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Larey AM, Spoerer TM, Daga KR, Morfin MG, Hynds HM, Carpenter J, Hines KM, Marklein RA. High throughput screening of mesenchymal stromal cell morphological response to inflammatory signals for bioreactor-based manufacturing of extracellular vesicles that modulate microglia. Bioact Mater 2024; 37:153-171. [PMID: 38549769 PMCID: PMC10972802 DOI: 10.1016/j.bioactmat.2024.03.009] [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: 11/13/2023] [Revised: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Due to their immunomodulatory function, mesenchymal stromal cells (MSCs) are a promising therapeutic with the potential to treat neuroinflammation associated with neurodegenerative diseases. This function is mediated by secreted extracellular vesicles (MSC-EVs). Despite established safety, MSC clinical translation has been unsuccessful due to inconsistent clinical outcomes resulting from functional heterogeneity. Current approaches to mitigate functional heterogeneity include 'priming' MSCs with inflammatory signals to enhance function. However, comprehensive evaluation of priming and its effects on MSC-EV function has not been performed. Furthermore, clinical translation of MSC-EV therapies requires significant manufacturing scale-up, yet few studies have investigated the effects of priming in bioreactors. As MSC morphology has been shown to predict their immunomodulatory function, we screened MSC morphological response to an array of priming signals and evaluated MSC-EV identity and potency in response to priming in flasks and bioreactors. We identified unique priming conditions corresponding to distinct morphologies. These conditions demonstrated a range of MSC-EV preparation quality and lipidome, allowing us to discover a novel MSC-EV manufacturing condition, as well as gain insight into potential mechanisms of MSC-EV microglia modulation. Our novel screening approach and application of priming to MSC-EV bioreactor manufacturing informs refinement of larger-scale manufacturing and enhancement of MSC-EV function.
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Affiliation(s)
- Andrew M. Larey
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Thomas M. Spoerer
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Kanupriya R. Daga
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Maria G. Morfin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Hannah M. Hynds
- Department of Chemistry, University of Georgia, Athens, GA, USA
| | - Jana Carpenter
- Department of Chemistry, University of Georgia, Athens, GA, USA
| | - Kelly M. Hines
- Department of Chemistry, University of Georgia, Athens, GA, USA
| | - Ross A. Marklein
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
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Larey AM, Spoerer TM, Daga KR, Morfin MG, Hynds HM, Carpenter J, Hines KM, Marklein RA. High throughput screening of mesenchymal stromal cell morphological response to inflammatory signals for bioreactor-based manufacturing of extracellular vesicles that modulate microglia. bioRxiv 2023:2023.11.19.567730. [PMID: 38014258 PMCID: PMC10680807 DOI: 10.1101/2023.11.19.567730] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Due to their immunomodulatory function, mesenchymal stromal cells (MSCs) are a promising therapeutic with the potential to treat neuroinflammation associated with neurodegenerative diseases. This function can be mediated by secreted extracellular vesicles (MSC-EVs). Despite established safety, MSC clinical translation has been unsuccessful due to inconsistent clinical outcomes resulting from functional heterogeneity. Current approaches to mitigate functional heterogeneity include 'priming' MSCs with inflammatory signals to enhance function. However, comprehensive evaluation of priming and its effects on MSC-EV function has not been performed. Clinical translation of MSC-EV therapies requires significant manufacturing scale-up, yet few studies have investigated the effects of priming in bioreactors. As MSC morphology has been shown to predict their immunomodulatory function, we screened MSC morphological response to an array of priming signals and evaluated MSC-EV identity and potency in response to priming in flasks and bioreactors. We identified unique priming conditions corresponding to distinct morphologies. These conditions demonstrated a range of MSC-EV preparation quality and lipidome, allowing us to discover a novel MSC-EV manufacturing condition, as well as gain insight into potential mechanisms of MSC-EV microglia modulation. Our novel screening approach and application of priming to MSC-EV bioreactor manufacturing informs refinement of larger-scale manufacturing and enhancement of MSC-EV function.
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Affiliation(s)
- Andrew M. Larey
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Thomas M. Spoerer
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Kanupriya R. Daga
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Maria G. Morfin
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
| | - Hannah M. Hynds
- Department of Chemistry, University of Georgia, Athens, GA, USA
| | - Jana Carpenter
- Department of Chemistry, University of Georgia, Athens, GA, USA
| | - Kelly M. Hines
- Department of Chemistry, University of Georgia, Athens, GA, USA
| | - Ross A. Marklein
- School of Chemical, Materials, and Biomedical Engineering, University of Georgia, Athens, GA, USA
- Regenerative Bioscience Center, University of Georgia, Athens, GA, USA
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Richards GC, Carpenter J, Okpalugo E, Howard DJ, Heneghan C. Assessing housing exposures and interventions that impact healthy cities: a systematic overview of reviews. Perspect Public Health 2023:17579139231180756. [PMID: 37542406 DOI: 10.1177/17579139231180756] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
AIM There are direct links between housing and health. However, there is a lack of systematic reviews that bring together the evidence to outline the health impacts of exposures in housing and housing interventions. This article aims to address this gap by synthesising systematic reviews on the themes of housing exposures and interventions. METHODS We searched four databases: Scopus (Elsevier), PsycINFO (OvidSP), Science Citation Index and Social Science Citation Index (Web of Science Core Collection), and the Sociology Collection (Proquest). We used keywords related to 'health' and 'city*' and included all types of reviews. We extracted data into a predesigned extraction form and synthesised information narratively. RESULTS 745 articles were identified and screened, of which 256 reviews were included and 16 (6%) related to housing. All reviews related to housing exposures found that poor housing, including crowding, coldness, dampness, mould, and indoor air pollution had a negative impact on health. Most reviews found that housing interventions such as housing refurbishment, heating, and energy efficiency interventions positively impacted health outcomes. An online toolkit was developed to disseminate and communicate this research: https://www.healthycitiescommission.org/toolkit/. CONCLUSION Governments have a pivotal role in addressing health issues related to housing interventions and exposures in housing. This includes interventions through building regulations following international guidance and financial assistance to encourage housing modifications that will improve health.
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Affiliation(s)
- G C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - J Carpenter
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford OX2 6PN, UK
| | - E Okpalugo
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - D J Howard
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
- Oxford University Department for Continuing Education, University of Oxford, Oxford, UK
| | - C Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
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Carpenter J, Falkson C, Nabell L, Santos JDL, Krontiras H, Bland K, Li Y, Bae S. P121 Primary Chemotherapy with Bevacizumab for Locally Advanced Triple Negative Breast Cancer. Breast 2023. [DOI: 10.1016/s0960-9776(23)00238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
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Carpenter J, Kesimer M. 560 Keratan sulfate decoration on airway epithelial surfaces and its role in host defense and infections. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Livraghi-Butrico A, Grubb B, Carpenter J, Danielsen S, Markovetz M, Chen G, Radicioni G, Saldana-Montavon A, Sun L, Gutay M, Vilar J, Ehre C, Thornton D, Cowley D, O'Neal W, Hill D, Button B, Kesimer M, Rubinstein M, Boucher R. 404 Why are mucins so gigantic, and is it rational to sever them to aid mucus clearance? J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Takaya C, Carpenter J, Muir R, Brittle S, Sarker D, Cooper I. Safety and passivation of faecal contamination in waste. Access Microbiol 2020. [DOI: 10.1099/acmi.ac2020.po0112] [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: 11/18/2022] Open
Abstract
Absorbent hygiene wastes like nappies and incontinence pads are ubiquitous in municipal and healthcare waste streams around the world as they are convenient products used in child-care and adult incontinence management. Absorbent Hygiene Product (AHP) manufacturing is resource-intensive as the products are required to be of the highest value as they are in almost-constant contact with sensitive body parts. The potential for recovering such valuable resources such as cellulose-based fibres and super-absorbent polymers for reuse in non-food sectors like the construction and wastewater industries has been considered in this study. Appropriate decontamination via chemical methods have been examined using AHPs contaminated with human-associated bacteria.
Findings suggest that for simulated AHP wastes inoculated with 108–109 CFU g-1 of human-associated bacteria like Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pyogenes, a 1:1 ratio of 0.5% calcium hypochlorite/AHP waste is adequate to inactivate the bacteria particularly when combined with an inorganic salt for at least 60 min. Specifically, 4 to 5 log10 reductions were observed. Following such disinfection, material storage and temperatures above 25ºC minimise incidences of microbial regrowth. The disinfection protocol was not found to adversely affect the AHP quality. Overall, such findings suggest that AHP recycling is a potential alternative to current AHP waste disposal practices like incineration (with or without energy recovery) and landfilling.
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Affiliation(s)
- C. Takaya
- University of Brighton,Brighton,United Kingdom
| | | | - R. Muir
- Medisort Ltd,Littlehampton,United Kingdom
| | - S. Brittle
- Medisort Ltd,Littlehampton,United Kingdom
| | - D.K. Sarker
- University of Brighton,Brighton,United Kingdom
| | - I. Cooper
- University of Brighton,Brighton,United Kingdom
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Hopkins C, Williamson E, Morris S, Clarke CS, Thomas M, Evans H, Little P, Lund VJ, Blackshaw H, Schilder A, Philpott C, Carpenter J, Denaxas S. Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records. Rhinology 2020; 57:420-429. [PMID: 31490466 DOI: 10.4193/rhin19.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. METHODS We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). RESULTS From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. CONCLUSIONS While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management.
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Affiliation(s)
- C Hopkins
- ENT Department, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - E Williamson
- Department of Medical Statistics, London School of Hygiene
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
| | - C S Clarke
- Department of Primary Care and Population Health, UCL, London, UK
| | - M Thomas
- University of Southampton, Southampton, UK
| | - H Evans
- Department of Medical Statistics, London School of Hygiene
| | - P Little
- University of Southampton, Southampton, UK
| | | | | | | | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Founda tion Trust, Great Yarmouth, UK
| | - J Carpenter
- ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; Institute of Health Informatics, UCL, London, UK
| | - S Denaxas
- Department of Medical Statistics, London School of Hygiene
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Sasser M, Kunitsky C, Jackoway G, Ezzell JW, Teska JD, Harper B, Parker S, Barden D, Blair H, Breezee J, Carpenter J, Cheek WV, DeMartino M, Evans B, Ezzell, JW, Francesconi S, Franko E, Gardner W, Glazier M, Greth K, Harper B, Hart T, Hodel M, Holmes-Talbot, K, Hopkins KL, Iqbal A, Johnson D, Krader P, Madonna A, McDowell M, McKee ML, Park M, Parker S, Pentella, M, Radosevic J, Robison RA, Rotzoll B, Scott K, Smith M, Syed N, Tang J, Teska JD, Trinh H, Hudson LI, Wolcott M. Identification of Bacillus anthracis from Culture Using Gas Chromatographic Analysis of Fatty Acid Methyl Esters. J AOAC Int 2019. [DOI: 10.1093/jaoac/88.1.178] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - John W Ezzell
- U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Ft. Detrick, MD 21702
| | - Jeffrey D Teska
- U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Ft. Detrick, MD 21702
| | - Bruce Harper
- U.S. Army Dugway Proving Ground, Life Sciences Division, Bldg 2029, Dugway, UT 84022
| | - Stephen Parker
- U.S. Army Dugway Proving Ground, Life Sciences Division, Bldg 2029, Dugway, UT 84022
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Williamson E, Denaxas S, Morris S, Clarke CS, Thomas M, Evans H, Direk K, Gonzalez-Izquierdo A, Little P, Lund V, Blackshaw H, Schilder A, Philpott C, Hopkins C, Carpenter J, Programme Team OBOTM. Risk of mortality and cardiovascular events following macrolide prescription in chronic rhinosinusitis patients: a cohort study using linked primary care electronic health records. Rhinology 2019; 57:252-260. [PMID: 30928998 DOI: 10.4193/rhin18.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with macrolide use. METHODOLOGY Observational cohort (1997-2016) using linked data from the Clinical Practice Research Datalink, Hospital Episodes Statistics, and the Office for National Statistics. Patients aged 16-80 years with CRS prescribed a macrolide antibiotic or penicillin were included, comparing prescriptions for macrolide antibiotics to penicillin. Outcomes were all-cause mortality, cardiac death, myocardial infarction, stroke, diagnosis of peripheral vascular disease, and cardiac arrhythmia. RESULTS Analysis included 320,798 prescriptions received by 66,331 patients. There were 3,251 deaths, 815 due to cardiovascular causes, 925 incident myocardial infarctions, 859 strokes, 637 diagnoses of peripheral vascular disease, and 1,436 cardiac arrhythmias. A non-statistically significant trend towards increased risk of myocardial infarction during the first 30 days following macrolide prescription was observed. No statistically significant short- or long-term risks were observed for macrolide prescription. No significant risks were identified for clarithromycin in particular. CONCLUSIONS Although not statistically significant, our best estimates suggest an increased short-term risk of myocardial infarction in patients with CRS following macrolide prescription, supporting previous observational evidence. However, confounding by indication remains a possible explanation for this apparent increased risk. We found no evidence of longer term increased risks.
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Affiliation(s)
- E Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK; HDR UK, London, UK
| | - S Denaxas
- HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
| | - C S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - M Thomas
- Primary Care and Population Science, University of Southampton, UK
| | - H Evans
- HDR UK, London, UK; Institute of Health Informatics, UCL, London, UK; Ear Institute, UCL, London, UK
| | - K Direk
- Institute of Health Informatics, UCL, London, UK
| | | | - P Little
- Primary Care and Population Science, University of Southampton, UK
| | - V Lund
- Ear Institute, UCL, London, UK
| | | | | | - C Philpott
- Norwich Medical School, University of East Anglia, Norwich, UK; ENT Department, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
| | - C Hopkins
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Carpenter
- Department of Medical Statistics, London School of Hygiene
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Takaya CA, Cooper I, Berg M, Carpenter J, Muir R, Brittle S, Sarker DK. Offensive waste valorisation in the UK: Assessment of the potentials for absorbent hygiene product (AHP) recycling. Waste Manag 2019; 88:56-70. [PMID: 31079651 DOI: 10.1016/j.wasman.2019.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Offensive human waste refers to non-hazardous waste that contains body fluids from non-infectious humans, comprised of post-consumer Absorbent Hygiene Products (AHPs), swabs, dressings, bedding, gloves, and other materials. While this waste category requires more stringent handling, storage and disposal measures than general waste, its non-hazardous nature suggests that there are opportunities for waste valorisation. An inventory of 200 offensive human waste bags collected from various healthcare institutions in South-Eastern England show that about 76% of the waste is comprised of AHPs, most of which are adult incontinence pads and child nappies. Mixed plastics comprised of predominantly HDPE represent 9% of the waste. To evaluate the potentials for offensive human waste valorisation, small-scale separation tests involving artificially-soiled nappies and associated mixed plastic packaging wastes have been performed. Findings suggest that about 50% of the total superabsorbent polymer is recoverable from fluff pulp fractions, recoveries of which are unaffected by the presence of ionic species typically present in human waste. On the other hand, recovery of mixed plastic packaging is more challenging. Overall, however, findings suggest that viable AHP recycling is possible if recyclate materials are targeted towards non-food related markets outlets such as the construction and land remediation sectors.
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Affiliation(s)
- C A Takaya
- School of Pharmacy & Biomolecular Sciences, Moulsecoomb Campus, University of Brighton, BN2 4GJ, United Kingdom; Medisort Limited, Unit A, Fort Road, Littlehampton, West Sussex BN17 7QU, United Kingdom
| | - I Cooper
- School of Pharmacy & Biomolecular Sciences, Moulsecoomb Campus, University of Brighton, BN2 4GJ, United Kingdom
| | - M Berg
- School of Pharmacy & Biomolecular Sciences, Moulsecoomb Campus, University of Brighton, BN2 4GJ, United Kingdom
| | - J Carpenter
- Green Growth Platform, University of Brighton, Watts Building, Lewes Road, BN2 4GJ, United Kingdom
| | - R Muir
- Medisort Limited, Unit A, Fort Road, Littlehampton, West Sussex BN17 7QU, United Kingdom
| | - S Brittle
- Medisort Limited, Unit A, Fort Road, Littlehampton, West Sussex BN17 7QU, United Kingdom
| | - Dipak K Sarker
- School of Pharmacy & Biomolecular Sciences, Moulsecoomb Campus, University of Brighton, BN2 4GJ, United Kingdom.
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Gorman PN, Lavelle M, Stavri PZ, Lyman J, Fournier L, Carpenter J, Ash JS. Perceptions of Physician Order Entry: Results of a Cross-Site Qualitative Study. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objective: To identify perspectives of success factors for implementing computerized physician order entry (POE) in the inpatient setting.
Design: Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes.
Results: A taxonomy of ten high level themes was developed, including 1) separating POE from other processes, 2) terms, concepts, and connotations, 3) context, 4) tradeoffs, 5) conflicts and contradictions, 6) collaboration and trust, 7) leaders and bridgers, 8) the organization of information, 9) the ongoing nature of implementation, and 10) temporal concerns.
Conclusion: The identified success factors indicate that POE implementation is an iterative and difficult process, but informants perceive it is worth the effort.
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Vale C, Fisher D, Carpenter J, White I, Burdett S, Clarke N, Fizazi K, Gravis G, James N, Mason M, Parmar M, Rydzewska L, Sweeney C, Spears M, Sydes M, Tierney J. What are the optimal systemic treatments for men with metastatic, hormone-sensitive prostate cancer? A STOPCaP systematic review and network meta-analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McDarby M, Carpenter J, Ersek M, Thorpe J, Smith D, Johnson M. ASSOCIATIONS BETWEEN TIMING OF PALLIATIVE CARE CONSULTS AND FAMILY EVALUATION OF CARE AMONG VETERANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M. McDarby
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania,
- University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania,
- Washington University in St. Louis, Department of Clinical Psychology, Clayton, Missouri,
| | - J. Carpenter
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania,
- University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania,
| | - M.T. Ersek
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania,
- University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania,
| | - J. Thorpe
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania,
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - D. Smith
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania,
- University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania,
| | - M. Johnson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania,
- University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania,
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Carpenter J, Berry P, Ersek M. PALLIATIVE CARE AFTER HOSPITALIZATION: PATIENT EXPERIENCES AND CARE OUTCOMES IN NURSING HOMES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Carpenter
- University of Utah, Berlin, Maryland,
- Corporal Michael J. Crescenz VAMC - Philadelphia, Philadelphia, Pennsylvania,
| | - P. Berry
- Oregon Health and Science University, Portland, Oregon,
| | - M. Ersek
- Corporal Michael J. Crescenz VAMC - Philadelphia, Philadelphia, Pennsylvania,
- University of Pennsylvania, Philadelphia, Pennsylvania
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Carpenter J, Chan L, Thevathasan N, De Sousa M, Stys D, McDiarmid L. Global Health Practice Competencies: Building Health Professionals'
Capacity to Work in Global Health Contexts. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Carpenter J, Chan L, Thevathasan N, De Sousa M, Suart T, McDiarmid L. Teaching Advocacy to Health Professional Students: Advancing Global and
Population Health by Training the Next Generation of Health
Professionals. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chen C, Kroenke K, Stump T, Kean J, Carpenter J, Kreb E, Bair M, Damush T, Monahan P. (354) Estimating Minimally Important Differences for the PROMIS ® Pain Interferences Scales Using Three Clinical Trials. The Journal of Pain 2017. [DOI: 10.1016/j.jpain.2017.02.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rai A, Link P, Boo S, Domico J, Lucke-Wold N, Tarabishy A, Carpenter J. P-004 Publishing Title: Incidence of Large Vessel Occlusions Amongst All Hospital Discharges for Acute Ischemic Stroke – Estimating a Thrombectomy Eligible Population. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Farias-Moeller R, Avery R, Diab Y, Carpenter J, Murnick J. Contralateral Hypoplastic Venous Draining Sinuses Are Associated with Elevated Intracranial Pressure in Unilateral Cerebral Sinovenous Thrombosis. AJNR Am J Neuroradiol 2016; 37:2392-2395. [PMID: 27469210 DOI: 10.3174/ajnr.a4899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/13/2016] [Indexed: 11/07/2022]
Abstract
Variations in cerebral venous development can influence the ability to regulate drainage. In cerebral sinovenous thrombosis, these variations can be associated with elevated intracranial pressure. We present a series of pediatric patients with unilateral cerebral sinovenous thrombosis and investigate whether the contralateral venous sinus size increases the risk of developing elevated intracranial pressure. Patients diagnosed with a unilateral cerebral sinovenous thrombosis were identified by querying our institutional radiology data base. The difference in the occurrence of elevated intracranial pressure in patients with cerebral sinovenous thrombosis with and without hypoplastic venous sinuses was studied. Twelve cases of unilateral cerebral sinovenous thrombosis met the inclusion criteria and had sufficient images. Six patients had hypoplastic contralateral venous sinuses. The presence of hypoplastic contralateral venous sinus in the setting of thrombosis of a dominant sinus was associated with elevation of intracranial pressure (83% versus 0%, P = .015). Patients with cerebral sinovenous thrombosis and contralateral hypoplastic venous sinuses are at higher risk of developing elevated ICP and may benefit from screening with an ophthalmologic examination.
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Affiliation(s)
| | - R Avery
- From the Divisions of Child Neurology (R.F.-M., R.A., J.C.).,Ophthalmology (R.A.)
| | - Y Diab
- Pediatric Hematology (Y.D.)
| | - J Carpenter
- From the Divisions of Child Neurology (R.F.-M., R.A., J.C.)
| | - J Murnick
- Diagnostic Imaging and Radiology (J.M.), Children's National Health System, Washington, DC.
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Rai A, Smith M, Boo S, Tarabishy A, Hobbs G, Carpenter J. P-014 A Six-Sigma Approach for Decreasing Door To Needle Times In Endovascular Stroke Therapy. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rai A, Tarabishy A, Link P, Boo S, Lucke-Wold N, Domico J, Carpenter J. O-008 Functional As Opposed To Anatomical Characterization Of The Middle Cerebral Artery “M2” Divisions Can Expand The Category Of Large Vessel Occlusions Amenable For Stroke Interventions. J Neurointerv Surg 2016. [DOI: 10.1136/neurintsurg-2016-012589.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arruda AG, Friendship R, Carpenter J, Hand K, Poljak Z. Network, cluster and risk factor analyses for porcine reproductive and respiratory syndrome using data from swine sites participating in a disease control program. Prev Vet Med 2016; 128:41-50. [PMID: 27237389 DOI: 10.1016/j.prevetmed.2016.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
The objectives of this study were to describe networks of Ontario swine sites and their service providers (including trucking, feed, semen, gilt and boar companies); to categorize swine sites into clusters based on site-level centrality measures, and to investigate risk factors for porcine reproductive and respiratory syndrome (PRRS) using information gathered from the above-mentioned analyses. All 816 sites included in the current study were enrolled in the PRRS area regional control and elimination projects in Ontario. Demographics, biosecurity and network data were collected using a standardized questionnaire and PRRS status was determined on the basis of available diagnostic tests and assessment by site veterinarians. Two-mode networks were transformed into one-mode dichotomized networks. Cluster and risk factor analyses were conducted separately for breeding and growing pig sites. In addition to the clusters obtained from cluster analyses, other explanatory variables of interest included: production type, type of animal flow, use of a shower facility, and number of neighboring swine sites within 3km. Unadjusted univariable analyses were followed by two types of adjusted models (adjusted for production systems): a generalizing estimation equation model (GEE) and a generalized linear mixed model (GLMM). Results showed that the gilt network was the most fragmented network, followed by the boar and truck networks. Considering all networks simultaneously, approximately 94% of all swine sites were indirectly connected. Unadjusted risk factor analyses showed significant associations between almost all predictors of interest and PRRS positivity, but these disappeared once production system was taken into consideration. Finally, the vast majority of the variation on PRRS status was explained by production system according to GLMM, which shows the highly correlated nature of the data, and raises the point that interventions at this level could potentially have high impact in PRRS status change and/or maintenance.
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Affiliation(s)
- A G Arruda
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada.
| | - R Friendship
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | | - K Hand
- Strategic Solutions Group, Puslinch, ON N0B 2J0, Canada
| | - Z Poljak
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada
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Rai A, Boo S, Carpenter J. E-037 large aneurysms at the basilar apex cause progressive basilar artery deformation and aneurysm tilt compared to small aneurysms. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Arruda AG, Friendship R, Carpenter J, Hand K, Ojkic D, Poljak Z. Investigation of the Occurrence of Porcine Reproductive and Respiratory Virus in Swine Herds Participating in an Area Regional Control and Elimination Project in Ontario, Canada. Transbound Emerg Dis 2015; 64:89-100. [PMID: 25766306 DOI: 10.1111/tbed.12343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 11/24/2014] [Indexed: 11/26/2022]
Abstract
The main goal of this study was to investigate the occurrence of porcine reproductive and respiratory syndrome virus (PRRSV)-specific genotypes in swine sites in Ontario (Canada) using molecular, spatial and network data from a porcine reproductive and respiratory syndrome (PRRS) regional control project. For each site, location, animal movement service provider (truck companies), PRRSV status and sequencing data of the open reading frame 5 (ORF5) were obtained. Three-kilometre buffers were created to evaluate neighbourhood characteristics for each site. Social network analysis was conducted on swine sites and trucking companies to assemble the network and define network components. Three different PRRSV genotypes were used as outcomes for statistical analysis based on the region's phylogenetic tree of the ORF5. Multivariable exact logistic regression was conducted to investigate the association between being positive for a specific genotype and two main exposures of interest: (i) having at least one neighbour within three km also positive for the same genotype outside the production system and (ii) having at least one positive site for the same genotype in the same truck network component outside the production system. Results showed that the importance of area spread and truck network on PRRSV occurrence differed according to genotype. Additionally, the Ontario PRRS database appears suitable for conducting regional disease investigations. Finally, the use of relatively new tools available for network, spatial and molecular analysis could be useful in investigation, control and prevention of endemic infectious diseases in animal populations.
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Affiliation(s)
- A G Arruda
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - R Friendship
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - J Carpenter
- Ontario Swine Health Advisory Board, Stratford, ON, Canada
| | - K Hand
- Strategic Solutions Group, Puslinch, ON, Canada
| | - D Ojkic
- Animal Health Laboratory, University of Guelph, Guelph, ON, Canada
| | - Z Poljak
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
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Rai A, Boo S, Domico J, Roberts T, Carpenter J. E-026 Time and Pressure - Possible Reasons Behind Worse Outcomes For GETA Patients Undergoing Stroke Interventions. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cherkashyna N, Kanaki K, Kittelmann T, Filges U, Deen P, Herwig K, Ehlers G, Greene G, Carpenter J, Connatser R, Hall-Wilton R, Bentley PM. High energy particle background at neutron spallation sources and possible solutions. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/528/1/012013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rai A, Cline B, Tarabishy A, Patterson J, Boo S, Carpenter J. P-002 The Financial Impact of Flow Diverters on The Endovascular Treatment of Cerebral Aneurysms. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rai A, Cline B, Patterson J, Tarabishy A, Carpenter J. O-025 Bigger Is Better– The Relevance of Coils In The Era Of Flow-Diversion: Abstract O-025 Table 1. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Grubb MR, Carpenter J, Crowe JA, Teoh J, Marlow N, Ward C, Mann C, Sharkey D, Hayes-Gill BR. Forehead reflectance photoplethysmography to monitor heart rate: preliminary results from neonatal patients. Physiol Meas 2014; 35:881-93. [PMID: 24742972 DOI: 10.1088/0967-3334/35/5/881] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Around 5%-10% of newborn babies require some form of resuscitation at birth and heart rate (HR) is the best guide of efficacy. We report the development and first trial of a device that continuously monitors neonatal HR, with a view to deployment in the delivery room to guide newborn resuscitation. The device uses forehead reflectance photoplethysmography (PPG) with modulated light and lock-in detection. Forehead fixation has numerous advantages including ease of sensor placement, whilst perfusion at the forehead is better maintained in comparison to the extremities. Green light (525 nm) was used, in preference to the more usual red or infrared wavelengths, to optimize the amplitude of the pulsatile signal. Experimental results are presented showing simultaneous PPG and electrocardiogram (ECG) HRs from babies (n = 77), gestational age 26-42 weeks, on a neonatal intensive care unit. In babies ⩾32 weeks gestation, the median reliability was 97.7% at ±10 bpm and the limits of agreement (LOA) between PPG and ECG were +8.39 bpm and -8.39 bpm. In babies <32 weeks gestation, the median reliability was 94.8% at ±10 bpm and the LOA were +11.53 bpm and -12.01 bpm. Clinical evaluation during newborn deliveries is now underway.
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Affiliation(s)
- M R Grubb
- Electrical Systems and Optics Research Division, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK
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Garcia Martin A, Fernandez Golfin C, Salido Tahoces L, Fernandez Santos S, Jimenez Nacher J, Moya Mur J, Velasco Valdazo E, Hernandez Antolin R, Zamorano Gomez J, Veronesi F, Corsi C, Caiani E, Lamberti C, Tsang W, Holmgren C, Guo X, Bateman M, Iaizzo P, Vannier M, Lang R, Patel A, Adamayn K, Tumasyan LR, Chilingaryan A, Nasr G, Eleraki A, Farouk N, Axelsson A, Langhoff L, Jensen M, Vejlstrup N, Iversen K, Bundgaard H, Watanabe T, Iwai-Takano M, Attenhofer Jost CH, Pfyffer M, Seifert B, Scharf C, Candinas R, Medeiros-Domingo A, Chin JY, Yoon H, Vollbon W, Singbal Y, Rhodes K, Wahi S, Katova TM, Simova II, Hristova K, Kostova V, Pauncheva B, Bircan A, Sade L, Eroglu S, Pirat B, Okyay K, Bal U, Muderrisoglu H, Heggemann F, Buggisch H, Welzel G, Doesch C, Hansmann J, Schoenberg S, Borggrefe M, Wenz F, Papavassiliu T, Lohr F, Roussin I, Drakopoulou M, Rosen S, Sharma R, Prasad S, Lyon A, Carpenter J, Senior R, Breithardt OA, Razavi H, Arya A, Nabutovsky Y, Ryu K, Gaspar T, Kosiuk J, Eitel C, Hindricks G, Piorkowski C, Pires S, Nunes A, Cortez-Dias N, Belo A, Zimbarra Cabrita I, Sousa C, Pinto F, Baron T, Johansson K, Flachskampf F, Christersson C, Pires S, Cortez-Dias N, Nunes A, Belo A, Zimbarra Cabrita I, Sousa C, Pinto F, Santoro A, Federico Alvino F, Giovanni Antonelli G, Raffaella De Vito R, Roberta Molle R, Sergio Mondillo S, Gustafsson M, Alehagen U, Johansson P, Tsukishiro Y, Onishi T, Chimura M, Yamada S, Taniguchi Y, Yasaka Y, Kawai H, Souza JRM, Zacharias LGT, Pithon KR, Ozahata TM, Cliquet AJ, Blotta MH, Nadruz WJ, Fabiani I, Conte L, Cuono C, Liga R, Giannini C, Barletta V, Nardi C, Delle Donne M, Palagi C, Di Bello V, Glaveckaite S, Valeviciene N, Palionis D, Laucevicius A, Hristova K, Bogdanova V, Ferferieva V, Shiue I, Castellon X, Boles U, Rakhit R, Shiu MF, Gilbert T, Papachristidis A, Henein MY, Westholm C, Johnson J, Jernberg T, Winter R, Ghosh Dastidar A, Augustine D, Cengarle M, Mcalindon E, Bucciarelli-Ducci C, Nightingale A, Onishi T, Watanabe T, Fujita M, Mizukami Y, Sakata Y, Nakatani S, Nanto S, Uematsu M, Saraste A, Luotolahti M, Varis A, Vasankari T, Tunturi S, Taittonen M, Rautakorpi P, Airaksinen J, Ukkonen H, Knuuti J, Boshchenko A, Vrublevsky A, Karpov R, Yoshikawa H, Suzuki M, Hashimoto G, Kusunose Y, Otsuka T, Nakamura M, Sugi K, Rosner S, Orban M, Lesevic H, Karl M, Hadamitzky M, Sonne C, Panaro A, Martinez F, Huguet M, Moral S, Palet J, Oller G, Cuso I, Jornet A, Rodriguez Palomares J, Evangelista A, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Gilmanov D, Baroni M, Cerone E, Galli E, Berti S, Glauber M, Soesanto A, Yuniadi Y, Mansyur M, Kusmana D, Venkateshvaran A, Dash PK, Sola S, Govind SC, Shahgaldi K, Winter R, Brodin LA, Manouras A, Dokainish H, Sadreddini M, Nieuwlaat R, Lonn E, Healey J, Nguyen V, Cimadevilla C, Dreyfus J, Codogno I, Vahanian A, Messika-Zeitoun D, Lim YJ, Kawamura A, Kawano S, Polte C, Gao S, Lagerstrand K, Cederbom U, Bech-Hanssen O, Baum J, Beeres F, Van Hall S, Boering Y, Zeus T, Kehmeier E, Kelm M, Balzer J, Della Mattia A, Pinamonti B, Abate E, Nicolosi G, Proclemer A, Bassetti M, Luzzati R, Sinagra G, Hlubocka Z, Jiratova K, Dostalova G, Hlubocky J, Dohnalova A, Linhart A, Palecek T, Sonne C, Lesevic H, Karl M, Rosner S, Hadamitzky M, Ott I, Malev E, Reeva S, Zemtsovsky E, Igual Munoz B, Alonso Fernandez Pau P, Miro Palau Vicente V, Maceira Gonzalez Alicia A, Estornell Erill J, Andres La Huerta A, Donate Bertolin L, Valera Martinez F, Salvador Sanz Antonio A, Montero Argudo Anastasio A, Nemes A, Kalapos A, Domsik P, Chadaide S, Sepp R, Forster T, Onaindia J, Arana X, Cacicedo A, Velasco S, Rodriguez I, Capelastegui A, Sadaba M, Gonzalez J, Salcedo A, Laraudogoitia E, Archontakis S, Gatzoulis K, Vlasseros I, Arsenos P, Tsiachris D, Vouliotis A, Sideris S, Karistinos G, Kalikazaros I, Stefanadis C, Ancona R, Comenale Pinto S, Caso P, Coppola M, Arenga F, Cavallaro C, Vecchione F, D'onofrio A, Calabro R, Correia CE, Moreira D, Cabral C, Santos J, Cardoso J, Igual Munoz B, Maceira Gonzalez A, Estornell Erill Jordi J, Jimenez Carreno R, Arnau Vives M, Monmeneu Menadas J, Domingo-Valero D, Sanchez Fernandez E, Montero Argudo Anastasio A, Zorio Grima E, Cincin A, Tigen K, Karaahmet T, Dundar C, Sunbul M, Guler A, Bulut M, Basaran Y, Mordi I, Carrick D, Berry C, Tzemos N, Cruz I, Ferreira A, Rocha Lopes L, Joao I, Almeida A, Fazendas P, Cotrim C, Pereira H, Ochoa JP, Fernandez A, Filipuzzi J, Casabe J, Salmo J, Vaisbuj F, Ganum G, Di Nunzio H, Veron L, Guevara E, Salemi V, Nerbass F, Portilho N, Ferreira Filho J, Pedrosa R, Arteaga-Fernandez E, Mady C, Drager L, Lorenzi-Filho G, Marques J, Almeida AMG, Menezes M, Silva G, Placido R, Amaro C, Brito D, Diogo A, Lourenco MR, Azevedo O, Moutinho J, Nogueira I, Machado I, Portugues J, Quelhas I, Lourenco A, Calore C, Muraru D, Melacini P, Badano L, Mihaila S, Puma L, Peluso D, Casablanca S, Ortile A, Iliceto S, Kang MK, Yu S, Park J, Kim S, Park T, Mun HS, C S, Cho SR, Han S, Lee N, Khalifa EA, Hamodraka E, Kallistratos M, Zacharopoulou I, Kouremenos N, Mavropoulos D, Tsoukas A, Kontogiannis N, Papanikolaou N, Tsoukanas K, Manolis A, Villagraz Tecedor L, Jimenez Lopez Guarch C, Alonso Chaterina S, Blazquez Arrollo L, Lopez Melgar B, Veitia Sarmiento A, Mayordomo Gomez S, Escribano Subias M, Lichodziejewska B, Kurnicka K, Goliszek S, Dzikowska Diduch O, Kostrubiec M, Krupa M, Grudzka K, Ciurzynski M, Palczewski P, Pruszczyk P, Sakata K, Ishiguro M, Kimura G, Uesugo Y, Takemoto K, Minamishima T, Futuya M, Matsue S, Satoh T, Yoshino H, Signorello M, Gianturco L, Colombo C, Stella D, Atzeni F, Boccassini L, Sarzi-Puttini P, Turiel M, Kinova E, Deliiska B, Krivoshiev S, Goudev A, De Stefano F, Santoro C, Buonauro A, Schiano-Lomoriello V, Muscariello R, De Palma D, Galderisi M, Ranganadha Babu B, Chidambaram S, Sangareddi V, Dhandapani V, Ravi M, Meenakshi K, Muthukumar D, Swaminathan N, Ravishankar G, Bruno RM, Giardini G, Catizzo B, Brustia R, Malacrida S, Armenia S, Cauchy E, Pratali L, Cesana F, Alloni M, Vallerio P, De Chiara B, Musca F, Belli O, Ricotta R, Siena S, Moreo A, Giannattasio C, Magnino C, Omede' P, Avenatti E, Presutti D, Sabia L, Moretti C, Bucca C, Gaita F, Veglio F, Milan A, Eichhorn J, Springer W, Helling A, Alarajab A, Loukanov T, Ikeda M, Kijima Y, Akagi T, Toh N, Oe H, Nakagawa K, Tanabe Y, Watanabe N, Ito H, Hascoet S, Hadeed K, Marchal P, Bennadji A, Peyre M, Dulac Y, Heitz F, Alacoque X, Chausseray G, Acar P, Kong W, Ling L, Yip J, Poh K, Vassiliou V, Rekhraj S, Hoole S, Watkinson O, Kydd A, Boyd J, Mcnab D, Densem C, Shapiro L, Rana B, Potpara T, Djikic D, Polovina M, Marcetic Z, Peric V, Lip G, Gaudron P, Niemann M, Herrmann S, Hu K, Strotmann J, Beer M, Bijnens B, Liu D, Ertl G, Weidemann F, Peric V, Jovanovic A, Djikic D, Otasevic P, Kochanowski J, Piatkowski R, Scislo P, Grabowski M, Marchel M, Opolski G, Bandera F, Guazzi M, Arena R, Corra U, Ghio S, Forfia P, Rossi A, Dini F, Cahalin L, Temporelli L, Rallidis L, Tsangaris I, Makavos G, Anthi A, Pappas A, Orfanos S, Lekakis J, Anastasiou-Nana M, Kuznetsov VA, Krinochkin DV, Yaroslavskaya EI, Zaharova EH, Pushkarev GS, Mizia-Stec K, Wita K, Mizia M, Loboz-Grudzien K, Szwed H, Kowalik I, Kukulski T, Gosciniak P, Kasprzak J, Plonska-Gosciniak E, Cimino S, Pedrizzetti G, Tonti G, Cicogna F, Petronilli V, De Luca L, Iacoboni C, Agati L, Hoffmann R, Barletta G, Von Bardeleben S, Kasprzak J, Greis C, Vanoverschelde J, Becher H, Galrinho A, Moura Branco L, Fiarresga A, Cacela D, Ramos R, Cruz Ferreira R, Van Den Oord S, Akkus Z, Bosch J, Renaud G, Sijbrands E, Verhagen H, Van Der Lugt A, Van Der Steen A, Schinkel A, Mordi I, Tzemos N, Stanton T, Delgado D, Yu E, Drakopoulou M, Gonzalez-Gonzalez A, Karonis T, Roussin I, Babu-Narayan S, Swan L, Senior R, Li W, Parisi V, Pagano G, Pellegrino T, Femminella G, De Lucia C, Formisano R, Cuocolo A, Perrone Filardi P, Leosco D, Rengo G, Unlu S, Farsalinos K, Amelot K, Daraban A, Ciarka A, Delcroix M, Voigt J, Miskovic A, Poerner T, Goebel B, Stiller C, Moritz A, Sakata K, Uesugo Y, Kimura G, Ishiguro M, Takemoto K, Minamishima T, Futuya M, Satoh T, Yoshino H, Miyoshi T, Tanaka H, Kaneko A, Matsumoto K, Imanishi J, Motoji Y, Mochizuki Y, Minami H, Kawai H, Hirata K, Wutthimanop A, See O, Vathesathokit P, Yamwong S, Sritara P, Rosner A, Kildal A, Stenberg T, Myrmel T, How O, Capriolo M, Frea S, Giustetto C, Scrocco C, Benedetto S, Grosso Marra W, Morello M, Gaita F, Garcia-Gonzalez P, Cozar-Santiago P, Chacon-Hernandez N, Ferrando-Beltran M, Fabregat-Andres O, De La Espriella-Juan R, Fontane-Martinez C, Jurado-Sanchez R, Morell-Cabedo S, Ridocci-Soriano F, Mihaila S, Piasentini E, Muraru D, Peluso D, Casablanca S, Puma L, Naso P, Iliceto S, Vinereanu D, Badano L, Tarzia P, Villano A, Figliozzi S, Russo G, Parrinello R, Lamendola P, Sestito A, Lanza G, Crea F, Sulemane S, Panoulas V, Bratsas A, Frankel A, Nihoyannopoulos P, Dores H, Andrade M, Almeida M, Goncalves P, Branco P, Gaspar A, Gomes A, Horta E, Carvalho M, Mendes M, Yue W, Li X, Chen Y, Luo Y, Gu P, Yiu K, Siu C, Tse H, Cho E, Lee S, Hwang B, Kim D, Jang S, Jeon H, Youn H, Kim J. Poster session Thursday 12 December - PM: 12/12/2013, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Skrastins E, Cunningham M, Jindal P, Fitzpatrick R, Oneko O, Carpenter J, Booth C, Yeates K, Aronson K, Smith L, Kaufman J, Strumpf E, Levesque L, van Gaalen R, Zhongjie L, Shengjie L, Honglong Z, Biyun C, Lidong G, Hongjie Y, Weizhong Y, Buckeridge D, Peterson W, Deonandan R, Arole S, Premkumar R, Kamble R, Hobbins M, Miller C, Small W, Thielman J, Moher D, McDowell I, Kristjansson E, Poirier A, Dodds L, Johnson M, Dummer T, Rainham D, Braund R, Billard M, Pfister T, Wang Q, Kopciuk KA, Doyle-Baker P, McLaren L, Matthews CE, Courneya KS, Friedenreich CM, Chalifoux M, Brehaut JC, Kohen D, Carroll K, Hutton B, Fergusson D. The Canadian Society for Epidemiology and Biostatistics 2013 National Student Conference. Am J Epidemiol 2013. [DOI: 10.1093/aje/kwt259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cline B, Vos J, Carpenter J, Rai A. O-027 Pathological Analysis Of Extracted Clots In Embolectomy Patients With Acute Ischaemic Stroke. J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Umphrey H, Bernreuter W, Bland K, Carpenter J, Falkson C, Forero A, Keene K, Krontiras H, Meredith R, Urist M, De Los Santos J. Abstract P3-03-03: A tri-modality imaging assessment algorithm to evaluate neoadjuvant therapy response in patients with operable breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-03-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: To determine the negative predictive value (NPV), positive predictive value (PPV), accuracy, sensitivity and specificity of a pre-surgical tri-modality imaging assessment algorithm to determine complete pathologic response (pCR) post neoadjuvant therapy in patients with operable breast cancer.
Methods: A retrospective analysis was performed on data collected from patients receiving neoadjuvant therapy and pre-surgical breast magnetic resonance imaging (MRI), ultrasound (US) and mammography between 2004 and 2010 at our institution. Tri-modality imaging was reviewed by a single blinded breast radiologist and evaluated for predetermined modality specific parameters as defined in Table 1. The NPV, PPV, accuracy, sensitivity, and specificity were calculated on the basis of the final surgical pathology report with a complete pathologic response in the breast defined as no residual invasive disease or in situ disease.
Results. Eighty-three tumors in 83 patients with a mean age of 50 (range 27–70) were evaluated. Twenty-three patients had a pCR. The NPV, PPV, sensitivity, specificity, and accuracy of tri-modality imaging algorithm for pCR were 0.87, 0.95, 0.95, 0.87 and 0.93 utilizing a cut-point of ≤ 5 for complete response by imaging. The mean score for patients with pCR was 4.61 (range 3–10) with 3 patients scoring above 5. The mean score for patients with residual disease was 7.73 (range 5–11).
Conclusions: A tri-modality imaging scoring algorithm is predictive of complete pathologic response. This algorithm will be tested in a developing prospective trial that will also assess the additive value of tumor bed biopsy in patients who achieve a score of 5 or less.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-03-03.
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Affiliation(s)
- H Umphrey
- University of Alabama at Birmingham, AL
| | | | - K Bland
- University of Alabama at Birmingham, AL
| | | | - C Falkson
- University of Alabama at Birmingham, AL
| | - A Forero
- University of Alabama at Birmingham, AL
| | - K Keene
- University of Alabama at Birmingham, AL
| | | | | | - M Urist
- University of Alabama at Birmingham, AL
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Rai A, Carpenter J, Roberts T, Rodgers D. O-021 Endovascular treatment significantly improves outcomes compared to IV thrombolysis for strokes secondary to large vessel occlusions. 8-year experience. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455a.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rai A, Carpenter J, Roberts T. E-025 The use of intra-arterial rt-PA improves functional outcomes over mechanical thrombectomy alone in patients undergoing acute stroke therapy. J Neurointerv Surg 2012. [DOI: 10.1136/neurintsurg-2012-010455c.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Reeves BC, Harding SP, Langham J, Grieve R, Tomlin K, Walker J, Guerriero C, Carpenter J, Patton WP, Muldrew KA, Peto T, Chakravarthy U. Verteporfin photodynamic therapy for neovascular age-related macular degeneration: cohort study for the UK. Health Technol Assess 2012; 16:i-xii, 1-200. [PMID: 22348600 DOI: 10.3310/hta16060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The verteporfin photodynamic therapy (VPDT) cohort study aimed to answer five questions: (a) is VPDT in the NHS provided as in randomised trials?; (b) is 'outcome' the same in the nhs as in randomised trials?; (c) is 'outcome' the same for patients ineligible for randomised trials?; (d) is VPDT safe when provided in the NHS?; and (e) how effective and cost-effective is VPDT? DESIGN Treatment register. SETTING All hospitals providing VPDT in the NHS. PARTICIPANTS All patients attending VPDT clinics. INTERVENTIONS Infusion of verteporfin followed by infrared laser exposure is called VPDT, and is used to treat neovascular age-related macular degeneration (nAMD). The VPDT cohort study advised clinicians to follow patients every 3 months during treatment or active observation, retreating based on criteria used in the previous commercial 'TAP' (Treatment of Age-related macular degeneration with Photodynamic therapy) trials of VPDT. MAIN OUTCOME MEASURES The primary outcome was logarithm of the minimum angle of resolution monocular best-corrected distance visual acuity (BCVA). Secondary outcomes were adverse reactions and events; morphological changes in treated nAMD (wet) lesions; and for a subset of patients, 6-monthly contrast sensitivity, generic and visual health-related quality of life (HRQoL) and resource use. Treated eyes were classified as eligible for the TAP trials (EFT), ineligible (IFT) or unclassifiable (UNC). RESULTS Forty-seven hospitals submitted data for 8323 treated eyes in 7748 patients; 4919 eyes in 4566 patients were treated more than 1 year before the last data submission or had completed treatment. Of 4043 eyes with nAMD in 4043 patients, 1227 were classified as EFT, 1187 as IFT and 1629 as UNC. HRQoL and resource use data were available for about 2000 patients. The mean number of treatments in years 1 and 2 was 2.3 and 0.4 respectively. About 50% of eyes completed treatment within 1 year. BCVA deterioration in year 1 did not differ between eligibility groups. EFT eyes lost 11.6 letters (95% confidence interval 10.1 to 13.0 letters) compared with 9.9 letters in VPDT-treated eyes in the TAP trials. EFT eyes had poorer BCVA at baseline than IFT and UNC eyes. Adverse reactions and events were reported for 1.4% of first visits - less frequently than those reported in the TAP trials. Associations between BCVA in the best-seeing eye with HRQoL and community health and social care resource use showed that the 11-letter difference in BCVA between VPDT and sham treatment in the TAP trials corresponded to differences in utility of 0.012 and health and social service costs of £60 and £92 in years 1 and 2, respectively. VPDT provided an incremental cost per quality-adjusted life-year (QALY) of £170,000 over 2 years. CONCLUSIONS VPDT was administered less frequently than in the TAP trials, with less than half of those treated followed up for > 1 year in routine clinical practice. Deterioration in BCVA over time in EFT eyes was similar to that in the TAP trials. The similar falls in BCVA after VPDT across the pre-defined TAP eligibility groups do not mean that the treatment is equally effective in these groups because deterioration in BCVA can be influenced by the parameters that determined group membership. Safety was no worse than in the TAP trials. The estimated cost per QALY was similar to the highest previous estimate. Although VPDT is no longer in use as monotherapy for neovascular AMD, its role as adjunctive treatment has not been fully explored. VPDT also has potential as monotherapy in the management of vascular malformations of the retina and choroid and with trials underway in neovascularisation due to myopia and polypoidal choroidopathy. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- B C Reeves
- London School of Hygiene and Tropical Medicine, London, UK
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Abbott D, Carpenter J. Talking about tricky transitions with young men with Duchenne muscular dystrophy and their families. BMJ Support Palliat Care 2012. [DOI: 10.1136/bmjspcare-2012-000250.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pergami P, Seemaladinne N, Yossuck P, Moyers A, Lynch S, Carpenter J. Can We Predict Functional Outcome in Neonates with Hypoxic Ischemic Encephalopathy by Using Neuroimaging and EEG? (P03.132). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Welch C, Petersen I, Walters K, Morris RW, Nazareth I, Kalaitzaki E, White IR, Marston L, Carpenter J. Two-stage method to remove population- and individual-level outliers from longitudinal data in a primary care database. Pharmacoepidemiol Drug Saf 2011; 21:725-732. [PMID: 22052713 DOI: 10.1002/pds.2270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/24/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022]
Abstract
PURPOSE: In the UK, primary care databases include repeated measurements of health indicators at the individual level. As these databases encompass a large population, some individuals have extreme values, but some values may also be recorded incorrectly. The challenge for researchers is to distinguish between records that are due to incorrect recording and those which represent true but extreme values. This study evaluated different methods to identify outliers. METHODS: Ten percent of practices were selected at random to evaluate the recording of 513,367 height measurements. Population-level outliers were identified using boundaries defined using Health Survey for England data. Individual-level outliers were identified by fitting a random-effects model with subject-specific slopes for height measurements adjusted for age and sex. Any height measurements with a patient-level standardised residual more extreme than ±10 were identified as an outlier and excluded. The model was subsequently refitted twice after removing outliers at each stage. This method was compared with existing methods of removing outliers. RESULTS: Most outliers were identified at the population level using the boundaries defined using Health Survey for England (1550 of 1643). Once these were removed from the database, fitting the random-effects model to the remaining data successfully identified only 75 further outliers. This method was more efficient at identifying true outliers compared with existing methods. CONCLUSIONS: We propose a new, two-stage approach in identifying outliers in longitudinal data and show that it can successfully identify outliers at both population and individual level. Copyright © 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- C Welch
- Department of Primary Care & Population Health, University College London, London, UK
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Gibbons C, Bruce J, Carpenter J, Wilson AP, Wilson J, Pearson A, Lamping DL, Krukowski ZH, Reeves BC. Identification of risk factors by systematic review and development of risk-adjusted models for surgical site infection. Health Technol Assess 2011; 15:1-156, iii-iv. [PMID: 21884656 DOI: 10.3310/hta15300] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are complications of surgery that cause significant postoperative morbidity. SSI has been proposed as a potential indicator of the quality of care in the context of clinical governance and monitoring of the performance of NHS organisations against targets. OBJECTIVES We aimed to address a number of objectives. Firstly, identify risk factors for SSI, criteria for stratifying surgical procedures and evidence about the importance of postdischarge surveillance (PDS). Secondly, test the importance of risk factors for SSI in surveillance databases and investigate interactions between risk factors. Thirdly, investigate and validate different definitions of SSI. Lastly, develop models for making risk-adjusted comparisons between hospitals. DATA SOURCES A single hospital surveillance database was used to address objectives 2 and 3 and the UK Surgical Site Infection Surveillance Service database to address objective 4. STUDY DESIGN There were four elements to the research: (1) systematic reviews of risk factors for SSI (two reviewers assessed titles and abstracts of studies identified by the search strategy and the quality of studies was assessed using the Newcastle Ottawa Scale); (2) assessment of agreement between four SSI definitions; (3) validation of definitions of SSI, quantifying their ability to predict clinical outcomes; and (4) development of operation-specific risk models for SSI, with hospitals fitted as random effects. RESULTS Reviews of SSI risk factors other than established SSI risk indices identified other risk; some were operation specific, but others applied to multiple operations. The factor most commonly identified was duration of preoperative hospital stay. The review of PDS for SSI confirmed the need for PDS if SSIs are to be compared meaningfully over time within an institution. There was wide variation in SSI rate (SSI%) using different definitions. Over twice as many wounds were classified as infected by one definition only as were classified as infected by both. Different SSI definitions also classified different wounds as being infected. The two most established SSI definitions had broadly similar ability to predict the chosen clinical outcomes. This finding is paradoxical given the poor agreement between definitions. Elements of each definition not common to both may be important in predicting clinical outcomes or outcomes may depend on only a subset of elements which are common to both. Risk factors fitted in multivariable models and their effects, including age and gender, varied by surgical procedure. Operative duration was an important risk factor for all operations, except for hip replacement. Wound class was included least often because some wound classes were not applicable to all operations or were combined because of small numbers. The American Association of Anesthesiologists class was a consistent risk factor for most operations. CONCLUSIONS The research literature does not allow surgery-specific or generic risk factors to be defined. SSI definitions varied between surveillance programmes and potentially between hospitals. Different definitions do not have good agreement, but the definitions have similar ability to predict outcomes influenced by SSI. Associations between components of the National Nosocomial Infections Surveillance risk index and odds of SSI varied for different surgical procedures. There was no evidence for effect modification by hospital. Estimates of SSI% should be disseminated within institutions to inform infection control. Estimates of SSI% across institutions or countries should be interpreted cautiously and should not be assumed to reflect quality of medical care. Future research should focus on developing an SSI definition that has satisfactory psychometric properties, that can be applied in everyday clinical settings, includes PDS and is formulated to detect SSIs that are important to patients or health services. FUNDING The National Institute for Health Research Technology Assessment programme.
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Affiliation(s)
- C Gibbons
- London School of Hygiene and Tropical Medicine, London, UK
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Carpenter J. Enriching the experience of patients on a hospice ward with volunteer carers. BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000100.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Frei D, Bellon R, Huddle D, Dooley G, Gerber J, Turk A, Heck D, Hui F, Joseph G, Jahan R, Miskolczi L, Carpenter J, Grobelny T, Goddard J, Leader B, Bose A, Sit SP. P-010 A Study of the novel 054 Penumbra aspiration device in the ICA and MCA. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alldred DP, Standage C, Fletcher O, Savage I, Carpenter J, Barber N, Raynor DK. The influence of formulation and medicine delivery system on medication administration errors in care homes for older people. BMJ Qual Saf 2011; 20:397-401. [DOI: 10.1136/bmjqs.2010.046318] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McMullen CK, Ash JS, Sittig DF, Bunce A, Guappone K, Dykstra R, Carpenter J, Richardson J, Wright A. Rapid assessment of clinical information systems in the healthcare setting: an efficient method for time-pressed evaluation. Methods Inf Med 2010; 50:299-307. [PMID: 21170469 DOI: 10.3414/me10-01-0042] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/07/2010] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Recent legislation in the United States provides strong incentives for implementation of electronic health records (EHRs). The ensuing transformation in U.S. health care will increase demand for new methods to evaluate clinical informatics interventions. Timeline constraints and a rapidly changing environment will make traditional evaluation techniques burdensome. This paper describes an anthropological approach that provides a fast and flexible way to evaluate clinical information systems. METHODS Adapting mixed-method evaluation approaches from anthropology, we describe a rapid assessment process (RAP) for assessing clinical informatics interventions in health care that we developed and used during seven site visits to diverse community hospitals and primary care settings in the U.S. SETTING Our multidisciplinary team used RAP to evaluate factors that either encouraged people to use clinical decision support (CDS) systems or interfered with use of these systems in settings ranging from large urban hospitals to single-practitioner, private family practices in small towns. RESULTS Critical elements of the method include: 1) developing a fieldwork guide; 2) carefully selecting observation sites and participants; 3) thoroughly preparing for site visits; 4) partnering with local collaborators; 5) collecting robust data by using multiple researchers and methods; and 6) analyzing and reporting data in a structured manner helpful to the organizations being evaluated. CONCLUSIONS RAP, iteratively developed over the course of visits to seven clinical sites across the U.S., has succeeded in allowing a multidisciplinary team of informatics researchers to plan, gather and analyze data, and report results in a maximally efficient manner.
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Affiliation(s)
- C K McMullen
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, Oregon 97227, USA.
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Forero A, Saleh M, Galleshaw J, Jones C, Nabell L, Carpenter J, Falkson C, Krontiras H, Urist M, Bland K, De Los Santos J, Meredith R, Caterinicchia V, Bernreuter W, O'Malley J, Yufeng L, LoBuglio A. Abstract P1-12-04: Long Term Follow-Up of a Pilot Trial of Pre-Operative (Neoadjuvant) Letrozole in Combination with Bevacizumab in Post-Menopausal Women with Newly Diagnosed Estrogen and/or Progesterone Receptor Positive Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-12-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Overexpression of vascular endothelial growth factor (VEGF) in breast cancer tumors has been associated with resistance to anti-estrogen adjuvant therapy. We designed a pilot study of neoadjuvant letrozole and bevacizumab (anti-VEGF) to assess feasibility and short term efficacy in post-menopausal women with stage II/III, ER/PR positive breast cancer. Patients and Methods: Patients were treated with a neoadjuvant regimen of letrozole, 2.5 mg/day (PO) and bevacizumab 15 mg/kg every 3 weeks (IV) for a total of 24 weeks prior to surgical treatment of their breast cancer. Patients were followed for toxicity at three week intervals and tumor assessment (physical exam and tumor ultrasound) at six week intervals. Results: Twenty-five evaluable patients were treated. The regimen was well tolerated except for two patients who were taken off-study for difficult to control hypertension. Objective clinical response occurred in 17/25 patients (68%) including 16% CR and 52% PR. The four patients with clinical CR had pathologic CR in their breasts (16%) although one had residual tumor cells in axillary nodes. Two of the 17 responding patients were lost to follow-up; with a median follow-up of 50 months, no relapses have been seen in the 15 responsive patients, including 10 patients who received no adjuvant chemotherapy. Two patients with progressive disease at 9 and 16 weeks received neoadjuvant chemotherapy, surgery and radiation. One of these patients relapsed at 35 months and the other is NED at 44 months. Four patients had stable disease and all received adjuvant chemotherapy; one patient relapsed at 25 months, and the reminder are NED at 44-52 months. Overall, 2 out of 21 patients with adequate follow-up had disease reoccurrence (9.5%) at a median follow-up of 45 months. Conclusion: Combination neoadjuvant therapy with letrozole and bevacizumab was well tolerated and resulted in impressive clinical and pathologic responses. Data suggest that patients having an objective response to neoadjuvant therapy had excellent 4 year disease-free survival (100%) while relapsed occurred in 2 out of 6 patients who failed to have an objective response despite additional neoadjuvant or adjuvant chemotherapy. The Breast Cancer Translational Research Consortium has an ongoing randomized phase II trial of letrozole ± bevacizumab in this patient population.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-12-04.
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Affiliation(s)
- A Forero
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - M Saleh
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - J Galleshaw
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - C Jones
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - L Nabell
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - J Carpenter
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - C Falkson
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - H Krontiras
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - M Urist
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - K Bland
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - J De Los Santos
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - R Meredith
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - V Caterinicchia
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - W Bernreuter
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - J O'Malley
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - L Yufeng
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
| | - A. LoBuglio
- University of Alabama at Birmingham; Georgia Cancer Specialists, Atlanta, GA
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Hinton B, De Los Santos J, Keene K, Meredith R, Carpenter J, LoBuglio A, Falkson C, Krontiras H, Bland K, Wang C, Kim Y, Forero A. Abstract P4-11-04: The Influence of Radiation on Survival in Patients with Triple Negative Stage II Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-11-04] [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: 11/16/2022]
Abstract
Abstract
Background: Prospective trials of locally advanced breast cancer patients treated with adjuvant radiation (RT) have demonstrated a survival advantage; however, use of postmastectomy RT in stage II patients is controversial. This study explores the possibility that patients with aggressive variant molecular subtypes [triple receptor negative (TN)] treated with modern chemotherapy, may experience a survival benefit from adjuvant RT.
Methods: Billing codes for all breast cancer patients treated with chemotherapy between 1/1998 and 5/2005 at the University of Alabama at Birmingham were reviewed to comprehensively capture all Stage II and III patients with intact data. Patient, tumor, and treatment related variables were recorded and patients were divided into 3 molecular subtypes based on receptor status: hormone receptor (HR) positive, Her2 negative; HR+/− , Her2+; and TN. Kaplan Meier curves to assess survival were performed by dividing the TN group into 2 groups: those who did or did not receive adjuvant RT.
Results: 409 patients with stage II-III disease with were identified. Out of this group, 81 patients had TN breast cancer (60 Stage II and 21 Stage III). RT data was known in 79 of these patients. Median age was 49 years. Median follow-up was 72 months. Thirty-seven stage II and 18 stage III patients received adjuvant RT. Of the stage II patients who received radiation, 25 underwent lumpectomy and 11 underwent mastectomy. Stage II patients who received adjuvant RT had a statistically significant improvement in DFS (p=0.03), and had a trend towards improvement in OS (p=0.07) when compared with those who did not receive adjuvant RT. There was no significant difference in survival for the stage III patients with use of RT, however numbers in this group were small. Conclusion: Adjuvant RT was associated with an improvement in DFS and a trend towards improvement in OS in patients with Stage II, TN breast cancers treated with modern chemotherapy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-11-04.
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Affiliation(s)
- B Hinton
- University of Alabama, Birmingham
| | | | - K Keene
- University of Alabama, Birmingham
| | | | | | | | | | | | - K Bland
- University of Alabama, Birmingham
| | - C Wang
- University of Alabama, Birmingham
| | - Y Kim
- University of Alabama, Birmingham
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De Los Santos J, Hinton B, Carpenter J, LoBuglio A, Falkson C, Keene K, Meredith R, Krontiras H, Bland K, Wang C, Kim Y, Forero A. Abstract P5-10-19: The Influence of Time to Completion of Chemotherapy on Survival in Patients with Triple Negative Stage III Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-10-19] [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: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant chemotherapy is increasingly delivered to facilitate breast conserving surgery through tumor downstaging. Prospective trials of neoadjuvant chemotherapy from the NSABP suggest no difference in survival outcomes in patients receiving neoadjuvant versus adjuvant therapy; however, subset analysis in 2 combined trials (B-18 and B-27) demonstrated a trend in DFS improvement in young patients (<50 yrs), who often have more aggressive variant tumors. This study explores the possibility that patients with aggressive variant molecular subtypes [triple receptor negative (TN)] treated with modern chemotherapy, may significantly benefit from earlier completion of drug delivery. Methods: Billing codes for all breast cancer patients treated with chemotherapy between 1/1998 and 5/2005 at the University of Alabama at Birmingham were reviewed to comprehensively capture all Stage II and III patients with intact data. Patient, tumor, and treatment related variables were recorded and patients were divided to 4 molecular subtypes based on receptor status: hormone receptor (HR) positive, Her2 negative; HR+/− , Her2+; and triple receptor negative (TN). Kaplan Meier curves to assess survival were performed by dividing the TN group into 2 groups: those completing chemotherapy ≥5 vs > 5 months from diagnosis. Results: 409 patients with Stage II-III disease with were identified: 124 received neoadjuvant and 285 received adjuvant chemotherapy. Out of this group, 81 patients had TN breast cancer (60 Stage II and 21 Stage III). Median age was 49 years. Median follow-up was 72 months. Chemotherapy consisted of adriamycin, taxol and cytoxan for a median of 9 cycles. Stage III patients who completed chemotherapy within 5 months had a statistically significant improvement in OS and DFS (p=0.03), and had a trend towards improvement in DMFS (p=0.10) when compared with those who took longer than 5 months to complete chemotherapy. Conclusion: Completion of chemotherapy in a shorter time interval in patients with Stage III, TN breast cancers was associated with an improvement in DFS and OS. Consideration of timing of chemotherapy warrants further study.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-10-19.
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Affiliation(s)
| | - B Hinton
- University of Alabama, Birmingham
| | | | | | | | - K Keene
- University of Alabama, Birmingham
| | | | | | - K Bland
- University of Alabama, Birmingham
| | - C Wang
- University of Alabama, Birmingham
| | - Y Kim
- University of Alabama, Birmingham
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Rai A, Hobbs G, Meadows J, Izar B, Carpenter J, Raghuram K. P-008 Collateral blood supply as predictor of good clinical outcome in patients undergoing endovascular therapy for acute ischemic stroke. J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003236.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Izar B, Rai A, Carpenter J, Raghuram K. E-023 Progressive occlusion in aneurysms treated with stent assisted coiling: flow diversion? J Neurointerv Surg 2010. [DOI: 10.1136/jnis.2010.003251.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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