)
- Dao Sen Wang
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Amy Phu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Kristen McKee
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, The University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sinead Sheils
- AW Morrow Gastroenterology and Liver Centre, The University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia
| | - Sue Sellar
- Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia
| | - Joshua S Davis
- Department of Infectious Diseases, University of Newcastle and John Hunter Hospital, Newcastle, NSW, Australia
| | - Mel Young
- Department of Infectious Diseases, University of Newcastle and John Hunter Hospital, Newcastle, NSW, Australia
| | - Alicia Braund
- Department of Gastroenterology and Hepatology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Geoffrey C Farrell
- Department of Gastroenterology and Hepatology, Australian National University and The Canberra Hospital, Canberra, ACT, Australia
| | - Anne Blunn
- Department of Gastroenterology and Hepatology, Australian National University and The Canberra Hospital, Canberra, ACT, Australia
| | - Damian Harding
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Lucy Ralton
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Kate Muller
- Department of Gastroenterology and Hepatology, Flinders Medical Centreand Flinders University, Adelaide, SA, Australia
| | - Scott A Davison
- Department of Gastroenterology and Hepatology, University of New South Wales and Liverpool Hospital, Liverpool, NSW, Australia
| | - David Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marnie Wood
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Richard Skolen
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jane Davies
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia
| | - Jaclyn Tate-Baker
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam Doyle
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Rhoda Tuma
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Simon Hazeldine
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Wendy Lam
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Natalie Edmiston
- Department of Gastroenterology and Hepatology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Krista Zohrab
- Department of Gastroenterology and Hepatology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - William Pratt
- Department of Medicine, Shoalhaven Hospital, Nowra, NSW, Australia
| | - Belinda Watson
- Department of Medicine, Shoalhaven Hospital, Nowra, NSW, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, Australia
| | - Carlie Stephens
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, Australia
| | - Paul J Clark
- Rockhampton Blood Borne Virus & Sexual Health Service and School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Melany Day
- Rockhampton Blood Borne Virus & Sexual Health Service and School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Gordon Park
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Hami Kim
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Mark Wilson
- Department of Gastroenterology and Hepatology, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | | | - Darren Russell
- Cairns Sexual Health Service and James Cook University Cairns, St Cairns City, QLD, Australia
| | - Thao Lam
- Department of Drug Health, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Peter Boyd
- Department of Medicine, Cairns Hospital, Cairns, QLD, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Mark W Douglas
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
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McCartney EM, Ralton L, Dawe J, Richmond J, Zobel J, Wigg A, Cock V, Tse EY, Rees T, Shaw D, Ferguson C. Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities - the PROMPt Study. Clin Infect Dis 2024:ciae155. [PMID: 38513072 DOI: 10.1093/cid/ciae155] [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: 07/12/2023] [Revised: 02/01/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care-testing (POCT) on testing rates, linkage to care, treatment and acceptability of testing in three priority settings in Australia. METHODS Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service (MHS), and inpatient alcohol and other drug (AOD) unit-between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert® HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control. RESULTS 1,549 participants received a HCV antibody test with 17% (264/1,549) receiving a positive result, of which 21% (55/264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by three-fold (RR:2.57 95% CI: 2.32, 2.85) for HCV antibody testing and four-fold (RR:1.62; 95% CI:1.31, 2.01) for RNA testing. Treatment uptake was higher during the POCT intervention (86%, 47/55; P=0.010) compared to the historical controls (61%, 27/44). CONCLUSIONS This study demonstrated across three settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake linkage to care. The testing model was highly acceptable for most participants. CLINICAL TRIAL REGISTRATION ACTRN-12621001578897.
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Affiliation(s)
- Erin M McCartney
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
| | - Lucy Ralton
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
| | - Joshua Dawe
- Disease Elimination, Burnet Institute, Victoria, Australia
| | | | - Joshua Zobel
- Gastroenterolgy & Hepatology Department, Royal Adelaide Hospital, South Australia, Australia
| | - Alan Wigg
- Hepatology and Liver Transplantation Medicine Unit, Southern Adelaide Local Health Network, South Australia, Australia
| | - Victoria Cock
- Drug and Alcohol Services, South Australia, Australia
| | - Edmund Y Tse
- Gastroenterolgy & Hepatology Department, Royal Adelaide Hospital, South Australia, Australia
| | - Tom Rees
- Communicable Disease Control Branch, SA Health, South Australia, Australia
| | - David Shaw
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
| | - Catherine Ferguson
- Infectious Diseases Department, Royal Adelaide Hospital, South Australia, Australia
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van Dijk N, de Jongh W, Stärcke P, Shaw D, Bollen J, van Mook W. Case report: Organ donation after euthanasia for psychiatric suffering: some of the practical and ethical lessons Martijn taught us. Front Psychiatry 2024; 15:1234741. [PMID: 38505793 PMCID: PMC10948434 DOI: 10.3389/fpsyt.2024.1234741] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 03/21/2024] Open
Abstract
Euthanasia in psychiatric patients presents unique challenges, especially when combined with organ donation. In this article, the hurdles psychiatric patients might encounter after expressing their wish for organ donation after euthanasia, are discussed and illustrated by the case of Martijn, a 45-year-old psychiatric patient who altruistically donated his organs after euthanasia. Hospital and physician-related factors, including caution in determination of mental capacity, consideration of conflicting interests, and healthcare staff stress are discussed as impediments to organ donation after euthanasia (ODE) in psychiatric patients. The primary objective of this article is to raise awareness among psychiatrists regarding the fact that although the combination of euthanasia and organ donation is an uncommonly performed procedure, it is frequently requested by psychiatric patients. In conclusion, the article advocates for a nuanced approach, respecting patients' altruistic wishes while at the same time addressing challenges associated with ODE in psychiatric suffering. Where possible, and within the current medical, ethical and legal boundaries, the importance of facilitating organ donation without unnecessarily prolonging the suffering of competent psychiatric patients seeking euthanasia is emphasized. The topic calls, for example, for further qualitative research to understand the stakeholders' perspectives to determine the perceived possibilities on the one hand and boundaries on the other.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wim de Jongh
- Department of Organ Donation Coordination, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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Zhao J, Uhde E, Salthammer T, Antretter F, Shaw D, Carslaw N, Schieweck A. Long-term prediction of the effects of climate change on indoor climate and air quality. Environ Res 2024; 243:117804. [PMID: 38042519 DOI: 10.1016/j.envres.2023.117804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
Limiting the negative impact of climate change on nature and humans is one of the most pressing issues of the 21st century. Meanwhile, people in modern society spend most of the day indoors. It is therefore surprising that comparatively little attention has been paid to indoor human exposure in relation to climate change. Heat action plans have now been designed in many regions to protect people from thermal stress in their private homes and in public buildings. However, in order to be able to plan effectively for the future, reliable information is required about the long-term effects of climate change on indoor air quality and climate. The Indoor Air Quality Climate Change (IAQCC) model is an expediant tool for estimating the influence of climate change on indoor air quality. The model follows a holistic approach in which building physics, emissions, chemical reactions, mold growth and exposure are combined with the fundamental parameters of temperature and humidity. The features of the model have already been presented in an earlier publication, and it is now used for the expected climatic conditions in Central Europe, taking into account various shared socioeconomic pathway (SSP) scenarios up to the year 2100. For the test house examined in this study, the concentrations of pollutants in the indoor air will continue to rise. At the same time, the risk of mold growth also increases (the mold index rose from 0 to 4 in the worst case for very sensitive material). The biggest problem, however, is protection against heat and humidity. Massive structural improvements are needed here, including insulation, ventilation, and direct sun protection. Otherwise, the occupants will be exposed to increasing thermal discomfort, which can also lead to severe heat stress indoors.
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Affiliation(s)
- Jiangyue Zhao
- Fraunhofer WKI, Department of Material Analysis and Indoor Chemistry, Riedenkamp 3, 38108, Braunschweig, Germany
| | - Erik Uhde
- Fraunhofer WKI, Department of Material Analysis and Indoor Chemistry, Riedenkamp 3, 38108, Braunschweig, Germany
| | - Tunga Salthammer
- Fraunhofer WKI, Department of Material Analysis and Indoor Chemistry, Riedenkamp 3, 38108, Braunschweig, Germany
| | - Florian Antretter
- C3RROlutions GmbH, Steinbrucker Str. 11, 83064, Raubling, Germany; Fraunhofer IBP, Fraunhoferstraße 10, 83626, Valley, Germany
| | - David Shaw
- University of York, Department of Environment and Geography, Heslington, York, YO10 5NG, UK
| | - Nicola Carslaw
- University of York, Department of Environment and Geography, Heslington, York, YO10 5NG, UK
| | - Alexandra Schieweck
- Fraunhofer WKI, Department of Material Analysis and Indoor Chemistry, Riedenkamp 3, 38108, Braunschweig, Germany.
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Shaw D, Rodriguez Perez C, Persson K. Slaying the Swiss Unicorn of Animal Dignity. Animals (Basel) 2024; 14:507. [PMID: 38338150 PMCID: PMC10854624 DOI: 10.3390/ani14030507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
In this article, we describe and analyse the Swiss legislation relating to animal dignity. We conclude that previous criticisms of the law do not go far enough: far from protecting animal dignity, the Swiss law not only undermines such dignity but itself serves as a means to ensure that animals can be used merely as a means, and not treated with respect. As such, the Swiss Animal Welfare Act is deeply unethical and undermines the constitutional requirement to treat animals with dignity.
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, 4056 Basel, Switzerland; (C.R.P.); (K.P.)
- Care and Public Health Research Institute, Maastricht University, 6229 ER Maastricht, The Netherlands
| | | | - Kirsten Persson
- Institute for Biomedical Ethics, University of Basel, 4056 Basel, Switzerland; (C.R.P.); (K.P.)
- Institut für Tierhygiene, Tierschutz und Nutztierethologie, Stiftung Tierärztliche Hochschule Hannover, 30173 Hannover, Germany
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Kennedy B, Ashokan A, Lim CK, Lagana D, Juraja M, Shaw D. Designed for a pandemic: Mitigating the risk of SARS-CoV-2 transmission through hospital design and infrastructure. Infect Dis Health 2024; 29:25-31. [PMID: 37806908 DOI: 10.1016/j.idh.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND To describe the new Royal Adelaide Hospital (RAH) design and infrastructure features that helped mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within the hospital during the pre-vaccination and pre-antiviral period. METHOD The RAH infrastructure, design and initial pandemic response was assessed. A retrospective review of all confirmed or suspected coronavirus disease 2019 (COVID-19) patients admitted from 1 February 2020 to 30 May 2020 was also performed to assess risk of transmission. Outbreak response reports were reviewed to identify episodes of nosocomial COVID-19. RESULTS Key infrastructure features include single-bed overnight rooms with dedicated bathrooms, creation of pandemic areas accessible only to pandemic staff, and sophisticated air-handling units with improved ventilation. A total of 264 COVID-19 related admission occurred, with 113 confirmed cases and 1579 total cumulative bed days. Despite a limited understanding of SARS-CoV-2 transmission, no vaccination or anti-viral therapy, global shortages of particulate filter respirators and restricted testing during this period, only one probable nosocomial COVID-19 case occurred in a healthcare worker, with no nosocomial cases involving patients. CONCLUSIONS The RAH design and pandemic features complimented existing infection control interventions and was important in limiting nosocomial spread of SARS-CoV-2.
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Affiliation(s)
- Brendan Kennedy
- Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Department of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Anushia Ashokan
- Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Department of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Diana Lagana
- Infection Prevention and Control Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Marija Juraja
- Infection Prevention and Control Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - David Shaw
- Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Department of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Arbelaez Ossa L, Lorenzini G, Milford SR, Shaw D, Elger BS, Rost M. Integrating ethics in AI development: a qualitative study. BMC Med Ethics 2024; 25:10. [PMID: 38262986 PMCID: PMC10804710 DOI: 10.1186/s12910-023-01000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND While the theoretical benefits and harms of Artificial Intelligence (AI) have been widely discussed in academic literature, empirical evidence remains elusive regarding the practical ethical challenges of developing AI for healthcare. Bridging the gap between theory and practice is an essential step in understanding how to ethically align AI for healthcare. Therefore, this research examines the concerns and challenges perceived by experts in developing ethical AI that addresses the healthcare context and needs. METHODS We conducted semi-structured interviews with 41 AI experts and analyzed the data using reflective thematic analysis. RESULTS We developed three themes that expressed the considerations perceived by experts as essential for ensuring AI aligns with ethical practices within healthcare. The first theme explores the ethical significance of introducing AI with a clear and purposeful objective. The second theme focuses on how experts are concerned about the tension that exists between economic incentives and the importance of prioritizing the interests of doctors and patients. The third theme illustrates the need to develop context-sensitive AI for healthcare that is informed by its underlying theoretical foundations. CONCLUSIONS The three themes collectively emphasized that beyond being innovative, AI must genuinely benefit healthcare and its stakeholders, meaning AI also aligns with intricate and context-specific healthcare practices. Our findings signal that instead of narrow product-specific AI guidance, ethical AI development may need a systemic, proactive perspective that includes the ethical considerations (objectives, actors, and context) and focuses on healthcare applications. Ethically developing AI involves a complex interplay between AI, ethics, healthcare, and multiple stakeholders.
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Affiliation(s)
| | - Giorgia Lorenzini
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Stephen R Milford
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine (CURML), University of Geneva, Geneva, Switzerland
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Arioua A, Shaw D. Use of Expired Drugs: Patients Benefits versus Industry Interest. JMA J 2024; 7:1-4. [PMID: 38314420 PMCID: PMC10834166 DOI: 10.31662/jmaj.2022-0209] [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: 01/05/2023] [Accepted: 08/28/2023] [Indexed: 02/06/2024] Open
Abstract
The question of the use of expired medication is a constant debate of many years most especially in a difficult environment. In this research, a literature review and reported practice of some countries are used. Findings show that some medications, if properly stored, remain safe to use after the expiry date and this sometimes could be extended by many years. However, the pharmaceutical manufacturers have an interest in producing products with short shelf life. To dispose of expired ones is to generate a sale and therefore put the profit into the improvement and development of new products for the benefit of medicine. This paper emphasizes the benefit of use of some drugs after expiration and the interest for the pharmaceutical industry to dispose of expired drugs and to shorten their shelf life.
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Affiliation(s)
- Anis Arioua
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Thom R, Ayares D, Cooper DKC, Dark J, Fovargue S, Fox M, Gusmano M, Locke J, McGregor C, Parent B, Ravanan R, Shaw D, Dorling A, Cronin AJ. Update on the ethical, legal and technical challenges of translating xenotransplantation. J Med Ethics 2023:jme-2023-109298. [PMID: 37949649 DOI: 10.1136/jme-2023-109298] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/01/2023] [Indexed: 11/12/2023]
Abstract
This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King's College London, with endorsement from the British Transplantation Society (BTS), and the European Society of Organ Transplantation (ESOT), brought together a group of experts in xenotransplantation science, ethics and law to discuss the ethical, regulatory and technical challenges surrounding translating xenotransplantation into the clinical setting. The symposium was the first of its kind in the UK for 20 years. This paper summarises the content of the expert lectures showcasing the progress which has been made in xenotransplantation including-the history of xenotransplantation, advances in gene edited animals and progress towards clinical xenotransplantation. We then set out the ethical and legal issues still to be resolved. Finally, we report the themes of the roundtable discussion highlighting areas of consensus and controversy. While the detail of the legal discussion was directed towards the UK, the principles and summary reported here are intended to be applicable to any jurisdiction seeking to implement clinical xenotransplantation.
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Affiliation(s)
- Rebecca Thom
- Department of Nephrology and Transplantation, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - David K C Cooper
- Centre for Transplantation Sciences, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - John Dark
- Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Sara Fovargue
- School of Law, The University of Sheffield, Sheffield, UK
| | - Marie Fox
- School of Law and Social Justice at the University of Liverpool, Liverpool, Merseyside, UK
| | - Michael Gusmano
- Community and Population Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Jayme Locke
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chris McGregor
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brendan Parent
- Medical Ethics, New York University School of Medicine, New York, New York, USA
| | | | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Anthony Dorling
- Department of Nephrology and Transplantation, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Centre for Nephrology, Urology and Transplantation, King's College, London, UK
| | - Antonia J Cronin
- Department of Nephrology and Transplantation, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Centre for Nephrology, Urology and Transplantation, King's College, London, UK
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Abdel-Hadi O, Zhong J, Tingerides C, Shaw D, McPherson S, Puppala S, Walker P. Midterm Outcomes of Primary and Secondary Use of an Endoanchor System for Thoracic and Abdominal Aortic Endovascular Aortic Repair. J Vasc Interv Radiol 2023; 34:1938-1945. [PMID: 37582422 DOI: 10.1016/j.jvir.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To assess the safety, technical success, and midterm outcomes of endoanchor (Heli-FX, Medtronic, Santa Rosa, California) deployment in thoracic endovascular aortic repair (TEVAR) or abdominal endovascular aortic repair (EVAR). MATERIALS AND METHODS This single-institution, retrospective study of all endoanchor procedures was performed from February 1, 2017 to March 30, 2021. All procedures were performed percutaneously by interventional radiologists. Clinical information and outcome data were retrieved from electronic medical records. Fifty patients (14% females, n = 7; 86% males, n = 43; median age, 79 years [range, 56-93 years]) underwent Endoanchor procedures, with 349 Endoanchors implanted; 33 procedures were primary deployments (at initial stent deployment) and 17 were secondary deployments (previous stent deployment). For the primary group (4 TEVARs and 29 EVARs), indications were prophylactic (n = 30), hostile neck (n = 28), hostile distal landing zone (n = 2), and intraprocedural type 1a endoleaks (n = 3). For the secondary group (4 TEVARs and 13 EVARs), indications were graft migration (n = 8), seal zone expansion without proven endoleak (n = 7) (proximal [n = 4] or distal seal [n = 3]), and proven type 1a endoleak (n = 2). RESULTS Median number of endoanchors deployed per procedure was 7 (range, 3-10). Median time to deploy endoanchors was 22 minutes (range, 8-46 minutes). The technical success rate of Endoanchor was 99.7% (348/349). The 30-day mortality rate was 0%. The overall adverse event rate was 6% (n = 3). Reinterventions were performed in 12% of patients (n = 6). Median follow-up was 38 months (range, 2-71 months). Overall survival at 1 and 3 years was 95% and 85%, respectively. Overall freedom from type 1a endoleak at 1 and 3 years was 96% and 93%, respectively. CONCLUSIONS Endoanchor procedures are safe with excellent technical success rate and good midterm clinical outcomes.
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Affiliation(s)
- Omar Abdel-Hadi
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom
| | - Jim Zhong
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom; School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Costa Tingerides
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom; School of Medicine, University of Leeds, Leeds, United Kingdom
| | - David Shaw
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom; School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon McPherson
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom; School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sapna Puppala
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom; School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Paul Walker
- Department of Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom; School of Medicine, University of Leeds, Leeds, United Kingdom.
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Milford SR, Shaw D, Starke G. Playing Brains: The Ethical Challenges Posed by Silicon Sentience and Hybrid Intelligence in DishBrain. Sci Eng Ethics 2023; 29:38. [PMID: 37882881 PMCID: PMC10602981 DOI: 10.1007/s11948-023-00457-x] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
The convergence of human and artificial intelligence is currently receiving considerable scholarly attention. Much debate about the resulting Hybrid Minds focuses on the integration of artificial intelligence into the human brain through intelligent brain-computer interfaces as they enter clinical use. In this contribution we discuss a complementary development: the integration of a functional in vitro network of human neurons into an in silico computing environment.To do so, we draw on a recent experiment reporting the creation of silico-biological intelligence as a case study (Kagan et al., 2022b). In this experiment, multielectrode arrays were plated with stem cell-derived human neurons, creating a system which the authors call DishBrain. By embedding the system into a virtual game-world, neural clusters were able to receive electrical input signals from the game-world and to respond appropriately with output signals from pre-assigned motor regions. Using this design, the authors demonstrate how the DishBrain self-organises and successfully learns to play the computer game 'Pong', exhibiting 'sentient' and intelligent behaviour in its virtual environment.The creation of such hybrid, silico-biological intelligence raises numerous ethical challenges. Following the neuroscientific framework embraced by the authors themselves, we discuss the arising ethical challenges in the context of Karl Friston's Free Energy Principle, focusing on the risk of creating synthetic phenomenology. Following the DishBrain's creator's neuroscientific assumptions, we highlight how DishBrain's design may risk bringing about artificial suffering and argue for a congruently cautious approach to such synthetic biological intelligence.
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Affiliation(s)
- Stephen R Milford
- Department of Theology, North-West University, Potchefstroom, South Africa.
- Institute for Biomedical Ethics, Basel University, Basel, Switzerland.
| | - David Shaw
- Institute for Biomedical Ethics, Basel University, Basel, Switzerland
- Maastricht University, Maastricht, Netherlands
| | - Georg Starke
- College of Humanities, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institute for History and Ethics of Medicine, Technical University of Munich, Munich, Germany
- Munich School of Philosophy, Munich, Germany
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13
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Floden A, Gardiner D, Jansen N, Shaw D. 117.4: Directed Deceased Donation - pros and cons. Transplantation 2023; 107:10. [PMID: 37845858 DOI: 10.1097/01.tp.0000993012.73335.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Anne Floden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Södra Älvsborg Hospital, Borås, Sweden
| | | | | | - David Shaw
- Dept. of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
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14
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Martinello M, Bhagani S, Shaw D, Orkin C, Cooke G, Gane E, Iser D, Ustianowski A, Kulasegaram R, Stedman C, Tu E, Grebely J, Dore GJ, Nelson M, Matthews GV. Glecaprevir-pibrentasvir for 4 weeks among people with recent HCV infection: The TARGET3D study. JHEP Rep 2023; 5:100867. [PMID: 37771545 PMCID: PMC10522905 DOI: 10.1016/j.jhepr.2023.100867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/01/2023] [Indexed: 09/30/2023] Open
Abstract
Background & Aims Short duration treatment may aid HCV elimination among key populations. This study evaluated the efficacy of glecaprevir-pibrentasvir for 4 weeks among people with recent HCV infection. Methods In this single-arm multicentre international trial, adults with recent HCV (duration of infection <12 months) received glecaprevir-pibrentasvir 300 mg-120 mg daily for 4 weeks. Primary infection was defined as a first positive anti-HCV antibody and/or HCV RNA measurement within 6 months of enrolment and either acute clinical hepatitis within 12 months (symptomatic illness or alanine aminotransferase >10x the upper limit of normal) or antibody seroconversion within 18 months. Reinfection was defined as new positive HCV RNA within 6 months and prior clearance (spontaneous or treatment). The primary endpoint was sustained virological response at 12 weeks post-treatment (SVR12) in the intention-to-treat (ITT) and per-protocol (PP) populations. Results Twenty-three participants (96% men, 70% HIV, 57% ever injected drugs) received treatment, of whom 74% had genotype 1a infection and 35% recent reinfection. At baseline, median duration of infection was 17 weeks (IQR 11-29) and HCV RNA was 5.8 log10IU/ml (IQR 5.2-6.9). SVR12 was achieved by 78% (18/23; 95% CI 56-93%) and 82% (18/22; 95% CI 60-95%) of the ITT and PP populations, respectively, and in 100% (12/12; 95% CI 74-100%) of participants with baseline HCV RNA ≤6 log10. There were four cases of virological failure (relapse); three received retreatment with 12 weeks sofosbuvir-velpatasvir or grazoprevir-elbasvir (SVR, n = 2; loss to follow-up, n = 1). No serious adverse events were reported. Conclusion While most achieved SVR, the efficacy of a 4-week regimen of glecaprevir-pibrentasvir was lower than observed with longer treatment durations (≥6 weeks) among people with recent HCV. Trial Registration Clinicaltrials.gov Identifier: NCT02634008. Impact and implications Short duration treatment may aid HCV elimination among key populations. This investigator-initiated single-arm multicentre international pilot trial demonstrated that efficacy of glecaprevir-pibrentasvir for 4 weeks among people with recent HCV infection was sub-optimal (SVR12 78% ITT, 82% PP). Baseline HCV RNA appeared to impact response, with higher efficacy among participants with lower baseline HCV RNA (≤6 log10; SVR12 100% ITT, 12/12). While most achieved SVR, the efficacy of 4 weeks of glecaprevir-pibrentasvir was below that seen with longer treatment durations (≥6 weeks).
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Affiliation(s)
- Marianne Martinello
- Kirby Institute, UNSW, Sydney, Australia
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
| | - Sanjay Bhagani
- Department of Infectious Diseases/HIV Medicine, Royal Free Hospital, London, UK
| | - David Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, Australia
| | - Chloe Orkin
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham Cooke
- Department of Infectious Diseases, Imperial College NHS Trust, St Mary’s Hospital, London, UK
| | - Edward Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - David Iser
- The Alfred Hospital, Melbourne, Australia Burnet Institute, Melbourne, Australia
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
| | | | | | | | - Elise Tu
- Kirby Institute, UNSW, Sydney, Australia
| | | | - Gregory J. Dore
- Kirby Institute, UNSW, Sydney, Australia
- Department of Infectious Diseases, St Vincent’s Hospital, Sydney, Australia
| | - Mark Nelson
- Chelsea and Westminster Hospital, London, UK
| | - Gail V. Matthews
- Kirby Institute, UNSW, Sydney, Australia
- Department of Infectious Diseases, St Vincent’s Hospital, Sydney, Australia
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15
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Shaw D, Abad R, Amin-Chowdhury Z, Bautista A, Bennett D, Broughton K, Cao B, Casanova C, Choi EH, Chu YW, Claus H, Coelho J, Corcoran M, Cottrell S, Cunney R, Cuypers L, Dalby T, Davies H, de Gouveia L, Deghmane AE, Demczuk W, Desmet S, Domenech M, Drew R, du Plessis M, Duarte C, Erlendsdóttir H, Fry NK, Fuursted K, Hale T, Henares D, Henriques-Normark B, Hilty M, Hoffmann S, Humphreys H, Ip M, Jacobsson S, Johnson C, Johnston J, Jolley KA, Kawabata A, Kozakova J, Kristinsson KG, Krizova P, Kuch A, Ladhani S, Lâm TT, León ME, Lindholm L, Litt D, Maiden MCJ, Martin I, Martiny D, Mattheus W, McCarthy ND, Meehan M, Meiring S, Mölling P, Morfeldt E, Morgan J, Mulhall R, Muñoz-Almagro C, Murdoch D, Murphy J, Musilek M, Mzabi A, Novakova L, Oftadeh S, Perez-Argüello A, Pérez-Vázquez M, Perrin M, Perry M, Prevost B, Roberts M, Rokney A, Ron M, Sanabria OM, Scott KJ, Sheppard C, Siira L, Sintchenko V, Skoczyńska A, Sloan M, Slotved HC, Smith AJ, Steens A, Taha MK, Toropainen M, Tzanakaki G, Vainio A, van der Linden MPG, van Sorge NM, Varon E, Vohrnova S, von Gottberg A, Yuste J, Zanella R, Zhou F, Brueggemann AB. Trends in invasive bacterial diseases during the first 2 years of the COVID-19 pandemic: analyses of prospective surveillance data from 30 countries and territories in the IRIS Consortium. Lancet Digit Health 2023; 5:e582-e593. [PMID: 37516557 PMCID: PMC10914672 DOI: 10.1016/s2589-7500(23)00108-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/22/2023] [Accepted: 05/25/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND The Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic. METHODS For this prospective analysis, laboratories in 30 countries and territories representing five continents submitted surveillance data from Jan 1, 2018, to Jan 2, 2022, to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype or group were examined. Interrupted time-series analyses were done to quantify the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models were used to estimate effect sizes and forecast counterfactual trends by hemisphere. FINDINGS Overall, 116 841 cases were analysed: 76 481 in 2018-19, before the pandemic, and 40 360 in 2020-21, during the pandemic. During the pandemic there was a significant reduction in the risk of disease caused by S pneumoniae (risk ratio 0·47; 95% CI 0·40-0·55), H influenzae (0·51; 0·40-0·66) and N meningitidis (0·26; 0·21-0·31), while no significant changes were observed for S agalactiae (1·02; 0·75-1·40), which is not transmitted via the respiratory route. No major changes in the distribution of cases were observed when stratified by patient age or serotype or group. An estimated 36 289 (95% prediction interval 17 145-55 434) cases of invasive bacterial disease were averted during the first 2 years of the pandemic among IRIS-participating countries and territories. INTERPRETATION COVID-19 containment measures were associated with a sustained decrease in the incidence of invasive disease caused by S pneumoniae, H influenzae, and N meningitidis during the first 2 years of the pandemic, but cases began to increase in some countries towards the end of 2021 as pandemic restrictions were lifted. These IRIS data provide a better understanding of microbial transmission, will inform vaccine development and implementation, and can contribute to health-care service planning and provision of policies. FUNDING Wellcome Trust, NIHR Oxford Biomedical Research Centre, Spanish Ministry of Science and Innovation, Korea Disease Control and Prevention Agency, Torsten Söderberg Foundation, Stockholm County Council, Swedish Research Council, German Federal Ministry of Health, Robert Koch Institute, Pfizer, Merck, and the Greek National Public Health Organization.
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Affiliation(s)
- David Shaw
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Raquel Abad
- National Reference Laboratory for Meningococci, National Center of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | | | - Desiree Bennett
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland
| | - Karen Broughton
- Staphylococcus and Streptococcus Reference Section, AMRHAI, UK Health Security Agency, London, UK
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Carlo Casanova
- Swiss National Reference Center for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Yiu-Wai Chu
- Department of Health, Microbiology Division, Public Health Laboratory Services Branch, Centre for Health Protection, Hong Kong Special Administrative Region, China
| | - Heike Claus
- University of Würzburg, Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, Würzburg, Germany
| | - Juliana Coelho
- Staphylococcus and Streptococcus Reference Section, AMRHAI, UK Health Security Agency, London, UK
| | - Mary Corcoran
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Robert Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lize Cuypers
- National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Tine Dalby
- Statens Serum Institut, Department of Infectious Disease Epidemiology & Prevention, Copenhagen, Denmark
| | - Heather Davies
- Meningococcal Reference Laboratory, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Linda de Gouveia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ala-Eddine Deghmane
- Institut Pasteur, Univeristé Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Stefanie Desmet
- National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Mirian Domenech
- National Center for Microbiology and CIBER of Respiratory Research, Instituto de Salud Carlos III, Madrid, Spain
| | - Richard Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Clinical Innovation Unit, Rotunda, Dublin, Ireland
| | - Mignon du Plessis
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | | | - Helga Erlendsdóttir
- Department of Clinical Microbiology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Norman K Fry
- Immunisation and Vaccine Preventable Diseases Division and Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
| | - Kurt Fuursted
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Copenhagen, Denmark
| | - Thomas Hale
- Blavatnik School of Government, University of Oxford, Oxford, UK
| | - Desiree Henares
- Microbiology Department, Institut Recerca Sant Joan de Déu, Hospital Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Birgitta Henriques-Normark
- Karolinska Institutet, Karolinska University Hospital, Public Health Agency of Sweden, Stockholm, Sweden
| | - Markus Hilty
- Swiss National Reference Center for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Steen Hoffmann
- Statens Serum Institut, Department of Bacteria, Parasites & Fungi, Copenhagen, Denmark
| | - Hilary Humphreys
- Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Susanne Jacobsson
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | | | | | - Jana Kozakova
- National Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Karl G Kristinsson
- Department of Clinical Microbiology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Pavla Krizova
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Alicja Kuch
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, UK Health Security Agency, London, UK
| | - Thiên-Trí Lâm
- University of Würzburg, Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, Würzburg, Germany
| | | | - Laura Lindholm
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
| | | | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Delphine Martiny
- National Belgian Reference Centre for Haemophilus influenzae, Laboratoire des Hôpitaux Universitaires de Bruxelles-Universitair Laboratorium van Brussel, Brussels, Belgium; Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium
| | | | - Noel D McCarthy
- Population Health Medicine, Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland
| | - Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Paula Mölling
- National Reference Laboratory for Neisseria meningitidis, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Julie Morgan
- Streptococcal Reference Laboratory, Institute of Environmental Science and Research Limited, Porirua, New Zealand
| | - Robert Mulhall
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland, Dublin, Ireland
| | - Carmen Muñoz-Almagro
- Microbiology Department, Institut Recerca Sant Joan de Déu, Hospital Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | - Martin Musilek
- National Reference Laboratory for Meningococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Alexandre Mzabi
- Ministère de la Santé - Direction de la santé, Luxembourg, Luxembourg
| | - Ludmila Novakova
- National Reference Laboratory for Haemophilus Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Shahin Oftadeh
- NSW Pneumococcal Reference Laboratory, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Sydney, NSW, Australia
| | - Amaresh Perez-Argüello
- Microbiology Department, Institut Recerca Sant Joan de Déu, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Maria Pérez-Vázquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Benoit Prevost
- National Belgian Reference Centre for Haemophilus influenzae, Laboratoire des Hôpitaux Universitaires de Bruxelles-Universitair Laboratorium van Brussel, Brussels, Belgium
| | | | - Assaf Rokney
- Public Health Laboratories-Jerusalem, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Merav Ron
- Public Health Laboratories-Jerusalem, Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Kevin J Scott
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow Royal Infirmary, Glasgow, UK
| | - Carmen Sheppard
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
| | - Lotta Siira
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Vitali Sintchenko
- NSW Pneumococcal Reference Laboratory, Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Sydney, NSW, Australia; Sydney Institute for Infectious Diseases, University of Sydney, NSW, Australia
| | - Anna Skoczyńska
- National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | | | | | - Andrew J Smith
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratories, Glasgow Royal Infirmary, Glasgow, UK; College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Anneke Steens
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Muhamed-Kheir Taha
- Institut Pasteur, Univeristé Paris Cité, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus influenzae, Paris, France
| | | | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Anni Vainio
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mark P G van der Linden
- Department of Medical Microbiology, German National Reference Centre for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
| | - Nina M van Sorge
- Department of Medical Microbiology and Infection Prevention, and Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Emmanuelle Varon
- Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France
| | - Sandra Vohrnova
- National Reference Laboratory for Streptococcal Infections, Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Jose Yuste
- National Center for Microbiology and CIBER of Respiratory Research, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosemeire Zanella
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz, São Paulo, Brazil
| | - Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Angela B Brueggemann
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK.
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16
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Jones J, Correll DJ, Lechner SM, Jazic I, Miao X, Shaw D, Simard C, Osteen JD, Hare B, Beaton A, Bertoch T, Buvanendran A, Habib AS, Pizzi LJ, Pollak RA, Weiner SG, Bozic C, Negulescu P, White PF. Selective Inhibition of Na V1.8 with VX-548 for Acute Pain. N Engl J Med 2023; 389:393-405. [PMID: 37530822 DOI: 10.1056/nejmoa2209870] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND The NaV1.8 voltage-gated sodium channel, expressed in peripheral nociceptive neurons, plays a role in transmitting nociceptive signals. The effect of VX-548, an oral, highly selective inhibitor of NaV1.8, on control of acute pain is being studied. METHODS After establishing the selectivity of VX-548 for NaV1.8 inhibition in vitro, we conducted two phase 2 trials involving participants with acute pain after abdominoplasty or bunionectomy. In the abdominoplasty trial, participants were randomly assigned in a 1:1:1:1 ratio to receive one of the following over a 48-hour period: a 100-mg oral loading dose of VX-548, followed by a 50-mg maintenance dose every 12 hours (the high-dose group); a 60-mg loading dose of VX-548, followed by a 30-mg maintenance dose every 12 hours (the middle-dose group); hydrocodone bitartrate-acetaminophen (5 mg of hydrocodone bitartrate and 325 mg of acetaminophen every 6 hours); or oral placebo every 6 hours. In the bunionectomy trial, participants were randomly assigned in a 2:2:1:2:2 ratio to receive one of the following over a 48-hour treatment period: oral high-dose VX-548; middle-dose VX-548; low-dose VX-548 (a 20-mg loading dose, followed by a 10-mg maintenance dose every 12 hours); oral hydrocodone bitartrate-acetaminophen (5 mg of hydrocodone bitartrate and 325 mg of acetaminophen every 6 hours); or oral placebo every 6 hours. The primary end point was the time-weighted sum of the pain-intensity difference (SPID) over the 48-hour period (SPID48), a measure derived from the score on the Numeric Pain Rating Scale (range, 0 to 10; higher scores indicate greater pain) at 19 time points after the first dose of VX-548 or placebo. The main analysis compared each dose of VX-548 with placebo. RESULTS A total of 303 participants were enrolled in the abdominoplasty trial and 274 in the bunionectomy trial. The least-squares mean difference between the high-dose VX-548 and placebo groups in the time-weighted SPID48 was 37.8 (95% confidence interval [CI], 9.2 to 66.4) after abdominoplasty and 36.8 (95% CI, 4.6 to 69.0) after bunionectomy. In both trials, participants who received lower doses of VX-548 had results similar to those with placebo. Headache and constipation were common adverse events with VX-548. CONCLUSIONS As compared with placebo, VX-548 at the highest dose, but not at lower doses, reduced acute pain over a period of 48 hours after abdominoplasty or bunionectomy. VX-548 was associated with adverse events that were mild to moderate in severity. (Funded by Vertex Pharmaceuticals; VX21-548-101 and VX21-548-102 ClinicalTrials.gov numbers, NCT04977336 and NCT05034952.).
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Affiliation(s)
- Jim Jones
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Darin J Correll
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Sandra M Lechner
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Ina Jazic
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Xiaopeng Miao
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - David Shaw
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Christopher Simard
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Jeremiah D Osteen
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Brian Hare
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Alina Beaton
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Todd Bertoch
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Asokumar Buvanendran
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Ashraf S Habib
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Lois J Pizzi
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Richard A Pollak
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Scott G Weiner
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Carmen Bozic
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Paul Negulescu
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
| | - Paul F White
- From Vertex Pharmaceuticals (J.J., D.J.C., S.M.L., I.J., X.M., D.S., C.S., J.D.O., B.H., C.B., P.N.) and Brigham and Women's Hospital (S.G.W.) - both in Boston; Lotus Clinical Research, Pasadena (A. Beaton), Cedars-Sinai Medical Center, Los Angeles (P.F.W.), and White Mountain Institute, Sea Ranch (P.F.W.) - all in California; JBR Clinical Research, Salt Lake City (T.B.); Rush University Medical Center, Chicago (A. Buvanendran); Duke University School of Medicine, Durham, NC (A.S.H.); the University of Pittsburgh Medical Center, Pittsburgh (L.J.P.); and Endeavor Clinical Trials, San Antonio, TX (R.A.P.)
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17
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Beel G, Langford B, Carslaw N, Shaw D, Cowan N. Temperature driven variations in VOC emissions from plastic products and their fate indoors: A chamber experiment and modelling study. Sci Total Environ 2023; 881:163497. [PMID: 37062317 DOI: 10.1016/j.scitotenv.2023.163497] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 06/01/2023]
Abstract
Plastic products are ubiquitous in our homes, but we know very little about emissions from these products and their subsequent impact on indoor air quality. This is the first study to systematically determine temperature-dependent emissions of volatile organic compounds from commonly used plastic consumer products found in the home. The plastic types included high-density polyethylene (HDPE), polypropylene (PP), polyethylene terephthalate (PET), polystyrene (PS) and polyester rubber. Plastic samples were exposed to increasing temperatures (between 18 and 28 °C) in controlled environmental chambers, connected to a proton-transfer-reaction time-of-flight mass-spectrometer (PTR-ToF-MS), where real-time emissions were detected. Average emission rates were determined and used to initialise an indoor air chemistry model (INCHEM-Py) at the highest and lowest experimental temperatures, to explore the impact these product emissions have on the indoor air chemistry. The PS tubing plastic proved to be the highest emitting polymer per surface area. Almost all selected VOC emissions were found to have a linear relationship with temperature. Upon observing the impacts of primary VOC emissions from plastics in modelled simulations, the hydroxyl radical concentration decreased by an average of 1.6 and 10 % relative to the baseline (with no plastics included) at 18 °C and 28 °C respectively. On the other hand, formaldehyde concentrations increased by 29 and 31.6 % relative to the baseline conditions at 18 °C and 28 °C respectively. The presence of plastic products indoors, therefore, has the potential to impact the indoor air quality.
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Affiliation(s)
- Georgia Beel
- UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Edinburgh EH26 0QB, United Kingdom; Department of Geography and Environment, University of York, Heslington, York YO10 5DD, United Kingdom.
| | - Ben Langford
- UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Edinburgh EH26 0QB, United Kingdom
| | - Nicola Carslaw
- Department of Geography and Environment, University of York, Heslington, York YO10 5DD, United Kingdom
| | - David Shaw
- Department of Geography and Environment, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Nicholas Cowan
- UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Edinburgh EH26 0QB, United Kingdom
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Shaw D, Morfeld P, Erren T. Turing, Djerassi, "athletics" & ethics: The (mis)use of ChatGPT in science and education: Turing, Djerassi, "athletics" & ethics. EMBO Rep 2023:e57501. [PMID: 37259767 DOI: 10.15252/embr.202357501] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
ChatGPT is an amazing advance in technology, but it poses problems for teachers in universities and schools. How should use of ChatGPT by students be dealt with?
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Peter Morfeld
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
| | - Thomas Erren
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University Hospital of Cologne, Cologne, Germany
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19
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van Dijk N, Shaw D, Shemie S, Wiebe K, van Mook W, Bollen J. Directed Organ Donation After Euthanasia. Transpl Int 2023; 36:11259. [PMID: 37324219 PMCID: PMC10262997 DOI: 10.3389/ti.2023.11259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Organ donation after euthanasia is performed in Belgium, the Netherlands, Canada and Spain. Directed deceased organ donation is currently possible under strict conditions in a limited number of countries, while it is currently not possible to opt for directed donation following euthanasia. While organ donation after euthanasia is a deceased donation procedure, directed organ donation after euthanasia could be seen as a deceased donation procedure with a living donation consent process. Therefore, directed organ donation after euthanasia is feasible on medical and ethical grounds. Strict safeguards should be in place, including the requirement of a pre-existing familial or personal relationship with the proposed recipient, without any evidence of coercion or financial gain.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Sam Shemie
- Division of Critical Care, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Kim Wiebe
- Medical Assistance in Dying, Shared Health Services, Winnipeg, MB, Canada
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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Tajaâte N, van Dijk N, Pragt E, Shaw D, Kempener-Deguelle A, Jongh WD, Bollen J, van Mook W. Reply to reaction on 'Organ donation after euthanasia starting at home in a patient with multiple system atrophy - case report'. BMC Med Ethics 2023; 24:33. [PMID: 37248488 DOI: 10.1186/s12910-023-00914-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
We would like to respond to the comment we received from our colleagues on our case report about organ donation after euthanasia starting at home. We reply to their statements on medical and legal aspects, and provide more information on our view of informed consent.
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Affiliation(s)
- Najat Tajaâte
- Department of Anesthesiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Nathalie van Dijk
- Department of Anesthesiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Elien Pragt
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
| | - A Kempener-Deguelle
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wim de Jongh
- Department of Organ Donation Coordination, Department of Organ Donation Coordination, Maastricht, The Netherlands
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Walther van Mook
- Department of Anesthesiology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
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21
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Jeker B, Shaw D, Lagnaux N, Wangmo T, Elger BS. Motivation and training needs of prison healthcare professionals: findings from a qualitative study. BMC Psychol 2023; 11:167. [PMID: 37210567 DOI: 10.1186/s40359-023-01076-8] [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: 04/09/2022] [Accepted: 02/03/2023] [Indexed: 05/22/2023] Open
Abstract
Health care in prison is a challenging task. The conditions of imprisonment create distinct difficulties for those providing health care in this setting. These particular circumstances have led to a shortage of quality professionals, working for the health of imprisoned people. The aim of this study is to elaborate reasons for healthcare professionals to work in a prison environment. The main research question is: why do healthcare workers choose to work in prisons? Furthermore, our study identifies training needs in various fields. Interview data that comes from a national project carried out in Switzerland and three other relatively wealthy countries were analyzed using content analysis. One-on-one, semi structured interviews were designed and conducted with professionals working in prison context. A total of 105 interviews were carried out and for this work 83 of them were analyzed and coded into themes responding to the study aim. Most participants chose to work in prison either because of practical reasons, as many reported various forms of contact with the studied prison environment at a younger age, or because of intrinsic reasons, including among others, having the wish to change the system of healthcare in prisons. Even though the education of the participants varied greatly, a lack of specialist training was expressed by many health care professions as an important factor. This study points out the need for more specific training programs for healthcare workers in prison and provides suggestions to ameliorate the recruitment and education for future prison health care workers.
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Affiliation(s)
- Benjamin Jeker
- Medizinische Fakultät, University of Basel, Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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22
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Worsham CM, Zimerman A, Woo J, Shaw D, Jena AB. Association between UFO sightings and emergency department visits. Am J Emerg Med 2023; 66:164-166. [PMID: 36681598 DOI: 10.1016/j.ajem.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/16/2023] Open
Affiliation(s)
- Christopher M Worsham
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - André Zimerman
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America; TIMI Study Group, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Jaemin Woo
- Department of Economics, Brown University, Providence, RI, United States of America
| | - David Shaw
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; National Bureau of Economic Research, Cambridge, MA, United States of America.
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23
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Shaw D. Dogs, Epistemic Indefensibility and Ethical Denial: Don't Let Sleeping Dog Owners Lie. J Bioeth Inq 2023; 20:7-12. [PMID: 36749536 PMCID: PMC9904516 DOI: 10.1007/s11673-023-10229-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/27/2022] [Indexed: 05/04/2023]
Abstract
In this paper I use normative analysis to explore the curious and seemingly singular phenomenon whereby some dog owners deny the physical and moral facts about a situation where it is claimed their dog harmed or irritated others. I define these as epistemic and ethical denial, respectively, and offer a tentative exploration of their implications in terms of relational autonomy and responsible behaviour in public spaces.
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
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24
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Crooks CJ, West J, Morling JR, Simmonds M, Juurlink I, Briggs S, Cruickshank S, Hammond-Pears S, Shaw D, Card TR, Fogarty AW. Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units. QJM 2023; 116:63-67. [PMID: 36066450 PMCID: PMC9928225 DOI: 10.1093/qjmed/hcac218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. AIMS This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units (ICUs) than individuals with White skin. METHODS Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with COVID-19 infection to ICUs were assessed, and how this varied by ethnic group. RESULTS Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to ICUs (Kruskal-Wallis test, P = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal-Wallis test, P = 0.005). There were significant differences in mean respiratory rates in these patients (P < 0.0001), ranging from 26 breaths/min in individuals with White ethnicity to 30 breaths/min for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. CONCLUSIONS These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia and may contribute to differences in health outcomes across ethnic groups globally.
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Affiliation(s)
- C J Crooks
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - J West
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- East Midlands Academic Health Science Network, University of Nottingham, Nottingham NG7 2TU, UK
| | - J R Morling
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - M Simmonds
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - I Juurlink
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Briggs
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Cruickshank
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - S Hammond-Pears
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- East Midlands Academic Health Science Network, University of Nottingham, Nottingham NG7 2TU, UK
| | - D Shaw
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - T R Card
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - A W Fogarty
- Address correspondence to Dr A.W. Fogarty, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham City Hospital, Nottingham NG5 1PB, UK.
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25
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van Dijk N, Stärcke P, de Jongh W, Jansen N, Shaw D, Bollen J, van Mook W. Organ Donation After Euthanasia in Patients Suffering From Psychiatric Disorders: 10-Years of Preliminary Experiences in the Netherlands. Transpl Int 2023; 36:10934. [PMID: 36846601 PMCID: PMC9948004 DOI: 10.3389/ti.2023.10934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Abstract
Euthanasia based on psychiatric suffering, followed by subsequent organ donation, is considered medically and legally permissible in the Netherlands. Although organ donation after euthanasia (ODE) in patients suffering from unbearable psychiatric illness is performed, it is not specifically addressed in the Dutch guideline on organ donation after euthanasia, and national data on ODE in psychiatric patients have not yet been published. In this article, the preliminary results of the 10-year Dutch case series of psychiatric patients who choose ODE are presented and potential factors influencing opportunities for donation in this population are discussed. We conclude that further future in-depth qualitative exploration of ODE in patients suffering from psychiatric illness and its associated ethical and practical dilemmas, including the consequences for the patient and their family and healthcare professionals, will be important to help make sense of potential barriers to donation for people undergoing euthanasia as a result of psychiatric suffering.
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Affiliation(s)
- Nathalie van Dijk
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - Wim de Jongh
- Department of Surgery, Transplantation Coordination Services, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - David Shaw
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jan Bollen
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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26
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Doetsch JN, Schlösser C, Barros H, Shaw D, Krafft T, Pilot E. A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable. Int J Equity Health 2023; 22:3. [PMID: 36604705 PMCID: PMC9815671 DOI: 10.1186/s12939-022-01806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. OBJECTIVE This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013). METHODS This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included. RESULTS The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status. CONCLUSION Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.
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Affiliation(s)
- Julia Nadine Doetsch
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Clara Schlösser
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Henrique Barros
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5808.50000 0001 1503 7226Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - David Shaw
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands ,grid.6612.30000 0004 1937 0642Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Thomas Krafft
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Eva Pilot
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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27
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Capoccia M, Sherif MA, Nassef A, Shaw D, Walker P, Evans B, Kaul P, Elmahdy W. Aortic arch surgery for type B aortic dissection: How far should we go? The value of a hybrid approach. Clin Case Rep 2023; 11:e6742. [PMID: 36619481 PMCID: PMC9810843 DOI: 10.1002/ccr3.6742] [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: 08/30/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023] Open
Abstract
Traditionally, the management of type B aortic dissection has been the domain of the vascular surgeons. Timing and type of intervention still generate debate. We sought to review our early experience with the treatment of this condition based on a hybrid approach following an aortic multi-disciplinary team meeting involving close cooperation between cardiac surgeons, vascular surgeons, interventional radiologists, vascular anesthetists, and cardiac anesthetists. Four patients (age 41-56 years; 3 males; 1 female) with type B aortic dissection underwent aortic arch surgery through a hybrid approach: one elective procedure consisting of ascending aorta and hemi-arch replacement with debranching followed by thoracic endovascular aortic repair (TEVAR); one redo procedure requiring aortic arch replacement with hybrid frozen elephant trunk; two acute presentations (aortic arch replacement and debranching followed by TEVAR; AVR with ascending aorta, arch, and proximal descending thoracic aorta replacement with conventional elephant trunk and debranching). Deep hypothermic circulatory arrest was required in three patients. Despite respiratory complications and slightly prolonged postoperative course, all patients survived without onset of stroke, paraplegia, malperfusion, endoleak, or need for re-exploration. Follow-up remains satisfactory. Different factors may affect outcome following complex aortic procedures. Nevertheless, close cooperation between cardiac surgeons, vascular surgeons, and interventional radiologists may reduce potential for complications and address aspects that may not be completely within the domain of individual specialists.
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Affiliation(s)
- Massimo Capoccia
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Mohamed Ashur Sherif
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Ahmed Nassef
- Vascular SurgeryLeeds Teaching Hospitals NHS TrustLeedsUK
| | - David Shaw
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Paul Walker
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Betsy Evans
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Pankaj Kaul
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Walid Elmahdy
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
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Abstract
In this paper, we discuss the largely neglected topic of semantics in medicine and the associated ethical issues. We analyse several key medical terms from the informed perspective of the healthcare professional, the lay perspective of the patient and the patient's family, and the descriptive perspective of what the term actually signifies objectively. The choice of a particular medical term may deliver different meanings when viewed from these differing perspectives. Consequently, several ethical issues may arise. Technical terms that are not commonly understood by lay people may be used by physicians, consciously or not, and may obscure the understanding of the situation by lay people. The choice of particular medical terms may be accidental use of jargon, an attempt to ease the communication of psychologically difficult information, or an attempt to justify a preferred course of action and/or to manipulate the decision-making process.
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Affiliation(s)
- David Shaw
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Alex Manara
- Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Anne Laure Dalle Ave
- Ethics Unit, Institute of Humanities in Medicine, University Hospital of Lausanne, Lausanne, Switzerland
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29
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Shaw D. Vaccination status and intensive care unit triage: Is it fair to give unvaccinated Covid-19 patients equal priority? Bioethics 2022; 36:883-890. [PMID: 35934875 PMCID: PMC9538027 DOI: 10.1111/bioe.13069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/17/2022] [Accepted: 06/09/2022] [Indexed: 05/13/2023]
Abstract
This article provides a systematic analysis of the proposal to use Covid-19 vaccination status as a criterion for admission of patients with Covid-19 to intensive care units (ICUs) under conditions of resource scarcity. The general consensus is that it is inappropriate to use vaccination status as a criterion because doing so would be unjust; many health systems, including the UK National Health Service, are based on the principle of equality of access to care. However, the analysis reveals that there are several unique features of Covid vaccination status in the context of a pandemic that make this issue disanalogous to cases (such as lung cancer caused by smoking) discussed previously. First, there is equality in access to care at the point of vaccination; the unvaccinated refuse the offer of preventive care when they decline vaccination, weakening their claim to ongoing care if they become ill (this is qualitatively different from 'poor lifestyle choices' such as smoking). Second, the decision of one person to refuse vaccination substantially increases the risk that they will become seriously ill and need ICU care; the person who chooses not to get vaccinated thus potentially increases the pressure on intensive care bed provision, as well as increasing the risk that he or she will infect others who in turn might end up needing ICU care. Third, justice cuts both ways, and giving unvaccinated patients equal priority may itself be unjust when other patients have reduced their risk of ending up on the ICU by getting vaccinated.
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Affiliation(s)
- David Shaw
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Institute for Biomedical EthicsUniversity of Basel, Basel, Switzerland
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30
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Thompson AT, White SA, Doub EE, Sharma P, Frierson K, Dominguez K, Shaw D, Weaver D, Vigil SL, Bonilla DL, Ruder MG, Yabsley MJ. The wild life of ticks: Using passive surveillance to determine the distribution and wildlife host range of ticks and the exotic Haemaphysalis longicornis, 2010-2021. Parasit Vectors 2022; 15:331. [PMID: 36127708 PMCID: PMC9487032 DOI: 10.1186/s13071-022-05425-1] [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: 05/16/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background We conducted a large-scale, passive regional survey of ticks associated with wildlife of the eastern United States. Our primary goals were to better assess the current geographical distribution of exotic Haemaphysalis longicornis and to identify potential wild mammalian and avian host species. However, this large-scale survey also provided valuable information regarding the distribution and host associations for many other important tick species that utilize wildlife as hosts. Methods Ticks were opportunistically collected by cooperating state and federal wildlife agencies. All ticks were placed in the supplied vials and host information was recorded, including host species, age, sex, examination date, location (at least county and state), and estimated tick burden. All ticks were identified to species using morphology, and suspect H. longicornis were confirmed through molecular techniques. Results In total, 1940 hosts were examined from across 369 counties from 23 states in the eastern USA. From these submissions, 20,626 ticks were collected and identified belonging to 11 different species. Our passive surveillance efforts detected exotic H. longicornis from nine host species from eight states. Notably, some of the earliest detections of H. longicornis in the USA were collected from wildlife through this passive surveillance network. In addition, numerous new county reports were generated for Amblyomma americanum, Amblyomma maculatum, Dermacentor albipictus, Dermacentor variabilis, and Ixodes scapularis. Conclusions This study provided data on ticks collected from animals from 23 different states in the eastern USA between 2010 and 2021, with the primary goal of better characterizing the distribution and host associations of the exotic tick H. longicornis; however, new distribution data on tick species of veterinary or medical importance were also obtained. Collectively, our passive surveillance has detected numerous new county reports for H. longicornis as well as I. scapularis. Our study utilizing passive wildlife surveillance for ticks across the eastern USA is an effective method for surveying a diversity of wildlife host species, allowing us to better collect data on current tick distributions relevant to human and animal health. Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05425-1.
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Affiliation(s)
- Alec T Thompson
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA. .,Center for the Ecology of Infectious Diseases, Odum School of Ecology, University of Georgia, Athens, GA, USA.
| | - Seth A White
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.,Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA, USA
| | - Emily E Doub
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Prisha Sharma
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.,Department of Environmental Health Sciences, College of Public Health, University of Georgia, Athens, GA, USA
| | - Kenna Frierson
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.,Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA, USA
| | - Kristen Dominguez
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - David Shaw
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | | | - Stacey L Vigil
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Denise L Bonilla
- United States Department of Agriculture, Veterinary Services, Fort Collins, CO, USA
| | - Mark G Ruder
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Michael J Yabsley
- Southeastern Cooperative Wildlife Disease Study, Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA, USA. .,Center for the Ecology of Infectious Diseases, Odum School of Ecology, University of Georgia, Athens, GA, USA. .,Warnell School of Forestry and Natural Resources, University of Georgia, Athens, GA, USA.
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31
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Bartlett SR, Verich A, Carson J, Hosseini‐Hooshyar S, Read P, Baker D, Post JJ, Finlayson R, Bloch M, Doyle JS, Shaw D, Hellard M, Martinez M, Marks P, Dore GJ, Matthews GV, Applegate T, Martinello M. Patterns and correlates of hepatitis C virus phylogenetic clustering among people living with HIV in Australia in the direct‐acting antiviral era: A molecular epidemiology study among participants in the CEASE cohort. Health Sci Rep 2022; 5:e719. [PMID: 36000082 PMCID: PMC9388196 DOI: 10.1002/hsr2.719] [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: 01/27/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Aims In moving towards the elimination of hepatitis C virus (HCV) infection among people living with HIV, understanding HCV transmission patterns may provide insights to guide and evaluate interventions. In this study, we evaluated patterns of, and factors associated with HCV phylogenetic clustering among people living with HIV/HCV co‐infection in Australia in the direct‐acting antiviral era. Methods HCV RNA was extracted from dried blood spot (DBS) samples collected between 2014 and 2018 in the CEASE cohort study. The HCV Core‐E2 region was amplified by a polymerase chain reaction and Sanger sequenced. Maximum likelihood phylogenetic trees (1000 bootstrap replicates) were used to identify patterns of clustering (3% genetic distance threshold). Mixed‐effects logistic regression was used to determine correlates of phylogenetic clustering. Factors assessed were sexual risk behavior, education, injecting drug use, housing, employment, HIV viral load, age, sex, and sexuality. Results Phylogenetic trees were reconstructed for HCV subtype 1a (n = 139) and 3a (n = 63) sequences, with 29% (58/202) in a pair or cluster. Overall (n = 202), phylogenetic clustering was positively associated with younger age (under 40; adjusted odds ratio [aOR] 2.52, 95% confidence interval [CI] 1.20–5.29), and among gay and bisexual men (n = 168), was positively associated with younger age (aOR 2.61, 95% CI 1.10–6.19), higher education (aOR 2.58, 95% CI 1.09–6.13), and reporting high‐risk sexual behavior (aOR 3.94, 95% CI 1.31–11.84). During follow‐up, five reinfections were observed, but none were in phylogenetic clusters. Conclusion This study found a high proportion of phylogenetic relatedness, predominantly among younger people and gay and bisexual men reporting high‐risk sexual behavior. Despite this, few reinfections were observed, and reinfections demonstrated little relationship with known clusters. These findings highlight the importance of rapid HCV treatment initiation, together with monitoring of the phylogeny.
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Affiliation(s)
- Sofia R. Bartlett
- British Columbia Centre for Disease Control Vancouver British Columbia Canada
- School of Population and Public Health University of British Columbia Vancouver British Columbia Canada
| | - Andrey Verich
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
| | - Joanne Carson
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
| | | | - Phillip Read
- Kirketon Road Centre Sydney New South Wales Australia
| | - David Baker
- East Sydney Doctors Sydney New South Wales Australia
| | - Jeffrey J. Post
- The Albion Centre Sydney New South Wales Australia
- Department of Infectious Diseases Prince of Wales Hospital Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney Sydney New South Wales Australia
| | | | - Mark Bloch
- Holdsworth House Medical Practice Sydney New South Wales Australia
| | - Joseph S. Doyle
- Department of Infectious Diseases Alfred Health & Monash University Melbourne Victoria Australia
- Burnet Institute, Melbourne Victoria Australia
| | - David Shaw
- Royal Adelaide Hospital Adelaide South Australia Australia
| | - Margaret Hellard
- Department of Infectious Diseases Alfred Health & Monash University Melbourne Victoria Australia
- Burnet Institute, Melbourne Victoria Australia
| | - Maria Martinez
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
| | - Philippa Marks
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
| | - Gregory J. Dore
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
- St Vincent's Hospital Sydney New South Wales Australia
| | - Gail V. Matthews
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
- St Vincent's Hospital Sydney New South Wales Australia
| | - Tanya Applegate
- The Kirby Institute, UNSW Sydney Sydney New South Wales Australia
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Abstract
Shaw DM, Henderson L, van den Berg M. Cognitive, sleep, and autonomic responses to induction of a ketogenic diet in military personnel: a pilot study. Aerosp Med Hum Perform. 2022; 93(6):507516.In the article by Shaw et al., the publishers neglected to include the
author corrections to the manuscript. The corrected manuscript is available through the online journal on Ingenta at: <ext-link ext-link-type="uri" xlink:href="https://www.ingentaconnect.com/contentone/asma/amhp/2022/00000093/00000006/art00007">https://www.ingentaconnect.com/contentone/asma/amhp/2022/00000093/00000006/art00007</ext-link>.Those
corrections that affect the study directly are published in this erratum. We sincerely apologize for this error and the inconvenience it has caused.
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Wind T, Jansen N, Flodén A, Haase-Kromwijk B, Shaw D, Gardiner D. Corrigendum: An Inventory of Deceased Donor Family Care and Contact Between Donor Families and Recipients in 15 European Countries. Transpl Int 2022; 35:10717. [PMID: 35992749 PMCID: PMC9390770 DOI: 10.3389/ti.2022.10717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Tineke Wind
- Maastricht University Medical Centre, Maastricht, Netherlands
- *Correspondence: Tineke Wind,
| | - Nichon Jansen
- Institute of Health and Care Science, Dutch Transplant Foundation, Leiden, Netherlands
| | - Anne Flodén
- Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
- Department of Anaestesiology, Södra Älvsborgs Hospital, Borås, Sweden
| | | | - David Shaw
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Shaw D. COVID-19 conscience tracing: mapping the moral distances of coronavirus. J Med Ethics 2022; 48:530-533. [PMID: 34103367 PMCID: PMC8189825 DOI: 10.1136/medethics-2021-107326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
One of the many problems posed by the collective effort to tackle COVID-19 is non-compliance with restrictions. Some people would like to obey restrictions but cannot due to their job or other life circumstances; others are not good at following rules that restrict their liberty, even if the potential consequences of doing so are repeatedly made very clear to them. Among this group are a minority who simply do not care about the consequences of their actions. But many others fail to accurately perceive the harms that they might be causing. One of the main reasons for this is that the harms done by transmitting COVID-19 to someone else are morally distant from the agent, particularly in cases where infection is asymptomatic. In this paper, I describe seven different aspects of moral distance in the context of COVID-19, explore how they affect (lack of) motivation to obey restrictions, and suggest several ways in which such moral distance can be reduced - primarily through enhanced-contact tracing that makes it clear to individuals and the public precisely who they could be harming and how.
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Affiliation(s)
- David Shaw
- Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, Limburg, The Netherlands
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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35
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Garcia-Valtanen P, Hope CM, Masavuli MG, Yeow AEL, Balachandran H, Mekonnen ZA, Al-Delfi Z, Abayasingam A, Agapiou D, Stella AO, Aggarwal A, Bouras G, Gummow J, Ferguson C, O'Connor S, McCartney EM, Lynn DJ, Maddern G, Gowans EJ, Reddi BAJ, Shaw D, Kok-Lim C, Beard MR, Weiskopf D, Sette A, Turville SG, Bull RA, Barry SC, Grubor-Bauk B. SARS-CoV-2 Omicron variant escapes neutralizing antibodies and T cell responses more efficiently than other variants in mild COVID-19 convalescents. Cell Rep Med 2022; 3:100651. [PMID: 35654046 PMCID: PMC9110310 DOI: 10.1016/j.xcrm.2022.100651] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19) convalescents living in regions with low vaccination rates rely on post-infection immunity for protection against re-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluate humoral and T cell immunity against five variants of concern (VOCs) in mild-COVID-19 convalescents at 12 months after infection with ancestral virus. In this cohort, ancestral, receptor-binding domain (RBD)-specific antibody and circulating memory B cell levels are conserved in most individuals, and yet serum neutralization against live B.1.1.529 (Omicron) is completely abrogated and significantly reduced for other VOCs. Likewise, ancestral SARS-CoV-2-specific memory T cell frequencies are maintained in >50% of convalescents, but the cytokine response in these cells to mutated spike epitopes corresponding to B.1.1.529 and B.1.351 (Beta) VOCs were impaired. These results indicate that increased antigen variability in VOCs impairs humoral and spike-specific T cell immunity post-infection, strongly suggesting that COVID-19 convalescents are vulnerable and at risk of re-infection with VOCs, thus stressing the importance of vaccination programs. Most mild COVID-19 convalescents maintain immunity at 12 months after disease onset B.1.1.529 escapes antibodies in convalescents infected with ancestral SARS-CoV-2 SARS-CoV-2 VOCs can partially avoid recognition by antigen-specific T cells Antigenic drift in SARS-CoV-2 VOCs significantly challenges convalescent immunity
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Affiliation(s)
- Pablo Garcia-Valtanen
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Christopher M Hope
- Molecular Immunology, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Makutiro G Masavuli
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Arthur Eng Lip Yeow
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | | | - Zelalem A Mekonnen
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Zahraa Al-Delfi
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | | | - David Agapiou
- School of Medical Sciences, Faculty of Medicine, UNSW, Australia, Sydney, NSW, Australia
| | | | - Anupriya Aggarwal
- The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - George Bouras
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia; The Department of Surgery - Otolaryngology, Head and Neck Surgery, University of Adelaide and the Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Woodville South, SA, Australia
| | - Jason Gummow
- Gene Silencing and Expression Core Facility, Adelaide Health and Medical Sciences, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Ferguson
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Stephanie O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Erin M McCartney
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - David J Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5001, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Guy Maddern
- Discipline of Surgery, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Eric J Gowans
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Benjamin A J Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - David Shaw
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Chuan Kok-Lim
- Gene Silencing and Expression Core Facility, Adelaide Health and Medical Sciences, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Microbiology and Infectious Diseases Department, SA Pathology, Adelaide, SA, Australia; Research Centre for Infectious Diseases, School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Michael R Beard
- Research Centre for Infectious Diseases, School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Daniela Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, USA
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA, USA; Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Stuart G Turville
- The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Rowena A Bull
- School of Medical Sciences, Faculty of Medicine, UNSW, Australia, Sydney, NSW, Australia
| | - Simon C Barry
- Molecular Immunology, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia; Women's and Children's Health Network, North Adelaide, SA, Australia.
| | - Branka Grubor-Bauk
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia.
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Mattis C, Bratcher N, Burns M, Carosino C, de Zafra C, Fancher RM, Georgi K, Graff C, Hukkanen RR, Johnson C, Lao Y, Lange A, Lee D, Lepherd M, Maguire S, Malisauskas M, Manuel M, Miranda S, Reed L, Santos R, Sayers B, Shaw D, Shuster D. Increasing the Reuse of Protein Non-Naïve Nonhuman Primates in Pharmaceutical Drug Discovery and Development: An Overview and Industry Position on the Challenges and Benefits. Int J Toxicol 2022; 41:291-296. [PMID: 35656559 DOI: 10.1177/10915818221101791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The IQ Consortium NHP Reuse Working Group (WG) comprises members from 15 pharmaceutical and biotechnology companies. In 2020, the WG developed and distributed a detailed questionnaire on protein non-naïve NHP reuse to the WG member companies. The WG received responses from key stakeholders including principal investigators, facility managers, animal welfare officers and research scientists. This paper's content reflects the consolidated opinion of the WG members and the questionnaire responses on the subject of NHP reuse within nonclinical programs at all stages of research and development. Many of the pharmaceutical companies represented in the working group or participating in the questionnaire have already achieved some level of NHP reuse in their nonclinical programs, but the survey results suggested that there is significant potential to increase NHP reuse further and a need to understand the considerations involved in reuse more clearly. The WG has also focused carefully on the inherent concerns and risks of implementing protein non-naive NHP reuse and has evaluated the best methods of risk assessment and decision-making. This paper presents a discussion on the challenges and opportunities surrounding protein non-naïve NHP reuse and aims to stimulate further industry dialogue on the subject and provide guidance for pharmaceutical companies to establish roadmaps and decision trees enabling increased protein non-naïve NHP reuse. In addition, this paper represents a solid basis for collaborative engagement between pharmaceutical and biotechnology companies with contract research organizations (CROs) to discuss how the availability of protein non-naïve NHP within CROs can be better leveraged for their use within nonclinical studies.
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Affiliation(s)
| | | | - Monika Burns
- 33413Novartis Institutes for Biomedical Research (NIBR), Cambridge, MA, USA
| | | | | | | | - Katrin Georgi
- The healthcare business of Merck KGaA, Darmstadt, Germany
| | | | | | | | - Yanbin Lao
- 3971Bristol-Myers Squibb, Inc., Princeton, NJ, USA.,Eli Lilly and Company, Indianapolis, IN, USA
| | - Amber Lange
- 33413Novartis Institutes for Biomedical Research (NIBR), Cambridge, MA, USA
| | - Donna Lee
- 7412Genentech, Inc., South San Francisco, CA, USA
| | | | - Sean Maguire
- 5545GlaxoSmithKline, Inc., Collegeville, PA, USA
| | | | | | - Sonia Miranda
- 33413Novartis Institutes for Biomedical Research (NIBR), Cambridge, MA, USA
| | | | | | | | - David Shaw
- Roche Innovation Center Basel, 1529F.Hoffmann-La Roche, Ltd., Basel, Switzerland
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Poordad F, Felizarta F, Yao BB, Overcash JS, Hassanein T, Agarwal K, Gane E, Shaw D, Waters M, Krishnan P, Topp A, Burroughs M, Nevens F. Durability of sustained virological response to glecaprevir/pibrentasvir and resistance development: A long-term follow-up study. Liver Int 2022; 42:1278-1286. [PMID: 35220658 DOI: 10.1111/liv.15211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/14/2022] [Accepted: 02/16/2022] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIMS This study aimed to determine durability of sustained virologic response (SVR) in hepatitis C virus-infected participants treated with glecaprevir- and/or pibrentasvir-containing regimens. METHODS M13-576, a rollover study, evaluated the durability of SVR in a follow-up period of approximately 3 years after hepatitis C virus genotype 1-6-infected participants received a glecaprevir- and/or pibrentasvir-containing regimen in previous phase 2/3 clinical trials. The primary efficacy endpoint was the percentage of participants maintaining SVR and the percentage of participants experiencing relapse or reinfections. Resistance-associated substitutions and safety outcomes related to liver progression were also assessed. RESULTS Of 384 participants enroled, 377 participants were included in the as-observed population and 287 participants completed the study. In prior studies, 99.7% (376/377) of participants achieved SVR12; of those, an observed 99.5% (374/376) and 100% (286/286) completing the study, maintained SVR. After non-responder imputation of missing data, 286/376 participants (76%) maintained SVR. The participant previously not achieving SVR was a treatment-experienced male with compensated cirrhosis who had NS3 and NS5A substitutions at enrolment, which remained detectable for 12 months. Of the two participants not maintaining SVR, one was re-infected and one experienced late relapse at post-treatment week 60. Five participants (all with a fibrosis stage ≥F3) had hepatocellular carcinoma. No events were deemed related to glecaprevir/pibrentasvir. CONCLUSIONS Glecaprevir/pibrentasvir demonstrated long-term durability of efficacy after SVR12 was achieved. Hepatic-related decompensation events were not seen. Owing to low incidence of virologic failure, conclusions were not drawn on persistence of resistance-associated substitutions.
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Affiliation(s)
- Fred Poordad
- The Texas Liver Institute, University of Texas Health, San Antonio, Texas, USA
| | | | | | | | - Tarek Hassanein
- Southern California GI and Liver Centers and Southern California Research Center, Coronado, California, USA
| | - Kosh Agarwal
- Institute of Liver Studies, Kings College Hospital NHS Foundation Trust, London, UK
| | - Edward Gane
- New Zealand Liver Transplant Unit, University of Auckland, Auckland, New Zealand
| | - David Shaw
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | | | | | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospital KULeuven, Leuven, Belgium
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Wang Z, Shaw D, Kahan T, Schoemaecker C, Carslaw N. A modeling study of the impact of photolysis on indoor air quality. Indoor Air 2022; 32:e13054. [PMID: 35762241 PMCID: PMC9328129 DOI: 10.1111/ina.13054] [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] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 05/26/2023]
Abstract
The importance of photolysis as an initiator of air chemistry outdoors is widely recognized, but its role in chemical processing indoors is often ignored. This paper uses recent experimental data to modify a detailed chemical model, using it to investigate the impacts of glass type, artificial indoor lighting, cloudiness, time of year and latitude on indoor photolysis rates and hence indoor air chemistry. Switching from an LED to an uncovered fluorescent tube light increased predicted indoor hydroxyl radical concentrations by ~13%. However, moving from glass that transmitted outdoor light at wavelengths above 380 nm to one that transmitted sunlight above 315 nm led to an increase in predicted hydroxyl radicals of more than 400%. For our studied species, including ozone, nitrogen oxides, nitrous acid, formaldehyde, and hydroxyl radicals, the latter were most sensitive to changes in indoor photolysis rates. Concentrations of nitrogen dioxide and formaldehyde were largely invariant, with exchange with outdoors and internal deposition controlling their indoor concentrations. Modern lights such as LEDs, together with low transmission glasses, will likely reduce the effects of photolysis indoors and the production of potentially harmful species. Research is needed on the health effects of different indoor air mixtures to confirm this conclusion.
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Affiliation(s)
- Zixu Wang
- Department of Environment and GeographyUniversity of YorkYorkUK
| | - David Shaw
- Department of Environment and GeographyUniversity of YorkYorkUK
| | - Tara Kahan
- Department of ChemistryUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Coralie Schoemaecker
- CNRS, UMR 8522 – PC2A – Physicochimie des Processus de Combustion et de l’AtmosphèreUniversité LilleLilleFrance
| | - Nicola Carslaw
- Department of Environment and GeographyUniversity of YorkYorkUK
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Crozier I, Haqqani H, Kotschet E, Shaw D, Prabhu A, Roubos J, Alison J, Melton I, Denman R, Lin T, Almeida A, Thompson A, Lande J, Liang S, O’donnell D. Three-year chronic follow-up from the pilot study of a substernal extravascular implantable cardioverter defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.467] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
The investigational Extravascular Implantable Cardioverter-Defibrillator (EV ICD) uses a substernal lead and delivers defibrillation and pacing therapies, including antitachycardia pacing (ATP).
Objective
To characterize EV ICD system performance through 3 years.
Methods
The prospective, first-in-human EV ICD Pilot study was conducted at 4 sites in Australia and New Zealand. ICD-indicated patients were enrolled July-December of 2018. Defibrillation testing was conducted for all patients at implant, and chronically per physician discretion. Electrical testing was conducted at pre-hospital discharge, 2 weeks, 4-6 weeks and 3 months post-implant, and every 6 months thereafter. Posture effects on pacing and sensing were evaluated through 3 months.
Results
Of 26 patients enrolled, 21 underwent the EV ICD implant procedure. There were no intraprocedural complications. After successful implantation and testing, 17 of 21 patients entered chronic follow-up. 14 patients continue follow up, representing 523 patient-months. Eight elective chronic defibrillation tests converted 7 of 7 patients with ≤ 40 J (maximum energy). Five episodes of spontaneous ventricular tachycardia (VT) were detected in 1 patient and either self-terminated or successfully defibrillated with appropriate shock.
Over the total course of follow-up, 3 patients received an inappropriate shock due to; lead tip displacement with subsequent P-wave oversensing; Electromagnetic interference (EMI) in a ungrounded hot-tub; and EMI while doing plumbing work on unearthed electrical pipes, resulting in an annualized inappropriate shock rate of 6.9%.
Pacing capture thresholds remained stable across time (5.1 ± 2.0 V at implant and 5.5 ± 2.7 V at 3 years); similarly, R-wave amplitudes were stable across time (3.4 ±2.0 mV at implant and 4.2 ± 2.7 mV at 3 years). Pacing thresholds tended to be lowest with the patient lying on the right side and pacing threshold often increased relative to supine position for left-side, prone or bending postures. R-wave amplitude tended to be greater when bending forward.
There were 10 system or procedure-related adverse events in 8 patients through 3 years, including 3 elective system removals for: a single inappropriate shock (1), chronic defibrillation testing showing no safety margin in a patient with arrhythmogenic right ventricular dysplasia (1), intolerance to ATP (1 - high pacing threshold and frequent VT). Other than the lead tip displacement within the first 3 months, no additional clinically significant lead displacements have been observed through 3 years.
Conclusion
The EV ICD is a novel platform for delivering high-voltage therapy. There were no procedure and system related complications observed after the first year post-implant. Lead position and chronic system performance have generally remained stable through 3 years with a low rate of adverse events.
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Affiliation(s)
- I Crozier
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - H Haqqani
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - E Kotschet
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - D Shaw
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - A Prabhu
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - J Roubos
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - J Alison
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - I Melton
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - R Denman
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - T Lin
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - A Almeida
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - A Thompson
- Medtronic, Inc., Minneapolis, United States of America
| | - J Lande
- Medtronic, Inc., Minneapolis, United States of America
| | - S Liang
- Medtronic, Inc., Minneapolis, United States of America
| | - D O’donnell
- Austin Health, Department of Cardiology, Heidelberg, Australia
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Oh SA, Senger K, Madireddi S, Akhmetzyanova I, Ishizuka IE, Tarighat S, Lo JH, Shaw D, Haley B, Rutz S. High-efficiency nonviral CRISPR/Cas9-mediated gene editing of human T cells using plasmid donor DNA. J Exp Med 2022; 219:213176. [PMID: 35452075 PMCID: PMC9040063 DOI: 10.1084/jem.20211530] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 12/26/2022] Open
Abstract
Genome engineering of T lymphocytes, the main effectors of antitumor adaptive immune responses, has the potential to uncover unique insights into their functions and enable the development of next-generation adoptive T cell therapies. Viral gene delivery into T cells, which is currently used to generate CAR T cells, has limitations in regard to targeting precision, cargo flexibility, and reagent production. Nonviral methods for effective CRISPR/Cas9-mediated gene knock-out in primary human T cells have been developed, but complementary techniques for nonviral gene knock-in can be cumbersome and inefficient. Here, we report a convenient and scalable nonviral method that allows precise gene edits and transgene integration in primary human T cells, using plasmid donor DNA template and Cas9-RNP. This method is highly efficient for single and multiplex gene manipulation, without compromising T cell function, and is thus valuable for use in basic and translational research.
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Affiliation(s)
- Soyoung A Oh
- Cancer Immunology, Genentech, South San Francisco, CA
| | - Kate Senger
- Molecular Biology, Genentech, South San Francisco, CA
| | | | | | | | - Somayeh Tarighat
- Cell Therapy Engineering and Development, Genentech, South San Francisco, CA
| | - Jerry H Lo
- Oncology Bioinformatics, Genentech, South San Francisco, CA
| | - David Shaw
- Cell Therapy Engineering and Development, Genentech, South San Francisco, CA
| | | | - Sascha Rutz
- Cancer Immunology, Genentech, South San Francisco, CA
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Wilf P, Zou X, Donovan MP, Kocsis L, Briguglio A, Shaw D, Slik JWF, Lambiase JJ. First fossil-leaf floras from Brunei Darussalam show dipterocarp dominance in Borneo by the Pliocene. PeerJ 2022; 10:e12949. [PMID: 35356469 PMCID: PMC8958975 DOI: 10.7717/peerj.12949] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/26/2022] [Indexed: 01/11/2023] Open
Abstract
The Malay Archipelago is one of the most biodiverse regions on Earth, but it suffers high extinction risks due to severe anthropogenic pressures. Paleobotanical knowledge provides baselines for the conservation of living analogs and improved understanding of vegetation, biogeography, and paleoenvironments through time. The Malesian bioregion is well studied palynologically, but there have been very few investigations of Cenozoic paleobotany (plant macrofossils) in a century or more. We report the first paleobotanical survey of Brunei Darussalam, a sultanate on the north coast of Borneo that still preserves the majority of its extraordinarily diverse, old-growth tropical rainforests. We discovered abundant compression floras dominated by angiosperm leaves at two sites of probable Pliocene age: Berakas Beach, in the Liang Formation, and Kampong Lugu, in an undescribed stratigraphic unit. Both sites also yielded rich palynofloral assemblages from the macrofossil-bearing beds, indicating lowland fern-dominated swamp (Berakas Beach) and mangrove swamp (Kampong Lugu) depositional environments. Fern spores from at least nine families dominate both palynological assemblages, along with abundant fungal and freshwater algal remains, rare marine microplankton, at least four mangrove genera, and a diverse rainforest tree and liana contribution (at least 19 families) with scarce pollen of Dipterocarpaceae, today's dominant regional life form. Compressed leaves and rare reproductive material represent influx to the depocenters from the adjacent coastal rainforests. Although only about 40% of specimens preserve informative details, we can distinguish 23 leaf and two reproductive morphotypes among the two sites. Dipterocarps are by far the most abundant group in both compression assemblages, providing rare, localized evidence for dipterocarp-dominated lowland rainforests in the Malay Archipelago before the Pleistocene. The dipterocarp fossils include winged Shorea fruits, at least two species of plicate Dipterocarpus leaves, and very common Dryobalanops leaves. We attribute additional leaf taxa to Rhamnaceae (Ziziphus), Melastomataceae, and Araceae (Rhaphidophora), all rare or new fossil records for the region. The dipterocarp leaf dominance contrasts sharply with the family's <1% representation in the palynofloras from the same strata. This result directly demonstrates that dipterocarp pollen is prone to strong taphonomic filtering and underscores the importance of macrofossils for quantifying the timing of the dipterocarps' rise to dominance in the region. Our work shows that complex coastal rainforests dominated by dipterocarps, adjacent to swamps and mangroves and otherwise similar to modern ecosystems, have existed in Borneo for at least 4-5 million years. Our findings add historical impetus for the conservation of these gravely imperiled and extremely biodiverse ecosystems.
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Affiliation(s)
- Peter Wilf
- Department of Geosciences and Earth & Environmental Systems Institute, Pennsylvania State University, University Park, Pennsylvania, United States
| | - Xiaoyu Zou
- Department of Geosciences and Earth & Environmental Systems Institute, Pennsylvania State University, University Park, Pennsylvania, United States
| | - Michael P. Donovan
- Department of Geosciences and Earth & Environmental Systems Institute, Pennsylvania State University, University Park, Pennsylvania, United States,Department of Paleobotany and Paleoecology, Cleveland Museum of Natural History, Cleveland, Ohio, United States
| | - László Kocsis
- Faculty of Science, Universiti Brunei Darussalam, Gadong, Brunei Darussalam,Institute of Earth Surface Dynamics, Faculty of Geosciences and Environment, University of Lausanne, Lausanne, Switzerland
| | - Antonino Briguglio
- Dipartimento di Scienze della Terra, dell’Ambiente e della Vita, Università degli Studi di Genova, Genoa, Italy
| | - David Shaw
- Biostratigraphic Associates (UK) Ltd., Stoke-on-Trent, UK
| | - JW Ferry Slik
- Faculty of Science, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
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Roberts MB, Ferguson C, McCartney E, Selvanderan K, Badiei A, Paradiso L, Wallace C, Torpy H, Zhang F, Sim B, Papanicolas L, Ashokan A, Shaw D, Bak N. Suboptimal COVID-19 vaccine uptake among hospitalised patients: an opportunity to improve vulnerable, hard-to-reach population vaccine rates. Intern Med J 2022; 52:1691-1697. [PMID: 35263026 PMCID: PMC9111600 DOI: 10.1111/imj.15731] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND COVID-19 vaccination represents a key preventative part of the Australian public health approach to the SARS-CoV-2 pandemic. Hospital inpatients are frequently high-risk for severe COVID-19 and death. Anecdotes of high-risk inpatients being unvaccinated and a lack of EMR visibility of COVID-19 vaccination status prompted this study as these patients could represent a risk to themselves, staff, other patients and service provision. AIMS To determine the uptake of COVID-19 vaccine among inpatients at an adult Australian tertiary public hospital and identify reasons for non-vaccination. METHODS A point-prevalence study of patient-reported COVID-19 vaccine status was conducted on 26th October 2021 via an in-person interview with collection of demographic factors and reasons for non-vaccination. RESULTS Of 368 (68% of inpatients) participants, 280 (76%) reported receiving at least 1 COVID-19 vaccine dose. Vaccination status was associated with older age, having received the flu vaccine, being born in Australia and not requiring an English-language interpreter. The majority (88%) of participants had at least 1 co-morbid risk factor for severe COVID-19. Of the unvaccinated (n=88), 67% were willing to be vaccinated with 54% of those indicating vaccination in hospital would be helpful and 42% requesting approval from their doctor. CONCLUSIONS Vaccine uptake in our cohort is sub-optimal. Existing public health programs have failed to reach this high-risk, vulnerable population. Changes to the national vaccination strategy to include a parallel in-hospital program for all hospital encounters and target culturally and linguistically diverse individuals may improve uptake among this high-risk, hard to reach group of patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Erin McCartney
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide
| | - Kendra Selvanderan
- Pharmacy Department, Royal Adelaide Hospital, Adelaide.,Department of General Medicine, Royal Adelaide Hospital, Adelaide
| | - Arash Badiei
- Thoracic Medicine Unit, Royal Adelaide Hospital, Adelaide
| | - Lisa Paradiso
- Department of General Medicine, Royal Adelaide Hospital, Adelaide
| | - Caitlin Wallace
- Department of General Medicine, Royal Adelaide Hospital, Adelaide
| | - Helena Torpy
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide
| | - Frank Zhang
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide
| | - Beatrice Sim
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide
| | | | | | - David Shaw
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide
| | - Narin Bak
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide
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Carslaw N, Shaw D. Modification of cleaning product formulations could improve indoor air quality. Indoor Air 2022; 32:e13021. [PMID: 35347794 PMCID: PMC9314617 DOI: 10.1111/ina.13021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Cleaning products contain numerous individual chemicals, which can be liberated on use. These species can react in air to form new chemical species, some of which are harmful to health. This paper uses a detailed chemical model for indoor air chemistry, to understand the chemical reactions that can occur following cleaning, assuming cleaning products with different proportions of limonene, α-pinene, and β-pinene are used. The tests included the pure compounds, 50:50 mixtures and mixtures in proportion to the rates of reaction with ozone and the hydroxyl radical. For the 3 h following cleaning, pure α-pinene was most efficient at producing particles, pure limonene for nitrated organic material, and a 50:50 mixture of β-pinene and limonene for formaldehyde, leading to enhancements of 1.1 μg/m3 , 400 ppt, and 1.8 ppb, respectively, compared to no cleaning. Cleaning in the afternoon enhanced concentrations of secondary pollutants for all the mixtures, owing to higher outdoor and hence indoor ozone compared to the morning. These enhancements in concentrations lasted several hours, despite the cleaning emissions only lasting for 10 min. Doubling the air exchange rate enhanced concentrations of formaldehyde and particulate matter by ~15% while reducing that of nitrated organic material by 13%. Changing product formulations has the potential to change the resulting indoor air quality and consequently, impacts on health.
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Affiliation(s)
- Nicola Carslaw
- Department of Environment and GeographyUniversity of YorkYorkUK
| | - David Shaw
- Department of Environment and GeographyUniversity of YorkYorkUK
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Shaw D. The Side Effects of Not Being Vaccinated: Individual Risk and Vaccine Hesitancy Nationalism. J Bioeth Inq 2022; 19:7-10. [PMID: 34817743 PMCID: PMC8611634 DOI: 10.1007/s11673-021-10141-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/16/2021] [Indexed: 05/24/2023]
Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
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Shaw D, Seaward H, Pageau F, Wangmo T, Elger BS. Perceptions of collective and other unjust punishment in Swiss prisons: a qualitative exploration. Int J Prison Health 2022; 19:241-250. [PMID: 35179854 DOI: 10.1108/ijph-06-2021-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to describe and analyse Swiss prisoners' and experts' views on collective punishment, the practice where a group is punished for one person's transgression. DESIGN/METHODOLOGY/APPROACH A series of qualitative interviews with prisoners and stakeholders are reported following thematic analysis. FINDINGS Despite being forbidden by the Geneva Convention and other international instruments, participants from this study expressed the view that collective punishment continues to be practiced in some form in prisons in Switzerland, violating the rights of prisoners via unjust and arbitrary decision-making, unjust rules, inequalities in prison structures and continuation of incarceration based on the behaviour of others. Families can also be both victims and vectors of collective punishment, and prolonging the detention of prisoners who would otherwise have been released because of rare high-profile cases of reoffending can also be considered a form of collective punishment. ORIGINALITY/VALUE These significant findings suggest that collective punishment in various forms continues to be used in Swiss prisons.
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Helene Seaward
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Felix Pageau
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland and Unit of Health Law and Humanitarian Medicine, Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Pisani L, Algera AG, Neto AS, Azevedo L, Pham T, Paulus F, de Abreu MG, Pelosi P, Dondorp AM, Bellani G, Laffey JG, Schultz MJ, Martinez A, Leal L, Jorge Pereira A, de Oliveira Maia M, Neto JA, Piras C, Caser EB, Moreira CL, Braga Gusman P, Dalcomune DM, Ribeiro de Carvalho AG, Gondim LAR, Castelo Branco Reis LM, da Cunha Ribeiro D, de Assis Simões L, Campos RS, Fernandez Versiani dos Anjos JC, Bruzzi Carvalho F, Alves RA, Nunes LB, Réa-Neto Á, de Oliveira MC, Tannous L, Cardoso Gomes B, Rodriguez FB, Abelha P, Lugarinho ME, Japiassu A, de Melo HK, Lopes EA, Varaschin P, de Souza Dantas VC, Freitas Knibel M, Ponte M, de Azambuja Rodrigues PM, Costa Filho RC, Saddy F, Wanderley Castellões TF, Silva SA, Osorio LAG, Mannarino D, Espinoza R, Righy C, Soares M, Salluh J, Tanaka L, Aragão D, Tavares ME, Kehdi MGP, Rezende VMC, Carbonell RCC, Teixeira C, de Oliveira RP, Maccari JG, Castro PS, Berto P, Schwarz P, Torelly AP, Lisboa T, Moraes E, Dal-Pizzol F, Tomasi Damiani C, Ritter C, Ferreira JC, Teixeira Costa R, Caruso P, Amendola CP, de Oliveira AMRR, Silva UVA, Sanches LC, Almeida RDS, Azevedo LC, Park M, Schettino G, Assunção MS, Silva E, Barboza CE, Junior APN, Marzocchi Tierno PFGM, Malbouisson LM, Oliveira L, Cristovao D, Neto ML, Rego Ê, Fernandes FE, Romano MLP, Cavalcanti AB, de Souza Barros D, Rodgers H, Dixon B, Smith R, Kol M, Wong H, Schmid W, Hermans G, Ceunen H, Bourgeois M, Anquez N, Suzumura ÉA, Decruyenaere J, DeCrop L, Neto AS, Souza dos Santos R, Beraldo D, dos Santos MC, Pellegrini JAS, Piras C, Oliveira V, Munhoz C, Meira KL, Peçanha AC, da Silva Ramos FJ, Maia I, Bahl M, Biondi R, Prado D, Pinto SF, Salgado J, Falcão LF, Macruz T, de Oliveira GA, Cavalcanti AB, Romano MLP, Ruas K, Mecatti GC, Caser EB, Gava IA, Carreño N, Morales M, Avendaño R, Aguirre S, Luciano PM, Sribar A, Klaric V, Skilijic S, Dvorscak MB, Krkusek M, Jurjevic M, Karanovic N, Simurina T, Stourac P, Kratochvil M, Pacheco ED, Máca J, Wrigge H, Schlegel C, Treschan TA, Schaefer M, Aytulun A, Kienbaum P, Clarkson K, Jaafar R, Collins D, Mazza BF, Plant R, Melchionda G, Di Lauro E, Cortegiani A, Russotto V, Caione R, Mestria D, Volta CA, Spadaro S, Botteri M, Machado FR, Seghelini E, Brazzi L, Sales G, D'Antini D, Molin A, Severgnini P, Bacuzzi A, Peluso L, Verrastro P, Raimondo P, Ferreira E, Gecaj-Gashi A, Simonis FD, Tuinman PR, Alberts E, van den Hul I, Kuiper M, de Wilde RBP, Koopmans M, Kose I, Zincircioglu Ç, dos Santos RB, Dogan N, Aydin D, Denker AS, Buyukkocak U, Akgun N, Turan G, Senturk E, Demirtürk Z, Özcan PE, Ekinci O, Colombo AS, Saylan S, Eren G, Ulger F, Dilek A, Ulusoy H, Goktas U, Soyoral L, Toman H, Orak Y, Kahveci F, Nogueira AC, Mills GH, Pinder A, Walker R, Harrison J, Snell J, Seasman C, Pearson R, Sharman M, Kaloo C, Bynorth N, Fernandes JB, Matthews K, Hughes C, Rose A, Simeson K, Niska L, Huneke N, Adderly J, Padilla-Harris C, Oliver R, Brohi F, Nóbrega RS, Wilson N, Talbot H, Wilson D, Smith D, Dark P, Evans T, Fisher N, Montgomery J, Fitzell P, Muench C, do CS Martins B, Hugill K, Cirstea E, Bentley A, Lynch K, White I, Cooper J, Brazier M, Devile M, Parris M, Gill P, Soriano F, Patel T, Criswell J, Trodd D, Griffin D, Martin J, Wreybrown C, Bewley J, Sweet K, Grimmer L, Kozlowski M, Morsch RD, James S, Limb J, Cowton A, Rogerson D, Downes C, Melbourne S, Humphries R, Pulletz M, Moreton S, Janes S, Nunes ALB, Corner A, Linnett V, Ritzema J, Watters M, Windebank S, Chenna S, Howard-Griffin R, Turner K, Suresh S, Blaylock H, de Almeida JP, Bell S, Blenk K, Everett L, Hopkins P, Mellis C, Hadfield D, Harris C, Chan A, Birch S, Pegg C, Hajjar L, Plowright C, Cooper L, Hatton T, McCullagh I, Wright S, Scott C, Boyd C, Holliday M, Poultney U, Crowther H, Moulin S, Thornthwaite S, Hollister N, Hunt J, Skinner A, Matsa R, Salt R, Matthews C, Reschreiter H, Camsooksai J, Venner N, Giannini FP, Barcraft-Barnes H, Tbaily L, Pogson D, Mouland J, Rose S, Lamb N, Tarmey N, Knighton J, Giles J, Weller D, Baptiston Nunes AL, Reed I, Hormis A, Pearson S, Harris M, Howe J, Paddle J, Burt K, Welters I, Walker A, Youds L, Rios F, Hendry S, Shaw D, Williams K, Hollands R, Carnahan M, Stickley J, Miller C, Donaldson D, Tonks L, Creagh-Brown B, Van Haren F, Hull D, Boyd O, Ortiz-Ruiz L, Gopal S, Metherell S, Spencer H, Frey C, Brown C, Clifford G, Leaver S, Sottiaux T, Ryan C, Mellinghoff JM, Prudden SP, Green HG, Roy AR, Furneval JF, Bell AB, Lakhani SL, Fasting LF, Murray LM, Lora FS, Preller K, McInerney A, Beavis S, Whileman A, Toms J, Glenn S, Ramali M, Ghosh A, Bullock C, Barrell L, Azevedo LC, Young E, Robertson H, Faulkner M, MacNaughton P, Tyson S, Pulak P, Sewell TA, Smalley C, Jacob R, Santos C, Depuydt P, Alzugaray P, Vidal Melo MF, Joyce K, Needleman J, Ahsan A, Faiz A, Alam AKMS, Khatoon SN, Nath RK, Rahman Chowdhury MA, Fan E, Banik D, Mondol MK, Bhuiyan SR, Nazneed S, Sultana R, Hamid T, Hossain M, Reza ST, Asaduzzaman M, Salim M, Bugedo G, Mostafa Kamal AH, Taher SM, Taohid TM, Karmaker P, Roy S, Das S, Sarkar SA, Dutta ML, Roy P, Iyer S, Qiu H, Krishna B, Sampath S, Pattnaik R, Kasi CK, Shah J, Dongre A, Reza Hashemian SM, Nooraei N, Raessi Estabragh R, Malekmohammad M, Gonzalez M, Khoundabi B, Mobasher M, Mohd Yunos N, Kassim M, Voon CM, Das SS, Azauddin SNS, Dorasamy D, Tai LL, Mat Nor MB, Silesky J, Zarudin N, Hasan MS, Jamaluddin MFH, Othman Jailani MI, Kayashta G, Adhikari A, Pangeni R, Hashmi M, Joseph S, Akhtar A, Cerny V, Qadeer A, Memon I, Ali SM, Idrees F, Kamal S, Hanif S, Rehman AU, Taqi A, Hussain T, Farooq A, Nielsen J, Khaskheli S, Hayat M, Indraratna K, Beane A, Haniffa R, Samaranayake U, Mathanalagan S, Gunaratne A, Mithraratne N, Thilakasiri K, Jibaja M, Pilimatalawwe C, Dilhani YAH, Fernando M, Ranatunge K, Samarasinghe L, Vaas M, Edirisooriya M, Sigera C, Arumoli J, De Silva K, Pham T, Kudavidanage B, Pinto V, Dissanayake L, Chittawatanarat K, Kongpolprom N, Silachamroon U, Pornsuriyasak P, Petnak T, Singhatas P, Tangsujaritvijit V, Wrigge H, Rungruanghiranya S, Piriyapatsom A, Juntaping K, Trongtrakul K, Thungtitigul P, Tajarernmuang P, Chatmongkolchart S, Bhurayanontachai R, Akaraborworn O, Navasakulpong A, Matamis D, Surasit K, Thwaites L, Nadjm B, Vu Quoc D, Nguyen Thi Thanh H, Nguyen Van K, Duong Bich T, Lam Minh Y, Ranero JL, Hashemian SM, Amin P, Clarkson K, Bellani G, Kurahashi K, Villagomez A, Zeggwagh AA, Heunks LM, Laake JH, Palo JE, do Vale Fernandes A, Sandesc D, Arabi Y, Bumbasierevic V, Lorente JA, Larsson A, Piquilloud L, Abroug F, McAuley DF, McNamee L, Hurtado J, Bajwa E, Démpaire G, Francois GM, Sula H, Nunci L, Cani A, Zazu A, Dellera C, Insaurralde CS, Alejandro RV, Daldin J, Vinzio M, Fernandez RO, Cardonnet LP, Bettini LR, Bisso MC, Osman EM, Setten MG, Lovazzano P, Alvarez J, Villar V, Milstein C, Pozo NC, Grubissich N, Plotnikow GA, Vasquez DN, Ilutovich S, Tiribelli N, Chena A, Pellegrini CA, Saenz MG, Estenssoro E, Brizuela M, Gianinetto H, Gomez PE, Cerrato VI, Bezzi MG, Borello SA, Loiacono FA, Fernandez AM, Knowles S, Reynolds C, Inskip DM, Miller JJ, Kong J, Whitehead C, Bihari S, Seven A, Krstevski A, Rodgers HJ, Millar RT, Mckenna TE, Bailey IM, Hanlon GC, Aneman A, Lynch JM, Azad R, Neal J, Woods PW, Roberts BL, Kol MR, Wong HS, Riss KC, Staudinger T, Wittebole X, Berghe C, Bulpa PA, Dive AM, Verstraete R, Lebbinck H, Depuydt P, Vermassen J, Meersseman P, Ceunen H, Rosa JI, Beraldo DO, Piras C, Ampinelli AMR, Nassar Jr AP, Mataloun S, Moock M, Thompson MM, Gonçalves CH, Antônio ACP, Ascoli A, Biondi RS, Fontenele DC, Nobrega D, Sales VM, Shindhe S, Ismail DMABPH, Laffey J, Beloncle F, Davies KG, Cirone R, Manoharan V, Ismail M, Goligher EC, Jassal M, Nishikawa E, Javeed A, Curley G, Rittayamai N, Parotto M, Ferguson ND, Mehta S, Knoll J, Pronovost A, Canestrini S, Bruhn AR, Garcia PH, Aliaga FA, Farías PA, Yumha JS, Ortiz CA, Salas JE, Saez AA, Vega LD, Labarca EF, Martinez FT, Carreño NG, Lora P, Liu H, Qiu H, Liu L, Tang R, Luo X, An Y, Zhao H, Gao Y, Zhai Z, Ye ZL, Wang W, Li W, Li Q, Zheng R, Yu W, Shen J, Li X, Yu T, Lu W, Wu YQ, Huang XB, He Z, Lu Y, Han H, Zhang F, Sun R, Wang HX, Qin SH, Zhu BH, Zhao J, Liu J, Li B, Liu JL, Zhou FC, Li QJ, Zhang XY, Li-Xin Z, Xin-Hua Q, Jiang L, Gao YN, Zhao XY, Li YY, Li XL, Wang C, Yao Q, Yu R, Chen K, Shao H, Qin B, Huang QQ, Zhu WH, Hang AY, Hua MX, Li Y, Xu Y, Di YD, Ling LL, Qin TH, Wang SH, Qin J, Han Y, Zhou S, Vargas MP, Silesky Jimenez JI, González Rojas MA, Solis-Quesada JE, Ramirez-Alfaro CM, Máca J, Sklienka P, Gjedsted J, Christiansen A, Nielsen J, Villamagua BG, Llano M, Burtin P, Buzancais G, Beuret P, Pelletier N, Mortaza S, Mercat A, Chelly J, Jochmans S, Terzi N, Daubin C, Carteaux G, de Prost N, Chiche JD, Daviaud F, Pham T, Fartoukh M, Barberet G, Biehler J, Dellamonica J, Doyen D, Arnal JM, Briquet A, Hraiech S, Papazian L, Follin A, Roux D, Messika J, Kalaitzis E, Dangers L, Combes A, Au SM, Béduneau G, Carpentier D, Zogheib EH, Dupont H, Ricome S, Santoli FL, Besset SL, Michel P, Gelée B, Danin PE, Goubaux B, Crova PJ, Phan NT, Berkelmans F, Badie JC, Tapponnier R, Gally J, Khebbeb S, Herbrecht JE, Schneider F, Declercq PLM, Rigaud JP, Duranteau J, Harrois A, Chabanne R, Marin J, Bigot C, Thibault S, Ghazi M, Boukhazna M, Ould Zein S, Richecoeur JR, Combaux DM, Grelon F, Le Moal C, Sauvadet EP, Robine A, Lemiale V, Reuter D, Dres M, Demoule A, Goldgran-Toledano D, Baboi L, Guérin C, Lohner R, Kraßler J, Schäfer S, Zacharowski KD, Meybohm P, Reske AW, Simon P, Hopf HBF, Schuetz M, Baltus T, Papanikolaou MN, Papavasilopoulou TG, Zacharas GA, Ourailogloy V, Mouloudi EK, Massa EV, Nagy EO, Stamou EE, Kiourtzieva EV, Oikonomou MA, Avila LE, Cortez CA, Citalán JE, Jog SA, Sable SD, Shah B, Gurjar M, Baronia AK, Memon M, Muthuchellappan R, Ramesh VJ, Shenoy A, Unnikrishnan R, Dixit SB, Rhayakar RV, Ramakrishnan N, Bhardwaj VK, Mahto HL, Sagar SV, Palaniswamy V, Ganesan D, Mohammadreza Hashemian S, Jamaati H, Heidari F, Meaney EA, Nichol A, Knapman KM, O'Croinin D, Dunne ES, Breen DM, Clarkson KP, Jaafar RF, Dwyer R, Amir F, Ajetunmobi OO, O'Muircheartaigh AC, Black CS, Treanor N, Collins DV, Altaf W, Zani G, Fusari M, Spadaro S, Volta CA, Graziani R, Brunettini B, Palmese S, Formenti P, Umbrello M, Lombardo A, Pecci E, Botteri M, Savioli M, Protti A, Mattei A, Schiavoni L, Tinnirello A, Todeschini M, Giarratano A, Cortegiani A, Sher S, Rossi A, Antonelli MM, Montini LM, Casalena P, Scafetti S, Panarello G, Occhipinti G, Patroniti N, Pozzi M, Biscione RR, Poli MM, Raimondi F, Albiero D, Crapelli G, Beck E, Pota V, Schiavone V, Molin A, Tarantino F, Monti G, Frati E, Mirabella L, Cinnella G, Fossali T, Colombo R, Terragni P, Pattarino I, Mojoli F, Braschi A, Borotto EE, Cracchiolo AN, Palma DM, Raponi F, Foti G, Vascotto ER, Coppadoro A, Brazzi L, Floris L, Iotti GA, Venti A, Yamaguchi O, Takagi S, Maeyama HN, Watanabe E, Yamaji Y, Shimizu K, Shiozaki K, Futami S, Ryosuke S, Saito K, Kameyama Y, Ueno K, Izawa M, Okuda N, Suzuki H, Harasawa T, Nasu M, Takada T, Ito F, Nunomiya S, Koyama K, Abe T, Andoh K, Kusumoto K, Hirata A, Takaba A, Kimura H, Matsumoto S, Higashijima U, Honda H, Aoki N, Imai H, Ogino Y, Mizuguchi I, Ichikado K, Nitta K, Mochizuki K, Hashida T, Tanaka H, Nakamura T, Niimi D, Ueda T, Kashiwa Y, Uchiyama A, Sabelnikovs O, Oss P, Haddad Y, Liew KY, Ñamendys-Silva SA, Jarquin-Badiola YD, Sanchez-Hurtado LA, Gomez-Flores SS, Marin MC, Villagomez AJ, Lemus JS, Fierro JM, Cervantes MR, Mejia FJF, Gonzalez DR, Dector DM, Estrella CR, Sanchez-Medina JR, Ramirez-Gutierrez A, George FG, Aguirre JS, Buensuseso JA, Poblano M, Dendane T, Zeggwagh AA, Balkhi H, Elkhayari M, Samkaoui N, Ezzouine H, Benslama A, Amor M, Maazouzi W, Cimic N, Beck O, Bruns MM, Schouten JA, Rinia M, Raaijmakers M, Heunks LM, Van Wezel HM, Heines SJ, Buise MP, Simonis FD, Schultz MJ, Goodson JC, rowne TSB, Navarra L, Hunt A, Hutchison RA, Bailey MB, Newby L, Mcarthur C, Kalkoff M, Mcleod A, Casement J, Hacking DJ, Andersen FH, Dolva MS, Laake JH, Barratt-Due A, Noremark KAL, Søreide E, Sjøbø BÅ, Guttormsen AB, Yoshido HHL, Aguilar RZ, Oscanoa FAM, Alisasis AU, Robles JB, Pasanting-Lim RAB, Tan BC, Andruszkiewicz P, Jakubowska K, Cox CM, Alvarez AM, Oliveira BS, Montanha GM, Barros NC, Pereira CS, Messias AM, Monteiro JM, Araujo AM, Catorze NT, Marum SM, Bouw MJ, Gomes RM, Brito VA, Castro S, Estilita JM, Barros FM, Serra IM, Martinho AM, Tomescu DR, Marcu A, Bedreag OH, Papurica M, Corneci DE, Negoita SI, Grigoriev E, Gritsan AI, Gazenkampf AA, Almekhlafi G, Albarrak MM, Mustafa GM, Maghrabi KA, Salahuddin N, Aisa TM, Al Jabbary AS, Tabhan E, Arabi YM, Trinidad OA, Al Dorzi HM, Tabhan EE, Bolon S, Smith O, Mancebo J, Aguirre-Bermeo H, Lopez-Delgado JC, Esteve F, Rialp G, Forteza C, De Haro C, Artigas A, Albaiceta GM, De Cima-Iglesias S, Seoane-Quiroga L, Ceniceros-Barros A, Ruiz-Aguilar AL, Claraco-Vega LM, Soler JA, Lorente MDC, Hermosa C, Gordo F, Prieto-González M, López-Messa JB, Perez MP, Pere CP, Allue RM, Roche-Campo F, Ibañez-Santacruz M, Temprano S, Pintado MC, De Pablo R, Gómez PRA, Ruiz SR, Moles SI, Jurado MT, Arizmendi A, Piacentini EA, Franco N, Honrubia T, Perez Cheng M, Perez Losada E, Blanco J, Yuste LJ, Carbayo-Gorriz C, Cazorla-Barranquero FG, Alonso JG, Alda RS, Algaba Á, Navarro G, Cereijo E, Diaz-Rodriguez E, Marcos DP, Montero LA, Para LH, Sanchez RJ, Blasco Navalpotro MA, Abad RD, Montiel González R, Toribio DP, Castro AG, Artiga MJD, Penuelas O, Roser TP, Olga MF, Curto EG, Sánchez RM, Imma VP, Elisabet GM, Claverias L, Magret M, Pellicer AM, Rodriguez LL, Sánchez-Ballesteros J, González-Salamanca Á, Jimenez AG, Huerta FP, Diaz JCJS, Lopez EB, Moya DDL, Alfonso AAT, Eugenio Luis PS, Cesar PS, Rafael SI, Virgilio CG, Recio NN, Adamsson RO, Rylander CC, Holzgraefe B, Broman LM, Wessbergh J, Persson L, Schiöler F, Kedelv H, Tibblin AO, Appelberg H, Hedlund L, Helleberg J, Eriksson KE, Glietsch R, Larsson N, Nygren I, Nunes SL, Morin AK, Kander T, Adolfsson A, Piquilloud L, Zender HO, Leemann-Refondini C, Elatrous S, Bouchoucha S, Chouchene I, Ouanes I, Ben Souissi A, Kamoun S, Demirkiran O, Aker M, Erbabacan E, Ceylan I, Girgin NK, Ozcelik M, Ünal N, Meco BC, Akyol OO, Derman SS, Kennedy B, Parhar K, Srinivasa L, McNamee L, McAuley D, Steinberg J, Hopkins P, Mellis C, Stansil F, Kakar V, Hadfield D, Brown C, Vercueil A, Bhowmick K, Humphreys SK, Ferguson A, Mckee R, Raj AS, Fawkes DA, Watt P, Twohey L, Thomas RRJM, Morton A, Kadaba V, Smith MJ, Hormis AP, Kannan SG, Namih M, Reschreiter H, Camsooksai J, Kumar A, Rugonfalvi S, Nutt C, Oneill O, Seasman C, Dempsey G, Scott CJ, Ellis HE, Mckechnie S, Hutton PJ, Di Tomasso NN, Vitale MN, Griffin RO, Dean MN, Cranshaw JH, Willett EL, Ioannou N, Gillis S, Csabi P, Macfadyen R, Dawson H, Preez PD, Williams AJ, Boyd O, De Gordoa LOR, Bramall J, Symmonds S, Chau SK, Wenham T, Szakmany T, Toth-Tarsoly P, Mccalman KH, Alexander P, Stephenson L, Collyer T, Chapman R, Cooper R, Allan RM, Sim M, Wrathall DW, Irvine DA, Zantua KS, Adams JC, Burtenshaw AJ, Sellors GP, Welters ID, Williams KE, Hessell RJ, Oldroyd MG, Battle CE, Pillai S, Kajtor I, Sivashanmugave M, Okane SC, Donnelly A, Frigyik AD, Careless JP, May MM, Stewart R, Trinder TJ, Hagan SJ, Wise MP, Cole JM, MacFie CC, Dowling AT, Hurtado J, Nin N, Hurtado J, Nuñez E, Pittini G, Rodriguez R, Imperio MC, Santos C, França AG, Ebeid A, Deicas A, Serra C, Uppalapati A, Kamel G, Banner-Goodspeed VM, Beitler JR, Mukkera SR, Kulkarni S, Lee J, Mesar T, Shinn Iii JO, Gomaa D, Tainter C, Mesar T, Cowley RA, Yeatts DJ, Warren J, Lanspa MJ, Miller RR, Grissom CK, Brown SM, Bauer PR, Gosselin RJ, Kitch BT, Cohen JE, Beegle SH, Gueret RM, Tulaimat A, Choudry S, Stigler W, Batra H, Huff NG, Lamb KD, Oetting TW, Mohr NM, Judy C, Saito S, Kheir FM, Schlichting AB, Delsing A, Elmasri M, Crouch DR, Ismail D, Blakeman TC, Dreyer KR, Gomaa D, Baron RM, Grijalba CQ, Hou PC, Seethala R, Aisiku I, Henderson G, Frendl G, Hou SK, Owens RL, Schomer A, Bumbasirevic V, Jovanovic B, Surbatovic M, Veljovic M, Van Haren F. Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies. The Lancet Global Health 2022; 10:e227-e235. [PMID: 34914899 PMCID: PMC8766316 DOI: 10.1016/s2214-109x(21)00485-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/05/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
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Abstract
CRITCON-Pandemic levels with an associated operational responsibility matrix were recently published by the Intensive Care Society as a modification to Winter Flu CRITCON levels, to better account for differences between a winter flu surge in critical care activity and the capacity challenges of the COVID-19 pandemic. In this paper, we propose an expansion and explanation of the operational matrix to suggest a stepwise ethical approach to clinician responsibility. We propose and outline the main ethical risks created at each level and discuss how those risks can be mitigated through a balanced application of the predominant ethical principle which in turn provides practical guidance to clinician responsibility. We thus seek to specify the ethical and legal principles that should be used in applying the operational matrix, and what the practical effects could be.
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Affiliation(s)
- Dan Harvey
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew McGee
- Faculty of Law, Queensland University of Technology, Brisbane, Australia
| | | | - David Shaw
- Universitat Basel Institut fur Bio-und Medizinethik, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Netherlands
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Ryan FJ, Hope CM, Masavuli MG, Lynn MA, Mekonnen ZA, Yeow AEL, Garcia-Valtanen P, Al-Delfi Z, Gummow J, Ferguson C, O'Connor S, Reddi BAJ, Hissaria P, Shaw D, Kok-Lim C, Gleadle JM, Beard MR, Barry SC, Grubor-Bauk B, Lynn DJ. Long-term perturbation of the peripheral immune system months after SARS-CoV-2 infection. BMC Med 2022; 20:26. [PMID: 35027067 PMCID: PMC8758383 DOI: 10.1186/s12916-021-02228-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious respiratory virus which is responsible for the coronavirus disease 2019 (COVID-19) pandemic. It is increasingly clear that recovered individuals, even those who had mild COVID-19, can suffer from persistent symptoms for many months after infection, a condition referred to as "long COVID", post-acute sequelae of COVID-19 (PASC), post-acute COVID-19 syndrome, or post COVID-19 condition. However, despite the plethora of research on COVID-19, relatively little is known about the molecular underpinnings of these long-term effects. METHODS We have undertaken an integrated analysis of immune responses in blood at a transcriptional, cellular, and serological level at 12, 16, and 24 weeks post-infection (wpi) in 69 patients recovering from mild, moderate, severe, or critical COVID-19 in comparison to healthy uninfected controls. Twenty-one of these patients were referred to a long COVID clinic and > 50% reported ongoing symptoms more than 6 months post-infection. RESULTS Anti-Spike and anti-RBD IgG responses were largely stable up to 24 wpi and correlated with disease severity. Deep immunophenotyping revealed significant differences in multiple innate (NK cells, LD neutrophils, CXCR3+ monocytes) and adaptive immune populations (T helper, T follicular helper, and regulatory T cells) in convalescent individuals compared to healthy controls, which were most strongly evident at 12 and 16 wpi. RNA sequencing revealed significant perturbations to gene expression in COVID-19 convalescents until at least 6 months post-infection. We also uncovered significant differences in the transcriptome at 24 wpi of convalescents who were referred to a long COVID clinic compared to those who were not. CONCLUSIONS Variation in the rate of recovery from infection at a cellular and transcriptional level may explain the persistence of symptoms associated with long COVID in some individuals.
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Affiliation(s)
- Feargal J Ryan
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Christopher M Hope
- Women's and Children's Health Network, North Adelaide, SA, Australia.,Molecular Immunology, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Makutiro G Masavuli
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Miriam A Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia
| | - Zelalem A Mekonnen
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Arthur Eng Lip Yeow
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Pablo Garcia-Valtanen
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Zahraa Al-Delfi
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia
| | - Jason Gummow
- Gene Silencing and Expression Core Facility, Adelaide Health and Medical Sciences, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Ferguson
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Stephanie O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Benjamin A J Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Pravin Hissaria
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Shaw
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Chuan Kok-Lim
- Infectious Diseases Department, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia.,Microbiology and Infectious Diseases Department, SA Pathology, Adelaide, SA, Australia
| | - Jonathan M Gleadle
- Department of Renal Medicine, Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia.,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Michael R Beard
- Research Centre for Infectious Diseases, School of Biological Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Simon C Barry
- Women's and Children's Health Network, North Adelaide, SA, Australia. .,Molecular Immunology, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.
| | - Branka Grubor-Bauk
- Viral Immunology Group, Adelaide Medical School, University of Adelaide and Basil Hetzel Institute for Translational Health Research, Adelaide, SA, Australia.
| | - David J Lynn
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, 5001, Australia. .,Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, 5042, Australia.
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Wind T, Jansen N, Flodén A, Haase-Kromwijk B, Shaw D, Gardiner D. An Inventory of Deceased Donor Family Care and Contact Between Donor Families and Recipients in 15 European Countries. Transpl Int 2022; 35:10188. [PMID: 35185370 PMCID: PMC8842228 DOI: 10.3389/ti.2021.10188] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022]
Abstract
Families of organ donors play an important role in the deceased organ donation process. The aim of this study was to gain insight into donor family care by creating an inventory of practice in various European countries. A questionnaire about donor family care and contact between donor families and recipients was developed. Representatives of the organ donor professionals of 15 European countries responded (94%). The donor coordinator plays a key role in care for the donor family. All countries provide information about the donation results to the families, although diminished due to privacy laws. Anonymous written contact between donor families and recipients is possible in almost all countries and direct contact in only a few. Remembrance ceremonies exist in most countries. Half of the respondents thought the aftercare could improve. This first inventory shows that differences exist between countries, depending on the organisation of the donation process, the law and the different role of the professionals. Direct contact between donor families and recipients is rarely supported by the donation organisation. To date there has been limited research about the experience of donor family aftercare and we would urge all donation organisations to consider this as a priority area.
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Affiliation(s)
- Tineke Wind
- Maastricht University Medical Centre, Maastricht, Netherlands
- *Correspondence: Tineke Wind,
| | - Nichon Jansen
- Institute of Health and Care Science, Dutch Transplant Foundation, Leiden, Netherlands
| | - Anne Flodén
- Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
- Department of Anaestesiology, Södra Älvsborgs Hospital, Borås, Sweden
| | | | - David Shaw
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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Shaw D. Withholding conflicts of interest: the many flaws of the new ICMJE disclosure form. J Med Ethics 2022; 48:19-21. [PMID: 32611617 DOI: 10.1136/medethics-2020-106136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 06/11/2023]
Abstract
In this article, I describe and analyse the proposed new International Committee of Medical Journal Editors form for disclosing conflicts of interest and conclude that it has many flaws. The form does not mention 'conflicts of interest' even once in either its body or its title, it introduces a conceptually confused categorisation of different potential conflicts and it ignores future conflicts and intellectual biases. Finally, many of the authors of the new form have themselves failed to declare relevant potential conflicts of interest.
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Affiliation(s)
- David Shaw
- Institute for Biomedical Ethics, Universität Basel, Basel 4056, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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